The duty invites you once again to the back roads of university life. A proposal that is both scholarly and intimate, to be picked up all summer long like a postcard. Today, we offer you a foray into health, on the side of 0-5 year olds.
The kickoff is launched. It is now time for vacations, trips to the park and free outdoor play. It is also the return of nearly 2,000 day camp and vacation sites that welcome children from all over Quebec. Through the laughter, the inevitable injuries that require a good supply of bandages creep in. Attention then turns to the bleeding, scratches and bruises that are clearly visible. But what about invisible injuries? Concussions, on the other hand, cannot be seen, but are very real for little ones.
As efforts to better manage concussions in athletes increase, children ages 0-5, the pediatric age group with the highest rates of head injuries, are struggling to be heard and included in the conversation. Is it time to address concussions more inclusively and ensure that young children are not left behind in the wake of treatment advances? We believe so.
It is estimated that concussions affect approximately 9,000 toddlers in Quebec each year, or nearly two out of 100 children aged 0 to 5. These occur following a blow to the head or body and disrupt brain function. Toddlers are nearly twice as likely to suffer a concussion as older children. And among children who have suffered a concussion, one in four still have symptoms a month or more after the trauma.
While most recover well from such an injury, research indicates that children who suffer a concussion are at greater risk of developing emotional, social and behavioral challenges in the years that follow, compared to their peers. They are just as deserving of our attention as our favorite athletes.
Yet, toddlers remain underrepresented in both the public space and the research sector. What explains this silence?
Part of the answer is simple: Detecting a concussion in a toddler is a real headache for health professionals and researchers. Recognizing this invisible injury depends primarily on the toddler’s ability to express his symptoms, a great challenge for him, compared to an older child or an adult. While playing, a two-year-old boy trips and hits his head hard on the floor. In the days that follow, he will cry more, touch his head often, lose his appetite and be less energetic. Without the vocabulary and knowledge to express their discomfort, toddlers can only hope that their behaviors will be “heard.”
Still, we’ve come a long way in concussion awareness and management since the days when head hits were considered commonplace and only featured as jokes in Bugs Bunny episodes. But toddlers still have too small a stride.
The concussion expert community, primarily comprised of sports concussion specialists, meets frequently at international meetings. These meetings lead to the development of screening and assessment tools and various recommendations that are subsequently adopted in clinical settings. However, children under the age of eight are not addressed. This is problematic because toddlers are different from older children: they do not typically get injured in a sporting context, their symptoms manifest differently, and the activities they engage in are completely different. As a result, existing tools and recommendations cannot easily be extended to toddlers.
Can Quebec become a pioneer?
A wind of change is slowly blowing. For the past two years, the annual meeting of the Canadian Concussion Network has turned its spotlight on groups that are underrepresented in research. More space is given to young people, but also to seniors, people experiencing homelessness and victims of domestic violence.
Experts acknowledge that the lack of clear guidelines for detecting and managing concussions in young children creates challenges for health professionals. It can be difficult for them to advise parents and provide effective interventions.
In the field, early childhood workers, such as educational staff, also face this difficulty. Although they already have solid notions of first aid, focusing on developing knowledge about concussions in toddlers would allow them to significantly increase the effectiveness of their interventions.
That said, in an already overburdened healthcare system, it can be discouraging to see an injury, wrongly considered trivial, require more intensive care. The high prevalence of concussions in young children raises questions about the capacity of our healthcare system to meet increasing demand. In order to avoid an overflow of cases, it becomes essential to align with science to develop and use the right tools, with the right patients, at the right time.
The Ministry of Health and Social Services is currently rolling out a new directive to reorganize the service trajectory for concussions, including earlier and more integrated follow-up. This is a step in the right direction. However, it is essential that this trajectory take into account very young children and that a committee of experts for this age group sit at the decision-making table. It is urgent to include aspects specific to younger children in the Ministry of Education’s Concussion Management Protocol.
Quebec can become a pioneer in the management of concussions in young children, and this is certainly the avenue to take to give a voice to little ones.