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Concussions

Concussions & Young Athletes

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Concussions

Your Child

Kids Who Specialize In One Sport Have More Injuries

Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries.Because a child’s body is still growing, children who specialize in only one sport suffer repetitive injuries more often, a new study says.

In fact, kids are twice as likely to get hurt –playing just one sport- as those who play multiple sports said Dr. Neeru Jayanthi, medical director of primary care sports medicine at Loyola University Chicago Stritch School of Medicine. "We saw a pretty significant difference with this intensity of training, along with specialization," said Jayanthi. The findings are slated to be presented Monday at the American Medical Society for Sports Medicine annual meeting in Salt Lake City. Research presented at medical meetings should be viewed as preliminary. "It's been accepted for the last five years or so that kids who are not super-specific do better. They're cross-trained, so they're conditioned for other movements," said Dr. Kory Gill, an assistant professor at Texas A&;M Health Science Center College of Medicine. Jayanith’s research team had done earlier studies on 519 junior tennis players and found that the kids who only played tennis were more likely to get hurt. Jayanthi wanted to see if the same findings extended to other sports. "As a physician, you get frustrated seeing kids come in with injuries that keep them out for two to three months. It's devastating," said Jayanthi, who recently saw a young gymnast with a knee injury that will keep her off the mat for at least three months. Here, the researchers looked at 154 young athletes, average age 13, who played a variety of sports. Eighty-five of the participants came to the clinic for treatment for a sports injury, while 69 were just getting sports physicals. The investigation ranked each athlete on how specialized they were, basing the score on factors like how often they trained in one sport, whether they had given up other sports to practice just one, and if they trained 8 months a year or more to compete more than 6 months a year on one sport. What they discovered was that 60.4 percent of the athletes who had been injured were specialized in one sport, compared with only 31.3 percent who came in for physicals. Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries. Why did these injuries occur? "One reason is repetitive use of the same muscle group and stressors to growing areas, for example, the spine," explained Jayanthi, who stressed that the findings were preliminary. His team, in collaboration with Children's Memorial Hospital in Chicago, plans to enroll more athletes in follow-up research, and those athletes will be evaluated every six months for three years, to look more closely at how intense training can affect a young athlete's body during growth spurts. "Second is exposure risk," he added. "If you're getting really good at one sport, the intensity increases because you are getting better. People are developing adult-type sports skills in a child's body. The growing body probably doesn't tolerate this." Younger children -- those who have not entered high school -- tend to be especially vulnerable as their bodies are still growing, said Gill, who recommended that kids cross-train and condition for other movements, or just play another sport. "I tell parents to let kids be kids and play multiple sports," he said. "See what they're good at and what they enjoy." By high school, when bodies are more mature, specializing is safer, he added. When children play different sports in different seasons, they are using a wide range of motions and muscles. But when they begin playing one sport year-round, the risk of overuse injuries increases.

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.

Your Teen

Websites May Encourage Self-Injury

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The videos may be a focus for communities of youth in which self-injury is encouraged and viewed as normal and exciting, which could potentially increase the risk for self-injury.Some at-risk teens are finding new ways to hurt themselves thanks to a popular website with videos that glorify self-injury.

Young adults and teens may believe that hurting themselves is normal and acceptable after watching videos and other media on Web-sharing sites like YouTube, new research indicates. The findings, published in the journal Pediatrics, warn professionals and parents to be aware of the availability and dangers of such material for at-risk teens and young adults. Deliberate self-injury without the intent of committing suicide is called “non-suicidal self-injury” or NSSI. An estimated 14% to 24% of youth and young adults engage in this destructive behavior, according to the study. NSSI can also include relationship challenges, mental health symptoms, and risk for suicide and death, the study noted. Common forms of self-injury include cutting, burning, picking and embedding objects to cause pain or harm. While other studies have looked at the availability of online information about self-injury, the authors focused on the scope of self-injury in videos uploaded on YouTube and watched by youth. They described their work as the first such study and noted that their findings could be relevant in risk, prevention and managing self-injury. The authors focused on YouTube because, according to the site, since its inception in 2005 “YouTube is the world's most popular online video community, allowing millions of people to discover, watch and share originally-created videos.” Using the site’s search function the researchers looked for the terms “self-harm” and “self-injury,” identifying the site’s top 50 viewed videos containing a live person, and the top 50 viewed videos with words and photos or visual elements. The top 100 items that the study focused on were viewed over 2 million times, according to the analysis, and most – 80% - were available to a general audience. The analysis of the self-injury content found that 53% was delivered in a factual or educational tone, while 51% was delivered in a melancholic tone. Pictures and videos commonly showed explicit demonstrations of the self-harming behavior. Cutting was the most common type of behavior; more than half of the videos did not contain warnings about the graphic nature of the behavior. The average age of uploaders of the self-injury material was 25.39 years, according to the findings, and 95% were female. The authors surmise that the actual average age is probably younger because many YouTube users say they are older in order to access more content. The study concludes that the findings about the volume and nature of self-injury content on YouTube show "an alarming new trend among youth and young adults and a significant issue for researchers and mental health workers." The videos may be a focus for communities of youth in which self-injury is encouraged and viewed as normal and exciting, which could potentially increase the  risk for self-injury. The study warns that health professionals need to be aware of this type and source of content, and to inquire about it when working with youth who practice self-injury because sites like YouTube can reach youth who may not openly discuss their  behavior. Self-harming is not typical behavior for otherwise untroubled teens and young adults, explained Dr. Charles Raison, an Emory University psychiatrist and CNNHealth.com's mental health expert. It’s an action that kids with psychiatric problems may try. “NSSI is a young person’s affliction…one in ten will kill themselves," he said.   "A lot of people will outgrow the behavior.” Raison said that it’s common for troubled young people to share information about hurting themselves. Treatments can include antidepressants, antipsychotic drugs and psychotherapy.

Daily Dose

Dealing With Dog Bites

What should you do if your child is bitten by a dog? I received an email via our iPhone App from a mom who was very worried after her daughter had been bitten by a friend's dog.  This is a common concern/query to the pediatrician.  In fact, one of my own children was severely bitten by a friend's dog, but I had somehow forgotten that experience and the 20 stitches to his face!

Tincture of time is the best remedy for many things. At any rate, I looked at the CDC's website to find that there are over 5 million dog bites a year and about 800,000 require medical attention. No wonder the health care system is overflowing! This mother was concerned as to what was the appropriate treatment. Her daughter's bite was on the face (very common for a child) but small. It did break the skin. The first thing a parent should do is to stop the bleeding by applying pressure. Then, clean the area with warm water and soap. Dogs, like humans, have dirty mouths, so you want to wash and rinse well and even flush out the wound if it is deep. If the bite wound is small, it is usually not sutured, as this may increase the risk for infection. On the other hand, facial wounds, and larger bites have to be well cleansed and irrigated, and may require suturing. The sooner this can be accomplished the better. For a child with a dog bite that has broken the skin, most pediatricians would recommend a 7-day course of an antibiotic, typically Augmentin (unless the child is penicillin allergic). Rabies is usually not a risk in dogs that are family pets and in homes. If the dog is not known or their rabies status is unclear and you cannot find the dog, check with your pediatrician about rabies prophylaxis. Lastly, you want to ensure minimal scarring by using a topical vitamin E cream on the healed skin and sunscreen. The less the sun exposure, the less scarring, especially if the face is involved.  That really goes for all cuts and scars. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Your Teen

Head Injury Linked To Violent Behavior

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A new study says that children who have suffered a head injury are more likely to get into a fight or take part in other types of violent behavior. Every parent knows that childhood often comes with bumps, bruises, cuts and falls. Sometimes those accidents include head injuries. A new study says that children who have suffered a head injury are more likely to get into a fight or take part in other types of violent behavior.

The connection between head injury and violence was particularly strong if the head injury had occurred within the past year, the authors of the study note in the journal Pediatrics. According to the U.S. Centers for Disease Control and Prevention, some 1.7 million Americans experience a traumatic brain injury every year, due to bumps, blows, jolts, or any injury that disrupts the brain's normal functioning. The study author, Dr. Sarah Stoddard with the University of Michigan in Ann Arbor, told Reuters Health that- with this type of research- it is difficult to figure out if brain injury is really the root of the aggression or if some other factor is the reason. Stoddard also notes that activities like drinking, drug use ,and a history of violence didn’t seem to explain the findings. Stoddard and a colleague analyzed several years' worth of data from 850 kids in high school and followed them until five years after they left school. All of the participants had a grade point average of 3 or lower, putting them at risk for dropping out. In the fifth year of the study, 88 of the young adults said they had suffered a head injury. Of those individuals, 43 percent said they had gotten into a fight, hurt someone, or taken part in some type of violence over the following year. That compared to 34 percent of those who didn't report a head injury. The findings suggest that the more recent a head injury is, the more likely a young adult is to be aggressive. According to Stoddard, "The brain does recover over time." Stoddard also adds that researchers should investigate the long-term effects of head injuries in young people, as well as preventive measures such as protective gear for sports and interventions that help kids with head injuries manage their behaviors before they lead to violence. A different study conducted by researchers at the Center for Injury Research and Policy Institute at Nationwide Children's Hospital, of young athletes 15-to-24 years old, reveals that sports are second only to motor vehicle crashes as the leading cause of injury to the brain. And concussions represent 10 percent of all high school athletic injuries. Previous studies have also shown that brain injuries can also cause changes in memory, reasoning, and emotions, including impulsivity and aggression. In studies with prisoners, researchers have found that those with a history of brain injuries are more likely to engage in violence. The study "does suggest there is a link between head injury and violence particularly early on," said Dr. Huw Williams, who has found the same relationship in prisoners, but was not involved in the new work. And if they believe their children experienced a brain injury in the past, they should also get expert advice on what to look for to make sure brain function doesn't deteriorate, he added. "It's important to monitor." Brain injury can range from mild to severe causing a short loss of consciousness and confusion to amnesia and coma. The American Academy of Pediatrics says that head injuries should be observed, and treatment should be sought if any of the following symptoms appear: •       A constant headache, particularly one that gets worse •       Slurred speech or confusion •       Dizziness that does not go away or happens repeatedly •       Extreme irritability or other abnormal behavior •       Vomiting more than 2 or 3 times •       Stumbling or difficulty walking •       Oozing blood or watery fluid from the nose or ears •       Difficulty waking up or excessive sleepiness •       Unequal size of the pupils (the dark center part of the eyes) •       Double vision or blurry vision •       Unusual paleness that lasts for more than an hour •       Convulsions (seizures) •       Difficulty recognizing familiar people •       Weakness of arms or legs •       Persistent ringing in the ears If your child does well through the observation period, there should be no long-lasting problems. Remember, most head injuries are mild. However, be sure to talk with your child's doctor about any concerns or questions you might have. The Center for Disease Control and Prevention’s website, www.cdc.gov/traumaticbraininjury also contains a free online training course on preventing sports-related brain injuries in young athletes.

Daily Dose

Paying Attention to the Road

I am always talking to my own children about paying attention to the road and having no other distractions in the car.As I was driving to work today, I routinely go through a school zone. Today was the day that they had motorcycle police using radar and ticketing those drivers who were not following the school zone speed limit. There were a lot of people pulled over getting tickets and a line waiting for the police officer.

This is the same school zone that my children walked through on their way to school, and therefore I am always aware of the speed limit as it is closest to my home. I am always amazed at the number of cars that go speeding by oblivious to the flashing yellow lights. But, I am also sure that I am not as aware of other areas of the city and those school zones. We all get preoccupied while driving and it seems to be related to other things going on in the car. Whether it is children fighting in the back seat, or the noise from a movie on the car DVD player, or the cell phone or blackberry, there are too many opportunities to have our attention diverted. I am always talking to my own children about paying attention to the road and having no other distractions in the car. I even went as far to have the radio disconnected when our oldest started driving (that didn't go over well!) Well, I think "us" parents need to heed the same advice. Stay off the phone in school zones, no texting while driving, and let's not have kids watching TV on their way to school. Instead, how about talking to the children in the back seat. Whether it is weather, sports, spelling words or quizzing math facts, talking to our kids is far better than any thing else we can find to do on the way to school. And if you find yourself in a school zone, and don't have kids in the car, just pay attention to the rules and enjoy the quiet. That's your daily dose, we'll chat tomorrow! Send your question to Dr. Sue!

Daily Dose

Ice Burns!

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Many schools are in spring sports or playoff season which means I'm seeing a few strains and sprains in the office. 

The treatment recommendation for a sprain or strain is usually RICE which stands for rest, ice, compression, elevation.  I just saw an adolescent volleyball player who had started back to her volleyball work outs and “pulled a muscle”. So, she followed her coaches directions to “ice it”.  Unfortunately, she just put the ice pack directly onto her skin and she came in with an ice burn! OUCH!

Yes, ice can burn the skin and cause frostbite as well. When treating an injury with ice you need to make sure that you put a towel or sheeting between the ice and your skin.  In this patient’s case the ice burn looked similar to a sunburn, and did not blister or cause any severe damage. In fact, when she pulled up her pants to show me her leg she “quizzed me” to see if I could guess what had caused the redness.......guess what, knowing that she was an athlete helped me guess correctly!

The picture above shows her injury as well.

The treatment is similar to a thermal burn, apply a lubricant like Aquaphor or aloe vera, and let the skin slowly heal.  If it is blistered or has had severe damage to the skin you may need to see your doctor.

Remember, ice is good for injuries but cannot be applied directly to the skin.  

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