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Your Teen

Concussions: Boys and Girls May Have Different Symptoms

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The findings suggest that boys are more likely to report amnesia and confusion/disorientation, whereas girls tend to report drowsiness and greater sensitivity to noise more often.A new study of high school athletes, finds that boys and girls who suffer concussions, may differ in their symptoms. The findings suggest that boys are more likely to report amnesia and confusion/disorientation, whereas girls tend to report drowsiness and greater sensitivity to noise more often. "The take-home message is that coaches, parents, athletic trainers, and physicians must be observant for all signs and symptoms of concussion, and should recognize that young male and female athletes may present with different symptoms," said R. Dawn Comstock, an author of the study and an associate professor of pediatrics at the Ohio State University College of Medicine in Columbus. More than 60,000 brain injuries occur among high school athletes every year, according to the U.S. Centers for Disease Control and Prevention. Although more males than females participate in sports, female athletes are more likely to suffer sports-related concussions, the researchers note. For instance, girls who play high school soccer suffer almost 40 percent more concussions than their male counterparts, according to NATA. The findings suggest that girls who suffer concussions might sometimes go undiagnosed since symptoms such as drowsiness or sensitivity to noise "may be overlooked on sideline assessments or they may be attributed to other conditions," Comstock said. For the study, Comstock and her co-authors at the University of Virginia, Charlottesville, and the University of California, Santa Barbara, examined data from an Internet-based surveillance system for high school sports-related injuries. The researchers looked at concussions involved in interscholastic sports practice or competition in nine sports (boys' football, soccer, basketball, wrestling and baseball and girls' soccer, volleyball, basketball and softball) during the 2005-2006 and 2006-2007 school years at a representative sample of 100 high schools. During that time, 812 concussions (610 in boys and 202 in girls) were reported. During the first year of the study, the surveillance system included only the primary concussion symptom for each athlete. In the second year, high school athletic trainers were able to record all the symptoms reported by the concussed athlete. In both years, headache was the most commonly reported symptom and no difference was noted between the sexes. However, in year one, 13 percent of the males reported confusion/disorientation as their primary symptom versus 6 percent of the girls. Also in the first year, amnesia was the primary symptom of 9 percent of the males but only 3 percent of the females. In the second year, amnesia and confusion/disorientation continued to be more common among males than females. In addition, 31 percent of the concussed females complained of drowsiness versus 20 percent of the males, and 14 percent of the females said they were sensitive to noise, compared with just 5 percent of the males. Concussion researcher Gerard A. Gioia, chief of pediatric neuropsychology at Children's National Medical Center in Washington, D.C., called the findings "relatively subtle" and "at best hypothesis-generating, meaning they are suggestive but in no way conclusive." Gioia said one of the study's limitations is that the reporting system didn't explain about how the injuries occurred. "The presence of increased amnesia and confusion, two early injury characteristics, in the males suggests that the injuries between the males and females may have been different," he said. Future studies will likely address this theory, said Comstock, now that the surveillance system has been expanded to include much more detailed information. Preliminary data suggest, for instance, that football players tend to get hit on the front of the head, while girls who play soccer or basketball often suffer a blow to the side of the head, she said. The findings will also be published in the January issue of the Journal of Athletic Training.

Daily Dose

Concussion Research

1.15 to read

Concussions were another topic for discussion at the American Academy of Pediatrics (AAP) meetings. While concussions continue to be on the rise and are most commonly seen among athletes involved in contact sports such as football, soccer, cheerleading and lacrosse, much of the literature has focused on when an athlete should return to play.  The AAP just published a report now looking at when an athlete should return to academics and school, rather than focusing solely on return to the field. 

While a concussion is a closed head injury sustained due to a blow to the head, students appear physically normal. There is not a scan or a physical exam that will diagnose a concussion but rather a constellation of physical symptoms that point to a concussion. Athletes will often complain of headaches, blurred vision, noise and light sensitivity, dizziness and mood changes.  These symptoms typically improve within 1-3 weeks after suffering a concussion, but during this time it may be difficult for a student to learn.

While the athlete is concerned about getting back to their sport, another challenge is returning to school and a rigorous course schedule. Therefore, it is important that parents, doctors and coaches understand that kids with concussions may have a hard time concentrating or learning new material.  They may also have problems with recall and testing. Returning to full throttle academics may also cause an increase in post-concussion symptoms. Slow and steady may be the best way to get a student back to learning.

It may be necessary to adjust a student’s academic schedule and allow them a gradual transition back to academics, just like has been proposed for return to play.  There needs to be collaboration with school, parent and child about how much their schedule should be modified.

Dr. Mark Halstead, lead author of report summed it up well when he stated, “the goal is to minimize disruptions to the student’s life and return the student to school as soon as possible, and as symptoms improve, to increase the student’s social, mental and physical activities.

These guidelines will help pediatricians guide their concussed patients  back to school and learning, before heading back to the field. 

Daily Dose

Concussion Update

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Football has started and cheerleaders are back flipping and flopping and unfortunately that means concussion “season” is beginning as well.  Concussions are also seen during soccer which has geared up for select teams, fall lacrosse, and many other contact sports.  

There is more and more data being published about concussions in children and adolescents, and most of the studies are showing that concussions are serious brain injuries and therefore needed to be treated appropriately.

A new study out of Boston Children’s Hospital showed that children and teens take longer to recover from a concussion if they have had one before.  For the study, a concussion was defined to include any altered mental status within 4 hours of the injury, and headache, nausea, vomiting, dizziness and or balance problems, fatigue,drowsiness, blurred vision, memory difficulty or trouble concentrating.  The most common symptoms noted were headache, fatigue, and dizziness. Of note, 20% of the kids in the study had neuroimaging, and all were negative. 

While 5-7 years ago it was previously thought that kids recovered from a concussion within a week, we now know that recovery time for preteens and teens is longer than previously expected.   Other risk factors for a prolonged recovery were being 13 years of age or older, not losing consciousness, and having a higher “post concussion symptom questionnaire score (RPSQ).  

So, what does this all mean? It means both doctors and parents need to be very conservative in making sure that any athlete who has sustained a concussion has both physical and cognitive rest.  In the study only 92% of people who had sustained a concussion were told to refrain from athletics. That number needs to be 100%.

There will be more and more studies on the way looking at whether there is a gap between when kids “feel better” and when they are truly physiologically recovered. Once again, this study verifies that a recurrent concussion is even more serious.

If ever in doubt that your child might have sustained what used to be called a “mild concussion”, be conservative and keep them out of play. That is never the wrong call.

Daily Dose

Parents Need To Take Concussions Seriously

Dr. Sue explains why parents need to take concussion seriously. They are a brain injury.I have blogged previously about the latest recommendations concerning concussions and restrictions on activity after sustaining a  concussion. This subject has been in the news a great deal lately, not only within the medical community, but also within the NFL and other major sports groups.

There is more and more data to show that concussions in and of themselves are dangerous, but that repetitive concussions may cause even greater damage to the brain, especially to the still developing brain of young athletes. I just saw an eleven year old boy who is a soccer play, actually, he is the goalie. He was at school, just playing around in the gym, when he sustained a concussion after running into another child head on and falling backwards.  The boy remembered falling, but shortly thereafter he became disoriented, could not take a test due to the fact that his memory was impaired, and subsequently vomited. His concerned parents brought him to my office to be evaluated.  By the time I saw him he was feeling better, and he had a normal neurological exam. Based upon the history of his injury he was diagnosed with a concussion.  Because of this he and his parents were advised that he not participate in sports for a minimum of a week.  Of course, as it would turn out,  his school soccer team was supposed to be in the State championship game in 48 hours.  Their team was 92 -0.  After much discussion and a conversation with his coach the parents we all agreed that he would not play. The following day, I received an email from his father who felt that his son was doing well and was “back to normal”.   He had been re-thinking the issue of his son not playing and wanted me to reconsider my instructions for his son not to play. He even noted that he himself had played college soccer and had often played after suffering a concussion.  He felt that if his son played (if he was absolutely needed to secure a win) and did not do “headers” that he would be okay. What was he thinking?  I don’t really think he was thinking about anything other than his son’s team winning a State championship. He seemed to have tunnel vision, and could not see that there would be many more soccer games in his son’s future, but another concussion could cause long term problems for his son.  So, I stood by my recommendation, for which his mother “thanked me”.  His team played the game and of course they lost. I felt terribly for their loss, but at the same time, knew that medically this was the appropriate decision. So many times, we as parents get so “wrapped up” in our children’s lives, whether it be in sports, academics or even having the “best” birthday party, that we lose sight of the “big picture”.  I see the” big picture” as trying to make the best decisions for our children, given the best information that we have to help make that decision. Many of those decisions may not be easy, but we as parents know they are right.  Whether that is keeping your child from playing a soccer game after suffering a concussion, or taking away a teen’s cell phone and computer privileges after they have been drinking under age.  There are so many of these difficult decisions and we all hope to make them correctly. This patients family did, and I am proud of them! That's your daily dose for today.  We'll chat again tomorrow! Send your question or comment to Dr. Sue!

Daily Dose

New Concussion Guidelines

1:30 to read

A really interesting study was published in Pediatrics online entitled “Benefits of Strict Rest After Acute Concussion”.  The guidelines for treating a concussion continue to be debated and that is what makes this study thought provoking.  

This was a “randomized controlled study”  which followed 88 patients between the ages of 11 and 22 years who had been diagnosed with a concussion.  45 of the patients were given instructions for 5 days of strict rest at home with no school, no work and no physical activity.  They were then allowed to have a “stepwise return to activity”.  The other 43 patients were told to “rest” for 1-2 days after which time they could  return to school also follow a “stepwise return to activity”.

Interestingly, there was no clinically significant difference in the  neurocognitive or balance outcomes between the two groups.  In fact the group that was “advised to rest for 5 days” reported more daily post concussive symptoms and slower resolution of symptoms than those who were told to rest for 1-2 days.  

This was a small study and does not mean that everyone should be treated the same way. In fact, when seeing a patient who has sustained a concussion each person seems to be a bit different.....as one could expect when discussing a “brain injury”.  No two brains are exactly alike...at least for the time being...who knows what will happen one day with genetics

In my own limited practice I have found that “very few” tweens and teens subscribe to the complete rest theory...that is no school, but also no TV, no computer and no videos or smart phones....WHAT??? No social media for 5 days?  You would have to put most of them on an isolated “post concussion island” to ensure they disconnect.  

The study authors also wondered if patients reported more symptoms after having strict rest recommended.  It seems plausible that I too might notice a few more symptoms when just sitting there wondering if my head hurts or if I seem to be more fatigued.

Subjective symptoms are always difficult to quantify...which makes treating a concussion more problematic.  I think erring on the conservative side and restricting “return to play” for a longer period seems to be of more importance than any other recommendation, including “5 days of strict rest”. In the meantime this is an interesting study....with more data to surely follow. 

 

Your Teen

Concussions May Affect Kid’s Academic Performance

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Can a concussion affect your child ‘s academic performance? According to a new study it might, depending on two factors - the severity of the concussion and the grade level of your child.

A concussion is a brain injury caused by a fall or blow, jolt or bump to the head that causes the brain and head to move back and forth rapidly. While most recover from mild concussions quickly, the young and the elderly can have symptoms that last for days or weeks.

Researchers from the Children's National Health System, George Washington University School of Medicine and Brody School of Medicine at East Carolina University studied 349 students ages 5 to 18 to find out what happened to their academic performance after concussions. They divided the students into those who were continuing to experience problems following head injuries and those who were fully recovered, and asked the students and their parents to fill out questionnaires about their academic performance.

The study found that the severity of the concussion symptoms was directly related to the degree of academic problems among all grade levels. Eighty-eight percent of the children who were not fully recovered still had problems with concentration, headaches and fatigue. Seventy-seven percent of those same children had problems taking notes and found themselves spending more time on homework and having problems studying for exams and quizzes.

High school students reported having the most learning problems, significantly more than middle or elementary school children.

The authors say that their findings suggest that school systems and medical professionals should be working together to support students who are still in the recovery phase.

"Our findings suggest that these supports are particularly necessary for older students, who face greater academic demands relative to their younger peers," the study's authors say.

The signs and symptoms of a concussion can be subtle and may not be immediately apparent. Symptoms can last for days, weeks or even longer.

The Mayo Clinic says that common symptoms after a concussive traumatic brain injury are headache, loss of memory (amnesia) and confusion. The amnesia, which may or may not follow a loss of consciousness, usually involves the loss of memory of the event that caused the concussion.

Signs and symptoms of a concussion may include:

•       Headache or a feeling of pressure in the head

•       Temporary loss of consciousness

•       Confusion or feeling as if in a fog

•       Amnesia surrounding the traumatic event

•       Dizziness or "seeing stars"

•       Ringing in the ears

•       Nausea

•       Vomiting

•       Slurred speech

•       Delayed response to questions

•       Appearing dazed

•       Fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:

•       Concentration and memory complaints

•       Irritability and other personality changes

•       Sensitivity to light and noise

•       Sleep disturbances

•       Psychological adjustment problems and depression

•       Disorders of taste and smell

Symptoms in infants and toddlers can be difficult to recognize because these little ones are unable to communicate how they feel. However, there are nonverbal clues of a possible concussion. These are:

•       Appearing dazed

•       Listlessness and tiring easily

•       Irritability and crankiness

•       Loss of balance and unsteady walking

•       Crying excessively

•       Change in eating or sleeping patterns

•       Lack of interest in favorite toys

Concussions should always be treated seriously even when a child doesn’t seem to be showing physical or mental symptoms. If you suspect your child may have a concussion seek a professional diagnosis to make sure.

Sources: Sandee LaMotte, http://www.cnn.com/2015/05/11/health/concussions-academic-problems/index.html

http://www.mayoclinic.org/diseases-conditions/concussion/basics/symptoms/con-20019272

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Concussions

Your Teen

Cheerleading: Fewer Sports Injuries, But More Severe

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Cheerleading used to be relatively simple sideline endeavor, but not any more. Today it can be a competitive sport, daring and sometimes dangerous.

It typically rates low in overall sports related injuries according to a recently published study, but because of the changing nature of cheerleading and how injuries are reported – whether as a sport or a nonathletic extracurricular activity- the ratings could change.

Researchers noted that while cheerleading may be more dangerous now than in the past, it still gets kids up and moving.

"Anecdotally, it's pretty clear to most people over the past few decades that cheerleading has shifted from a sideline activity to a competitive sport itself. This may have resulted in an increase in injury," said study author Dustin Currie, a doctoral student in epidemiology at Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.

"We only have five years of data ... but I don't know whether to say it's better for cheerleading to not become a more competitive sport," he added. "If it's getting more children to participate in athletics, it's probably a net positive."

About 400,000 students in the United States participate in high school cheerleading each year, including more than 123,000 involved in competitive "spirit squads" that incorporate stunts, pyramids, tosses and jumps, according to the U.S. National Federation of State High School Associations.

But states classify cheerleading in various ways, with some defining it as a sport and others lumping it with other nonathletic extracurricular activities, Currie said.

The distinction is important because defining it as a sport requires stricter rules regarding practice location and other safety measures, as well as coaching certification requirements, he said.

The new study found that while overall injury rates are low for cheerleading, the injuries that do occur are more severe.

Researchers discovered that concussions were the most common cheerleading injury, involving 31 percent of all injuries. However, concussion rates were significantly lower in cheerleading that all other sports combined as well as other girl sports.

More than half of cheerleading injuries occurred during stunts, with pyramid formations constituting 16 percent and tumbling accounting for 9 percent. Most stunt- and pyramid-related concussions resulted from contact with another person, most commonly their elbow, the study said.

Currie said one way to potentially reduce cheerleading injuries would be for all states to change the classification of cheerleading to a sport and recognize that the "vast majority of high school cheerleaders are athletes" requiring the support of athletic trainers and other appropriate medical staff.

"States need to think about it in terms of cheerleaders being athletes, as they are now, rather than some recreational activity on the sidelines," he said.

The study was published online in the journal Pediatrics.

Source: Maureen Salamon, http://consumer.healthday.com/cognitive-health-information-26/concussions-news-733/as-cheerleading-becomes-more-competitive-concussions-top-list-of-injuries-study-says-706029.html

 

 

Your Child

Study: More and Younger Children Suffering From Concussion

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In order to develop statistics on how many U.S. children and teens are being diagnosed with concussion, the Centers for Disease Control and Prevention (CDC) analyzes emergency room data from around the country.

But, a new study finds that children’s concussions may be vastly underreported because family pediatricians, not ER doctors, are doing the examinations.

In the study, published today in the Journal of the American Medical Association Pediatrics, researchers from Children's Hospital of Philadelphia (CHOP) and the CDC used CHOP's regional pediatric network to figure out when and where children were diagnosed with a concussion.

They found approximately 82 percent had their first concussion visit at a primary care site like a pediatrician's office, 12 percent were diagnosed in an emergency department, 5 percent were diagnosed from a specialist, such as a sports medicine doctor or neurologist, and 1 percent were directly admitted to the hospital.

The authors noted that the findings indicate that many more children have suffered a concussion than recent stats suggest.

In another surprising turn, researchers found that one-third of those injured were under the age of 12.  Many reports have been focused on teen athletes instead of younger children.

"We learned two really important things about pediatric concussion healthcare practices," Kristy Arbogast, lead author and Co-Scientific Director of CHOP's Center for Injury Research and Prevention, said in a statement today. "First, four in five of this diverse group of children were diagnosed at a primary care practice -- not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems that focus on high school athletes."

Alex Diamond, a pediatric sports medicine specialist at Vanderbilt University Medical Center and director of the injury prevention program, told ABC News that these findings are important to help health officials understand how prevalent concussions really are. Diamond was not involved in the study.

Pediatricians are a good choice for seeking advice and diagnosis on concussions because they know the history of the child, Diamond said.

"That’s why it’s great for a pediatrician to deal with this," Diamond said. "They know the kid at baseline and they know the family."

The findings may have far-reaching implications for what we know about the number of concussions in the U.S., the authors said, noting that this study suggests that the condition is extremely underreported if the vast majority of concussions are diagnosed outside the emergency department.

"We need surveillance that better captures concussions that occur in children and adolescents," Dr. Debra Houry, director of CDC's National Center for Injury Prevention and Control, said in a statement today. "Better estimates of the number, causes, and outcomes of concussion will allow us to more effectively prevent and treat them, which is a priority area for CDC's Injury Center."

Concussions often happen without a loss of consciousness and can have long-term effects.

In fact, a brief loss of consciousness or "blacking out" doesn't mean a concussion is any more or less serious than one where a child didn't black out.

If your child might have had a concussion, go to the emergency room or see your pediatrician if he or she has any of these symptoms:

•       Loss of consciousness

•       Severe headache, including a headache that gets worse

•       Blurred vision

•       Trouble walking

•       Confusion and saying things that don't make sense

•       Slurred speech

•       Unresponsiveness (you're unable to wake your child)

•       Ringing in the ears

•       Nausea

•       Vomiting

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:

•       Concentration and memory complaints

•       Irritability and other personality changes

•       Sensitivity to light and noise

•       Sleep disturbances

•       Psychological adjustment problems and depression

•       Disorders of taste and smell

Symptoms in infants and toddlers may be more difficult to recognize because they cannot express how they feel. Nonverbal clues of a concussion might include:

•       Appearing dazed

•       Listlessness and tiring easily

•       Irritability and crankiness

•       Loss of balance and unsteady walking

•       Crying excessively

•       Change in eating or sleeping patterns

•       Lack of interest in favorite toys

Experts recommend that parents take their child in for an evaluation if their child receives more than a light bump on the head.

Story sources: Gillian Mohney, http://abcnews.go.com/Health/concussions-children-vastly-underreported-study-finds/story?id=39506549

http://www.mayoclinic.org/diseases-conditions/concussion/basics/symptoms/con-20019272

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