Transcription:
Concussions Outside the Playing Field

Melanie Cole. (Host):  While concussions are most commonly associated with sports, they can happen in a variety of other settings. My guest today is Dr. Kristen Heinan. She’s a pediatric neurologist who specializes in caring for children with concussions. Welcome to the show, Dr. Heinan. So tell us a little bit about concussions. They are most commonly associated with sports but there are other settings; I mean kids can bump their head in a variety of ways.

Dr. Heinan (Guest):  Yes, absolutely. We see a lot of different mechanisms for concussion in the clinic. For some of the older teenagers, car accidents are quite common, cars versus trees, or rollovers. For the younger kids, playground accidents, or this winter, a lot of flooding mishaps were causes of concussion that brought people in.

Melanie:  You know, these are things you don’t always really realize and think about, but now that you say that sliding playgrounds, kids fall off of the equipment, what’s a parent to do? You know, in sports we are looking to the helmets, to teams, to coaches to help us with this. What do you do on the playground or the sliding hill?

Dr. Heinan:  We have this conversation with parents a lot particularly if they’ve had a child with one concussion. They are especially sensitive to the risks and are hoping to prevent future injuries. You can’t wrap your kids in bubblewrap, you have to let them go out into the world, but common sense things, if you are sliding on a hill, probably a well-travelled hill not in the forest but a bunch of trees on the playground with a good soft surface and again parental or teacher supervision. But accidents and things will happen. And that’s what we are here for if something does.

Melanie:  So what are some signs that a child has gotten a concussion? If we see them fall off the monkey bars, or bump into a table, what are some signs we might notice?

Dr. Heinan:  Sure. So a lot of times, sometimes kids are afraid to say that they have gotten hurt practising gymnastics in their room without permission. So, a parent, or teachers even, might notice that the child seems more fatigued. A lot of times they might be grumpier; appetite can be decreased. They may not directly complain of a headache but you can notice changes like not being as active as usual, being more quiet, not wanting to do all the fun things that they usually want to do. And sometimes obviously they’ll say, “My head hurts, it hurts for me to read, I don’t want to play the video games or watch the TV.” Parents are just really good at picking up when their child just doesn’t seem right, and so those are kind of the big key features of concern.

Melanie:  Dr. Heinan, when children, little babies, are learning to walk, we worry about them falling and hitting things. Can little babies get concussions too?

Dr. Heinan:  They can. It helps that toddlers are closer to the ground. Usually you hear the thump and they end up with a bruise on the outside that looks terrible but they are typically okay. They sure can though; I mean we’ve seen young kids who have fallen or been involved in car accidents and they’ll do the same thing. They’ll be sleepier, they might be fussier, not wanting to eat as much; they seem out of sort just like they are getting sick almost.

Melanie:  If you do suspect that your child has a concussion, should you always take them to the doctor? Do you go to the emergency room? What do you do?

Dr. Heinan:  Nobody would ever fault a parent for bringing their child to the doctor or the emergency room if they were concerned. A lot of times what we do is offer reassurance that, yes, this is a concussion and it’s going to be uncomfortable and nerve-wracking for a while but then the child will be fine. It’s difficult to tell the severity of a concussion oftentimes, but certainly you should definitely seek medical attention if there is loss of consciousness involved, if the child is not making a lot of sense when they return, when they wake up. If there is any weakness on one side of the body or both sides, if they are complaining of really excruciating headache, if there is a lot of confusion, those are some major warning signs. Also a lot of vomiting, some is okay, some is pretty common but we can worry about more severe head injuries if there is a lot of vomiting or if there is any physical abnormalities that are going along with the concussion like weakness or…

Melanie:  And what do you do for a concussion? Is there anything for a parent to do or you as a physician? What about things like, you know, for the headache or symptom management, Tylenol? Are any of these things okay, ice? What do we even do?

Dr. Heinan:  Yeah, we are still working on that one. Unfortunately, there is no silver bullet for how to make the brain heal faster at this point aside from rest. It is very okay to treat the headache. Oftentimes there is associated neck pain too. If you think about hitting your head, your neck is attached, so they can have head and neck pain.
Tylenol is fine. Typically recommendations are, for the first 48 hours or so, to give Tylenol rather than ibuprofen or naproxen which is Aleve, because it has less of a chance of contributing to bleeding, in case there is a more significant injury. But after the first couple of days, your pain medication of choice is fine. We caution people to not rely on that so heavily after the first couple of weeks but initially that’s fine. And then the brain really just needs to rest. For the first 24, 48 hours, even three days, we say treat it like you have the flu. You are not going to feel good, let them rest; it’s kind of very symptom-guided, it’s very patient-specific. So whatever they indicate that they are up to doing, they should be allowed to do, but rest is key for those first couple of days.

Melanie:  Is there any truth to the video game, television, reading, to keep them out of those things for that first day or so, to allow your brain not to, you know, work so hard?

Dr. Heinan:  That’s a great question. We get that question a lot. There is nothing magic about the TV, video games, and reading. It is, as you said, just a cognitive exercise, if you will, that those things tend to require; that is the problem. So, if they are feeling well enough to want to email a friend and say, you know, “Hey, I have a concussion, I’m resting but I’m doing okay,” that’s fine. A lot of times the bright light of the computer screen or the TV screen are really exacerbating and the kids really don’t want to do that anyway. So there is, you know, there is no magic in what you can or cannot do; it’s just whatever symptoms tend to be exacerbated. The noise, the light, is what they should avoid. And the reading is great if your child loves to be read to; sometimes that’s easier. There is a lot of visual symptoms that go along with concussion that conversionsinsufficiency, difficulty sort of coordinating the eyes, and reading can sometimes be really annoying. So, if they try it for a little bit and it’s okay, no problem; if they try it for a little bit and they just feel terrible, then stop.

Melanie:  So in just the last minute, Dr. Heinan, why should families come to UVA brain injury and sports concussion clinic for their care?

Dr. Heinan:  It’s a really great clinic. It’s very interdisciplinary. So we have physicians that are there, we have occupational therapy who does a lot of work with the visual symptoms, there is physical therapy, education no consultants, are available and then we can set people up with neurocognitive testing or neuropsychiatric testing if they are having trouble with school, memory, things like that. So it’s a really great, very whole-person-oriented, family-oriented, inclusive clinic.

Melanie:  Thank you so muh for joining us today. You are listening to UVA Health Systems radio. For more information, you can go to uvahealth.com; that’s uvahealth.com. This is Melanie Cole, thanks so much for listening.