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Your Child

Kid’s Head Injury Linked to Long Term Attention Problems

1:45

Even mild brain injuries may cause children to have momentary gaps in attention long after an accident occurs, according to a new study.

The study of 6- to 13-year-olds found these attention lapses led to lower behavior and intelligence ratings by their parents and teachers.

"Parents, teachers and doctors should be aware that attention impairment after traumatic brain injury can manifest as very short lapses in focus, causing children to be slower," said study researcher Marsh Konigs, a doctoral candidate at VU University Amsterdam in the Netherlands.

This loss of focus was apparent even when brain scans showed no obvious damage, the researchers said.

The study’s results are being released as schools gear up for a new academic year combined with some sports programs that can put children at risk for head injuries.

Traumatic brain injury can occur from a blow to the head caused by a fall, traffic accident, and assault or sports injury.

Concussion is one type of traumatic brain injury. In 2009, more than 248,000 teens and children were treated in U.S. emergency rooms for sports- and recreation-related traumatic brain injuries or concussions, according to the U.S. Centers for Disease Control and Prevention.

Here’s how the study was conducted.  Researchers compared 113 children who had been hospitalized with a traumatic brain injury with 53 children who had a trauma injury not involving the head. The injuries, which ranged from mild to severe, occurred more than 18 months earlier on average.

The researchers tested mental functioning and evaluated questionnaires completed by parents and teachers at least two months after the injuries.

The head-injured group had slower processing speed, the researchers found. And their attention lapses were longer than those noted in the other children. But unlike other research, no differences were reported in other types of attention, such as executive attention -- the ability to resolve conflict between competing responses.

As is typical with most studies, the results do not prove a cause and effect relationship, but an association.

The take-home message from this study is that even mild head injury can lead to problems, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York in New Hyde Park, N.Y. He was not involved with the research.

"This study provides further evidence of the importance of trying to minimize brain trauma, since even when there is no visible damage on CAT scans or MRIs, there can still be a significant adverse effect on attention span and behavior," Adesman said.

This research underscores the need to protect children from head injuries through proper supervision, consistent use of child car seats and seat belts, as well as headgear when bike riding and playing contact sports, he added.

The study was published in the journal Pediatrics.

More information on brain injury in children can be found at the Brain Injury Association of America’s website, http://www.biausa.org/brain-injury-children.htm.

Source: Kathleen Doheny,  http://consumer.healthday.com/cognitive-health-information-26/brain-health-news-80/head-injury-may-trigger-attention-issues-in-kids-701821.html

Your Child

Concussion’s Effects May Linger in Kids

2.00 to read

Concussions have been in the news a lot lately, particularly when they relate to children. Awareness about the dangers of concussions has changed how schools, coaches and parents watch for and treat this kind of injury. A new study released this week points out that some concussion side effects can last longer than thought.

Children who suffer even a mild concussion can have attention and memory problems a year after their injury.

The study results were published in the Archives of Pediatrics and Adolescent Medicine, and suggest that problems such as forgetfulness, dizziness,  and fatigue may linger for up to about 20 percent after an accident.

Forgetfulness, difficulty paying attention, headaches and fatigue were more common in study children who lost consciousness or who had other mild head trauma that caused brain abnormalities on imaging tests, compared with kids who didn't get knocked out or who had normal imaging test results.

Longer lasting symptoms were not determined since the study only followed children for a year after their injury. For that year though, children who had injury-related symptoms experienced "significant functional impairment in their daily lives."

"What parents want to know is if my kid is going to do OK. Most do OK, but we have to get better at predicting which kids are going to have problems," said study author Keith Owen Yeates, a Neuropsychologist at Ohio State University's Center for Biobehaviorial Health.

Children who have concussion symptoms may need temporary accommodations such as extra time taking school tests, or wearing sunglasses if bright light gives them headaches, Yeates said.

Most of the children in the study received their concussion from a sports related injury or fall, but about 20 percent had a mild brain trauma injury from a traffic accident or some other cause.

The study included 186 children, aged 8 to 15, with mild concussions and other mild brain injuries treated at two hospitals in Cleveland and Columbus, Ohio. The reports are based on parents' reports of symptoms up to 12 months after the injuries.

The brain injuries studied were considered mild because they involved no more than half an hour of unconsciousness; 60 percent of kids with concussions or other brain trauma had no loss of consciousness.

Overall, 20 percent who lost consciousness had lingering forgetfulness or other non-physical problems a year after their injury; while 20 percent who had abnormal brain scans had lingering headaches or other physical problems three months after being injured.

The study adds to research showing that mild traumatic brain injuries, including concussions "should not necessarily be treated as minor injuries," Dr. Frederick Rivara, Archives' editor, said in a journal editorial.

More information is needed to determine who is most at risk for lingering problems after these injuries, and to determine what type of treatment and activity restriction is needed, said Rivara, a pediatrician and University of Washington researcher.

The Centers for Disease Control and Prevention (CDC) defines a concussion as a type of traumatic brain injury caused by a bump, blow, or jolt to the head that can change the way the brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious.

According to the CDC, if your child has any symptoms of a concussion - which include different sleeping patterns, mood changes or problems with cognitive processes - you should bring them to a medical professional. If the child is having a headache that won't go away, weakness or decreased coordination, vomiting or nausea, slurred speech, will not nurse or eat and/or is crying and cannot be consoled, they need to be taken to a hospital immediately.

Source: http://www.cbsnews.com/8301-504763_162-57391791-10391704/kids-with-concu...

http://www.cdc.gov/concussion/sports/index.html

Your Child

Obesity Related Heart Disease Found in Children as Young as 8

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All you have to do is look around, wherever children are gathered, to see that there are far too many kids that are overweight in this country.  And sadly, some of these children may already be developing heart disease according to a new study.

The study reports that obese children as young as 8 years of age, are beginning to show signs of heart abnormalities.

"It is both surprising and alarming to us that even the youngest obese children in our study who were 8 years old had evidence of heart disease," said study lead author Linyuan Jing, a postdoctoral fellow with Geisinger Health System in Danville, Pa.

"Ultimately, we hope that the effects we see in the hearts of these children are reversible," Jing added. "However, it is possible that there could be permanent damage."

Researchers conducted MRI scans of 40 children between 8 and 16 years old. Half of the participants were obese; the other half was of normal weight for their age and height.

They found that the obese children had an average of 27 percent more muscle mass in the left ventricle region their heart, and 12 percent thicker heart muscle overall. Both are considered indicators of heart disease, Jing said.

Among 40 percent of the obese children, scans showed thickened heart muscle had already translated into a reduced ability to pump blood. The children with this reduced heart capacity were considered to be at “high risk” for adult cardiac strain and heart disease.

"This should be further motivation for parents to help children lead a healthy lifestyle," Jing said.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, called the findings "alarming."

Some of the obese children in the study were struggling with health complications often associated with excess weight, including asthma, high blood pressure and depression, the researchers said. But none displayed customary warning signs of heart disease such as fatigue, dizziness or shortness of breath, Jing said.

The study did not include kids with diabetes or those that were too large to fit inside the MRI scanning machine. Jing noted that the study might actually underestimate how many children are suffering from heart related problems associated with obesity.

Jing said it’s up to parents to help their children maintain a healthy weight. They should buy healthy foods instead of cheap fast food and fruit juice, "which is high in sugar but low in fiber," she said.

She also recommended that parents limit TV, computer and video game time and encourage more physical outdoor activities.

Childhood obesity isn’t just an American problem; it’s a global problem as well.  The World Heart Federation says that one in 10 school-aged children worldwide are estimated to be overweight. However, in the USA, the number of overweight children has doubled and the number of overweight adolescents has tripled since 1980.

The researchers believe that schools can play a role in helping families understand the health problems associated with obesity.

“…Schools and communities need to do a better job at educating both the parents and children about the health risks of overweight and obesity," said Jing.

Fonarow agreed adding, "Substantially increased efforts are needed to prevent and treat childhood obesity."

The findings were presented at the annual meeting of the American Heart Association in Orlando, Fla.

Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

Source: Alan Mozes, http://consumer.healthday.com/cardiovascular-health-information-20/misc-stroke-related-heart-news-360/obese-kids-as-young-as-8-show-heart-disease-signs-705099.html

 

 

 

Your Child

Adult and Childhood ADHD Two Different Disorders?

1:45

A couple of recent studies are taking a new look at the differences in adult and childhood ADHD.

They suggest that adult ADHD is not just a continuation of childhood ADHD, but that the two are different disorders entirely.

In addition, the researchers say that adult-onset ADHD might actually be more common than childhood onset.

The two studies used similar methodology and showed fairly similar results.

The first study, conducted by a team at the Federal University of Rio Grande do Sul in Brazil, evaluated more than 5,000 individuals born in the city of Pelotas in 1993. Approximately 9 percent of them were diagnosed with childhood ADHD — a fairly average rate. Twelve percent of the subjects met criteria for ADHD in adulthood — significantly higher than the researchers expected — but there was very little overlap between the groups. In fact, only 12.6 percent of the adults with ADHD had shown diagnosable signs of the disorder in childhood.

The second study, which looked at 2,040 twins born in England and Wales from 1994-5, found that of 166 subjects who met the criteria for adult ADHD, more than half (67.5 percent) showed no symptoms of ADHD in childhood. Of the 247 individuals who had met the criteria for ADHD in childhood, less than 22 percent retained that diagnosis into adulthood.

These reports support findings from a third study from New Zealand, published in 2015. Researchers followed subjects from birth to age 38. Of the patients who showed signs of ADHD in adulthood in that study, 90 percent had demonstrated no signs of the disorder in childhood.

While the results from these studies suggests that the widely accepted definition of ADHD – a disorder that develops in childhood, is occasionally “outgrown” as the patient ages- may need to be reassessed.

However, not everyone is on board with the recent findings. Some experts suggest that the study’s authors may have simply missed symptoms of ADHD in childhood in cases where it didn’t seem to become apparent until adulthood.

“Because these concerns suggest that the UK, Brazil, and New Zealand studies may have underestimated the persistence of ADHD and overestimated the prevalence of adult-onset ADHD, it would be a mistake for practitioners to assume that most adults referred to them with ADHD symptoms will not have a history of ADHD in youth,” write Stephen Faraone, Ph.D., and Joseph Biederman, M.D., in an editorial cautioning the ADHD community to interpret the two most recent studies with a grain of salt. They called the findings “premature.”

In both of these studies and in previous research, adult ADHD has been linked to high levels of criminal behavior, substance abuse, traffic accidents and suicide attempts. These troubling correlations remained even after the authors adjusted for the existence of other psychiatric disorders — proving once again that whether it develops in childhood or adulthood, untreated ADHD is serious business.

Both of the studies challenge conventional beliefs that childhood onset ADHD is more likely to continue into adulthood. Many experts would like to see more research on this topic to verify these findings

The two studies were published in the July 2016 issue of JAMA Psychiatry.

Story source: Devon Frye, http://www.additudemag.com/adhdblogs/19/12040.html

Your Child

ADHD: Behavioral Therapy First Before Drugs

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Researchers have been studying the possible benefits of using behavioral therapy as a first choice in treatment for children with attention-deficit hyperactivity disorder (ADHD).

One paper found that children’s ADHD problems improve quicker when behavioral therapy is started initially instead of medications, the New York Times reported. . Another paper noted that this treatment progression is less expensive over time.

If the effectiveness of the behavior therapy-first approach is confirmed in larger studies, experts say it could change standard medical practice for children with ADHD, which currently favors medications as first-line treatments.

Medications were most effective when used as supplemental, second-line treatment for children with ADHD who required the drugs. In many cases, the drugs were effective at doses lower than normally prescribed, according to the findings in the Journal of Child & Adolescent Psychology.

"We showed that the sequence in which you give treatments makes a big difference in outcomes," study co-leader William Pelham Florida International University, told The Times.

"The children who started with behavioral modification were doing significantly better than those who began with medication by the end, no matter what treatment combination they ended up with," he said.

Some experts noted that the research focused on behaviors and not some of the other complications associated with ADHD such as attention and learning problems.

"I think this is a very important study, and the take-home is that low-cost behavioral treatment is very effective, but the irony is that that option is seldom available to parents," Mark Stein, a professor of psychiatry and pediatrics at the University of Washington, told The Times.

One resource for more information on finding a specialist in behavioral and cognitive therapies is, http://www.abct.org/Home. Click on the “Find a CBT Therapist” link.

Another online resource is, www.additudemag.com, which offers information on the program, COPE (Community Parent Education) and how to locate one in your community.

Story Source: WebMD News from HealthDay, http://www.webmd.com/add-adhd/childhood-adhd/news/20160218/behavioral-therapy-adhd

Daily Dose

Treating Ear Infections

Plenty if ear infections going around, so what's the best treatment?It has been very busy in my office with plenty of ear infections going around.  Once you have taken your child to the pediatrician and they have indeed been diagnosed with an ear infection (otitis), what’s next?

Like many things in medicine there is not one right answer to that question and there continues to be a debate on the treatment of ear infections.  The many articles that have been published in past years have looked at the prevalence of certain bacteria in causing ear infections, the role of viruses as a cause of ear infections and even when and if to treat an ear infection. The articles did not seem to have a clear consensus.  You may have noticed that too if you have seen different doctors who have different opinions about otitis treatment. Now, two recent articles in the New England Journal of Medicine (Jan. 2011) once again looked at antibiotic use for the treatment of ear infections.  In two double blind, placebo controlled, randomized trials (the gold standard for studies) researchers defined otitis as the “acute onset and presence of middle-ear effusion (fluid), bulging tympanic membrane (ear drum), erythema (redness) and pain. The studies were done in Europe and the United States, and looked at whether children between 6 months and 35 months of age improved more quickly if they received an antibiotic rather than a placebo (no antibiotic). This debate had been ongoing, and both of these studies showed that the children who received antibiotics had symptom resolution more quickly than those who were given placebo.  The study also showed that those who received antibiotics were more likely to develop diarrhea. (bummer, hate those side effects!) Given these recent studies I think that the consensus would be that young children with documented ear infections should receive a course of antibiotics. That would typically mean children 2 and under. But, these studies did not look at the practice of what is called “watchful waiting” which has been advocated for older children. When a child over the age of two complains of ear pain, and is then examined and found to have an ear infection it may not always be necessary to prescribe an antibiotic. If the child is old enough to easily evaluate and does not appear ill it may be appropriate to be conservative about antibiotic use, and to provide pain relief with topical ear drops and oral pain relievers such as acetaminophen or ibuprofen. In many cases in an older child, the pain and infection will resolve over several days and an antibiotic will not be necessary. I often write a prescription for a parent to use if their child seems to become more uncomfortable, or the pain persists. In most cases these prescriptions have not been used. Doctors should take into account the history of previous ear infections, parental concerns as well as concerns about excessive use of antibiotics. “Watchful waiting” requires educating parents and having a discussion as to the pros and cons of antibiotic use. Each case may be a little different. Ear infections are still one of the most common reasons a child receives an antibiotic. These two articles now help clear up the debate about antibiotic use in younger children. “Watchful waiting” may still be appropriate for an older child with a simple ear infection. That’s your daily dose for today.  We’ll chat again tomorrow.

Your Child

1 in 10 Kids Have an Alcoholic Parent

2.00 to read

Since the passing of singing legend, Whitney Houston, the public has heard almost non-stop about her battle with serious drinking and drug problems. We’ve also learned that her 18-year-old daughter has had her own trouble with drugs and alcohol. They may be celebrities, but they share one thing in common with many American families - the long-term effects of alcohol abuse.

More than 1 in 10 U.S. children are living with an alcoholic parent and are at increased risk of developing a host of health problems of their own, according to a new government study released on Thursday.

Researchers at the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed national survey data from 2005 through 2010. They found that on average, 7.5 million children, under the age of 18, lived with a parent abusing alcohol during any given year. That’s about 10.5 percent of the under 18 population.

About 6.1 million of the children, lived in a 2-parent household where one or both of the adults abused alcohol.

Researchers said that of the 1.4 million children who lived in a single parent home where the adult had a drinking issue, the overwhelming majority was in female-head of households. The figure given was 1.1 million households.

"The enormity of this public health problem goes well beyond these tragic numbers as studies have shown that the children of parents with untreated alcohol disorders are at far greater risk for developing alcohol and other problems in life," SAMHSA representative Pamela Hyde said in a statement.

The study said that children of alcoholics were at a greater risk for mental health problems including anxiety and depression.

Another not surprising discovery was that these children were at higher risk for being abused or neglected by their parents. They were also more likely to have thinking or language difficulties and four times more likely to develop alcohol problems of their own.

While this study looks at how many children live with an alcoholic parent, the American Academy of Child & Adolescent Psychiatry (AACAP) reports that if you substitute relative for parent then the statistic changes to one in five adult Americans have lived with an alcoholic relative while growing up.  Again, the statistic is pretty staggering.

What can be done to help children of alcoholics? There are support groups and resources available, but understanding family members, friends, teachers, coaches and counselors can also help lead these children down a more positive path.  

Children and adolescents of alcoholic parents can benefit from educational programs and mutual-help groups such as programs for children of alcoholics, Al-Anon, and Alateen. Early professional help is also important in preventing more serious problems for the child, including reducing risk for future alcoholism.  Child and adolescent psychiatrists can diagnose and treat problems in children of alcoholics. They can also help the child to understand they are not responsible for the drinking problems of their parents and that the child can be helped even if the parent is in denial and refusing to seek help.

Some resources for families dealing with alcohol abuse are:

1. National Association for Children of Alcoholics- www.nacoa.net

2. Al-Anon – www.al-anon.alateen.org

3. Adult Children of Alcoholics – www.adultchildren.org

4. The American Academy of Child & Adolescent Psychiatry- www.aacap.org

Sources: http://www.reuters.com/article/2012/02/16/us-usa-drinking-study-idUSTRE81F0CB20120216  / http://www.aacap.org/

Your Teen

More Teens Fall Victim to Dating Violence

2:00

The teenage years are supposed to be filled with laughter, fun and testing the boundaries of parental control. It’s also a time when many boys and girls will start dating. For some teens, the beginning of couple relationships is about as far away from fun as it could possibly be.

Some teenagers may think that teasing and name-calling are somehow linked with a fondness for someone, and that might have been true when they were six or seven years old. However, by the time a young girl or boy reaches their teenage years, that kind of behavior can take on a much different tone. What was once an awkward attempt at gaining someone’s attention can turn into physical and sexual abuse.

According to a new study from the Centers for Disease Control and Prevention (CDC) that is happening more than you might think.

Twenty-one percent of high school girls have been physically or sexually assaulted by someone they dated -- a figure twice as high as previously estimated.

Ten percent of high school boys also reported being physically or sexually assaulted by someone they had dated.

The authors of the new report noted that the CDC has changed the way it phrases its questions about teen dating violence, leading more students to report assaults.

Sadly, teens that have experienced dating violence are at risk for other serious problems as well. Research has shown that they are more than twice as likely to consider suicide. They are also more likely to get into fights, carry a weapon, use alcohol, marijuana or cocaine and to have sex with multiple partners. Not the kind of life any parent would want for their teenager or the one that they would truly want for themselves.  

Researchers don't know if any of these events causes the others. While it's possible that dating violence could cause thoughts of suicide, it's also possible that children who are depressed are more likely than others to fall into abusive relationships, says Adiaha Spinks-Franklin, a developmental and behavioral pediatrician at Texas Children's Hospital in Houston who was not involved in the study.

Assaults by romantic partners often aren't isolated events. Many teens reported being assaulted multiple times, according to the study, based on the CDC's Youth Behavior Risk Surveillance System using questionnaires answered by more than 13,000 high school students.

"If there is violence once, there is likely to be violence again," Spinks-Franklin says. "It has to be taken very seriously."

Spinks-Franklin says she has seen violence even among relationships between 10- and 11-year-olds.

"If a parent is concerned that a child is in an unhealthy relationship, they need to address it, but do it in a way that doesn't make the child shut down," she says. "They need to feel safe telling a parent."

Teens often hide the abuse from their parents, Spinks-Franklin says. Teens may not be able to confide in friends, either, because abusers sometimes isolate their victims from loved ones. Teens are sometimes more willing to talk to doctors, especially if their parents are not in the room.

Some schools have taken the lead in promoting awareness of and education on teen dating violence. Pediatricians can also discuss this important topic with their patients and parents. If time is limited, brochures in the waiting room can offer information and open the door for questions.

"This study makes it even more important for parents to ask lots of questions and get to know their teen's friends and significant others, and not ignore anything that makes them uncomfortable," says McCarthy, a pediatrician at Boston Children's Hospital. "They also shouldn't ignore any changes in their teen's behavior."

Dating violence may never be eliminated one hundred percent, but can be considerably lessoned when teens, families, organizations, and communities work together to implement effective prevention strategies.

One of the best strategies for prevention is for parents and teens to be able to communicate about serious topics without judgmental attitudes or closed-minded opinions. Your teen wants your help even if he or she doesn’t know how to ask. They'll appreciate you being there before and when they need you.

The new study was published in JAMA Pediatrics.

Sources: Liz Szabo, http://www.usatoday.com/story/news/2015/03/02/teen-dating-violence-study/24127121/

http://www.cdc.gov/violenceprevention/intimatepartnerviolence/teen_dating_violence.html

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.

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