STEP 2: Concussion Live Course - October 21-22, 2025, in Salt Lake City, UT-Case Discussion: Risk Factors of Special Populations (Pediatrics)

Pdf Summary

This case study focuses on a 10-year-old boy who sustained a concussion during a football game four weeks prior and now experiences persistent headaches. His risk factors include two previous concussions, ADHD (with cessation of Ritalin after injury), a strong family history of migraines, and a history of depression, anxiety, and sleep disorder (stopped melatonin post-concussion). Social challenges include divorced parents, a father with high expectations for football, and three older football-playing brothers. Academically, he is in 5th grade with a 504 plan but has not returned to school due to headaches triggered by computer use.<br /><br />Pediatric concussion assessment emphasizes tailored communication—engaging both child and parents, sometimes separately—and age-appropriate cognitive and balance tests. Establishing a comprehensive history from all caregivers and schools (with HIPAA release) is essential to understand the child's function across environments and to clarify complicating factors.<br /><br />Management includes involving the patient in treatment discussions, addressing social pressures, educating family and school, and possibly holding family meetings including school representatives. Collaboration with schools on concussion education and return-to-learn/play protocols is recommended, sometimes utilizing healthcare system learning specialists.<br /><br />Clinical priorities are restarting ADHD and sleep medications if safe, monitoring headache and mental health symptoms, and providing education across multiple visits to all caregivers and school personnel. A clear school letter outlining needed accommodations is critical to facilitate the child’s return. Early aerobic exercise is encouraged once safe. If symptoms persist, referral for neuropsychological evaluation is advisable to assess mood disorders or learning issues.<br /><br />Overall, care is multidisciplinary, focused on consistent communication and support across home, school, and sports settings, with attention to the child's medical, psychological, and social risk factors for prolonged recovery.

Asset Subtitle

Aaron M. Karlin, MD

Keywords

pediatric concussion

persistent headaches

ADHD management

migraine family history

mental health comorbidities

school accommodations

return-to-learn protocol

multidisciplinary care

neuropsychological evaluation

social support in recovery