Terra Blatnik, MD: Hi, my name is Dr. Terra Blatnick, and I'm a Pediatric Sports Medicine Specialist at St. Louis Children's Hospital, and I'm a Mom Doc.

Melanie Cole (Host): Whether kids fall off their bikes or play a sport, their risk for head injury rises. Parents, teachers, and caregivers really should know the differences between mild head injuries and concussions, and when to seek medical help. Welcome to Mom Docs, the podcast from St. Louis Children's Hospital. I'm Melanie Cole and we're talking about concussions today. Dr. Blatnick, thank you so much for joining us. Tell us a little bit about concussion. What are they, what happens in the brain when a child gets a concussion?

Terra Blatnik, MD: So when I'm talking to my parents, I try to make, keep it pretty simple. So what a concussion is, is basically an injury to the brain on a very fine chemical level. So it's not anything that we would see if we did an MRI or a CT scan of your child's head. It's happening on a very fine level in just the little chemicals and the blood flow inside the brain, and when the brain gets jarred by either a hit to the head or a hit to the body, these little chemical changes create all of the things that we think of when we think about a kid having a concussion.

Host: What are the most common ways that you see that children get these concussions?

Terra Blatnik, MD: So I would say, at least in my line of work, it is certainly sports. So contact sports like football, hockey, soccer, but certainly kids can get them in accident type ways. Falls, motor vehicle accidents, bike accidents, things like that as well.

Host: So it, not just sports, I mean falling off a bicycle, any of those kinds of things. Yes?

Terra Blatnik, MD: Certainly, yeah. I mean, you can get a concussion any way that you hit if you hit your head or body quite hard can lead to a concussion.

Host: So, Dr. Blatnick, I'd like to ask you, because we think to ourselves, okay, we're going to put helmets on our kids when they ride their bikes or their skateboards or their scooters and they're playing a a contact sport, even though soccer's pretty contact and they don't wear helmets. Should we feel safer with our children with that helmet on?

Do they protect kids from concussions? And even if they do just a little bit, it's a really good idea. Yes?

Terra Blatnik, MD: So helmets are absolutely a good idea. Unfortunately, they don't prevent concussion. Bicycle helmets, football helmets, all of those are designed basically to avoid a fracture to the skull or a head injury, but not necessarily a concussion. Absolutely, we advocate for them 100%. But for concussion prevention, it's not really doing a whole lot, at least not yet, at least not with the technology we have right now.

Host: That's interesting. So now let's talk about symptoms, because that's the main thing is the symptoms of a concussion are what we're all supposed to watch out for, whether we're parents on the sidelines, whether we are buddies on the field. Because there is that buddy system where you keep an eye on your teammate or a coach. What are we looking for?

Terra Blatnik, MD: So I would say, and the most common symptom that we see for concussion is typically headache. Dizziness is, comes in in a close second. But certainly if it's a coach or a parent or another teammate that's looking at someone, if they're looking dazed, if they're not answering your questions, if they're just not acting normally, then certainly it's concerning and you should probably let someone know.

Host: So really when we think about these symptoms, are they something that are emergent? When you say let someone know if a child is throwing up or they're dizzy or there, any of those things, is this emergent, do we take them to the urgent care? What do we do?

Terra Blatnik, MD: Not necessarily emergent. I think it's especially important to get the child out of the sport, especially if that's where this is occurring. It's important to not let a kid go back into, say, a football game or a soccer game, if there's even the slightest concern about concussion, just because it could lead to more serious injury or further injury to the child.

Host: Well, that's certainly true and some kids really don't want to stay out of their sport. Tell us the treatment and how long a child is not going to play that sport for just a little while.

Terra Blatnik, MD: So every concussion is a little bit different. I would say, you know, at this point, average time out of sports, probably somewhere between two and three weeks, but that certainly is variable depending upon the age of the child. But certainly some kids will be better in about a week and then others may take six or eight weeks to get better.

Treatment right now for concussion, definitely still working on that, but we do know that you don't necessarily have to place a child into a dark room and avoid all stimuli at this point. We do encourage getting back to school early with accommodations to help them with things that they're struggling with concussion.

We also have started advocating for sort of early light physical activity. We're not talking going back to sports, but just doing a little bit of light cardio just to get their blood flowing a little bit. And we're talking just a few minutes at a time to start.

Host: That's changed though, hasn't it? We used to keep them in the dark room. They couldn't play video games, they couldn't go to school. But that's really changed, hasn't it?

Terra Blatnik, MD: Yes, I would say certainly over the last, probably at least five years no,w we've certainly started to get them back to school much earlier. Kids that are at home in this dark room, away from their peers, away from the things that they see as normal often can make them more depressed. And we've more recently found that early physical activity, does actually help kids potentially recover more quickly from concussion. And again, we're not talking going back to contact, but just doing like a walk around the block, something like that.

Host: So you said we're not talking about going back to contact, right at that point, how do you determine return to play?

Terra Blatnik, MD: So typically with return to play, we're waiting for the child to get symptom free. And symptom free is basically determined by the physician, the athletic trainer, the parent and the child, as a group effort. So we want the kid to feel like they felt before they ever had the head injury. And once that occurs and once we feel like the child's back in school, doing normally, doing well, like they typically do, and feeling completely back to normal is when we can actually talk about returning to sports in a slow fashion.

Host: When in doubt sit them out? Is that still what we think?

Terra Blatnik, MD: For sure. Yeah, we still need to sit them out if there's even the thought of a concussion or there's any inkling of a symptom, a headache, a little bit of dizziness; it's more safe to just sit them out for the rest of that game and then reassess in the next day or two.

Host: Well then Dr. Blatnick, because some kids I know that play sports have gotten one or two or more. Is there a certain number of concussions that it's like, okay, no more, you cannot play that sport anymore. You cannot do this activity anymore. It's just too many.

Terra Blatnik, MD: So that number is certainly different for every child. So it's not really, you can't really say a specific number for every kid. We want kids to be able to get back to the way they felt before the concussion happened. We want them to be doing as well as they were doing before in school, and we want everything to be getting back to normal. If that's not happening, then they probably have had maybe one too many concussions and we need to think about changing sports, talking about whether going back to sports is in their best interest.

Host: Dr. Blatnick, you're speaking to parents now and coaches and other kids; what would you like them to know as we get ready to wrap up? Because this is really important, and especially now kids are in contact sports season, there's all kinds of things. I mean, so many of these sports, including things like cheerleading, that can all cause concussion.

Not only activities, but just playing outside, falling down. What would you like them to know about watching out for those very important symptoms? And when it's time to call your pediatrician, or take your child to urgent care?

Terra Blatnik, MD: I would say you could never be too careful. I think that's probably the biggest message. If there's anything that you think is concerning, whether they have a lingering headache, or they're telling you they're a little bit dizzy, or they're just not acting themselves. You can always ask your pediatrician or you can always call us at the Young Athlete Center to find out if what they're experiencing is an issue, but certainly always take it seriously and it's better to keep them out and be safe rather than try to put them back to play too early.

Host: I agree completely. Thank you so much Dr. Blatnick, for joining us. As always, you're an excellent guest and just really such a great educator. Thank you again. And for more advice and articles, check out the Mom Docs website at children'smd.org. That concludes another episode of Mom Docs with St. Louis Children's Hospital.

Please always remember to subscribe, rate, and review this podcast and all the other St. Louis Children's Mom Docs podcasts. For more health tips, follow us on your social channels, and if you found this podcast to be informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.