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Tips of the Week for November, 2013

Get Smart About Antibiotics

The American Academy of Pediatrics (AAP) is a partner in Get Smart About Antibiotics week, Nov. 18-24. The focus is on the importance of improving antibiotic use in health care settings. The AAP encourages pediatricians and families to participate in the week by implementing recommendations on antibiotic use. For more information and campaign resources, visit the links below:

Get Smart About Antibiotics Campaign:

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After a Concussion: When to Return to School

After a concussion, it is common for many parents and coaches ask when their child/athlete can return to their sport or to recreational activities. However, it is also important to for parents to remember that children are “students” first and “athletes” second. 

The American Academy of Pediatrics (AAP) has developed the following guidance on when children with a concussion should return to school and learning.

How Concussions Affect Learning

A concussion is an injury that (usually only) temporarily disrupts the normal function the brain. A concussion will usually disrupt a child’s ability to:

  • Think
  • Concentrate
  • Remember
  • Be efficient at processing  and learning new school material

When to Return to School?

The first few days following a concussion, when the brain is still healing, a child may be too symptomatic to attend school. Brain cells repair themselves daily, so the effects of the concussion should lessen and become more tolerable and manageable with time. When this happens, a child is encouraged to go back to school.

Following a concussion, it can be very difficult for a healthcare provider to know exactly when a child is ready to return to school. For example, if a healthcare provider sees a child on a Thursday she/he may or may not be ready to return to school on Monday morning. Therefore, it is important for parents and healthcare providers to watch a child’s symptoms to determine when to return to school.


It is not necessary for a child to be 100% symptom-free

before returning to school.

When concussion symptoms have lessened and are tolerable for up to 30 to 45 minutes, a child should return to school. This will usually happen within a few days/within the first week of the concussion. 

School Policies

Check with your child’s school to see if your district or school has a policy in place to help students recovering from a concussion succeed when they return to school. If not, consider working with your child’s school administration to develop such a policy.

Policy statements can include:

  • The district’s or school’s commitment to safety
  • A brief description of concussion for teachers and suggestions for academic adjustments
  • A plan to help students ease back into school life (learning, social activity, etc.)
  • Information on when students can safely return to physical activity following a concussion


Returning to School Does Not Mean Returning to Play!

In order to reduce the risk of another brain injury, a child must be removed from the following upon returning to school:


  • All school and club sports
  • Physical education (PE) class
  • Dance class
  • All physical play at recess

In addition, teachers should reduce cognitive demands.


Concussion Recovery Time

Children need an average of 3+ weeks recovery time after a concussion.


Team Effort to Adjust and Heal

Supporting a child recovering from a concussion requires a collaborative, team approach among school professionals, health care professionals, parents, and students. 

It is encouraged that the family team (student, parents, guardians, grandparents, siblings, peers, family friends) help to facilitate feedback and information to, from and between the school teams and the medical teams (pediatrician, concussion specialist, neurologist, psychologist, school/team physician).

It is important that the school have two teams:

  • Academic Team (teacher, counselor, school mental health, school nurse, administrator)
  • Physical Team (certified athletic trainers, school nurse, coach, PE teacher, playground supervisor)

Before a child can even consider returning to the field or to recreational activities, he must successfully adjust back into the social and academic demands of school.


Additional Information:

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AAP Council on Sports Medicine and Fitness (Copyright © 2013 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances


Your Family Health History & Genetics

It is important for parents to learn as much as they can about their family health history in order to have a complete record for your child throughout his or her life.

Family Health History Plays a Major Role In:

  • Identifying family and hereditary disorders
  • Determining inheritance patterns and recurrence risks for known and suspected genetic disorders
  • Identifying those at risk for a genetic disorder
  • Identifying those not at risk for a genetic disorder
  • Providing information necessary for appropriate genetic counseling
  • Providing an important adjunct to patient management of all childhood diseases, such as growth problems and asthma

Ideally a family history is recorded at your child first visit to the pediatrician, as well as a mother’s first prenatal visit. A family history should also be updated yearly with each well-child visit.

Questions Your Pediatrician May Ask About Family History:

  • Are there any health problems that are known to run in your family, or that close relatives have been told are genetic? If so, what are these conditions?
  • Is there anyone in the family who had cancer, heart disease, or other adult-onset health problem at an early age, such as between 20 and 50?
  • Does/did anyone in the family have intellectual disability, learning problems, or have to go to a special school?
  • Have there been any early deaths in the family, including stillbirths, infant deaths, multiple miscarriages, or shortened life span?
  • Have any relatives had extreme or unexpected reactions to medications or therapy?

Ethnic and Racial Factors

Racial and ethnic origins of the child and family are important to note in a family history, because certain geographic, ethnic, and racial groups may be at relatively high risk for otherwise rare genetic disorders. The table below lists examples of several major ethnic and racial groups and associated genetic disorders.

​Racial or Ethnic Group

​Genetic Disorder

​African American

​Sickle cell disease

Glucose-6-phosphate dehydrogenase deficiency


​Maple syrup urine disease

Chondroectodermal dysplasia

(Ellis-van Creveld syndrome)

Cartilage-hair hypoplasia

McKusick-Kaufman syndrome

Limb girdle muscular dystrophy

Glutaric aciduria type I

​Ashkenazi Jewish

​Tay-Sachs disease

Canavan disease

Gaucher disease type 1

Hereditary breast/ovarian cancer

Sensorineural deafness

Familial dysautonomia

Mucolipidosis type IV

Niemann-Pick disease type A


​Hereditary nephrosis

Caartilage-hair hypoplasia

Infantile neuronal ceroid lipofuscinosis

Mullibrey nanism

​French Canadian

​Leigh syndrome, French-Canadian type

Hereditary multiple intestinal atresias

Tyrosinemia type I

Tay-Sachs disease


Pseudo-vitamin D deficiency rickets

​Mediterranean (Italian, Greek, North African) ​


Glucose-6-phosphate dehydrogenase deficiency

Sickle cell disease

​Middle Eastern


Familial Mediterranean fever


​Machado-Joseph disease

​Puerto Rican

​Hermansky-Pudlak syndrome

​Southeast Asian



Barriers to Collecting a Family History

According to a survey by the Centers for Disease Control and Prevention, although 96.3% of Americans considered knowledge of family history important to their personal health, only about 30% have ever tried to actively gather and organize their families’ health histories.

Barriers for families to collecting a family history include:

  • Lack of time
  • Incomplete records
  • Inaccessible family members
  • Adoption
  • Incorrect or vague diagnoses
  • Denial or guilt
  • Family members not talking to each other
  • Blame
  • Multiple family members who care for a child
  • Fear of discrimination and stigmatization

Additional Resources

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Last Updated



Adapted from Medical Genetics in Primary Practice (Copyright © 2013 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


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