This is the season of football heroes banging heads, soccer stars heading the ball too hard, and cheerleaders tumbling the wrong way and falling. The leaves are about to turn color; and like clockwork, the number of young patients trickling into emergency departments with concussions is on the rise.
The good news: Parents and coaches are paying more attention than ever to head injuries. The bad: Some kids are still missing whole semesters of school; others are suffering multiple concussions, which, research shows, could have a long-term impact.
“The tide has shifted tremendously,” said Katherine Holmes, a Yale Medical Group (YMG) APRN and primary provider for Yale-New Haven Children’s Hospital (YNHCH) Pediatric Concussion Clinic. “I think the general temperature out there is that most people are scared. They are recognizing that this needs to be taken seriously.” Such events as the first-ever White House summit on concussions this past spring have helped. So has news about football players suffering long-term damage from multiple concussions, including chronic traumatic encephalopathy—a progressive degenerative disease linked with such symptoms as depression and dementia.
Kids’ concussions on the rise
YNHCH opened its pediatric concussion clinic a year ago in response to the rising numbers of concussions—young people make nearly 250,000 emergency room visits each year with sports or recreation-related brain injuries—and the increasing number of patients who need symptom management beyond a few days of rest.
“A concussion is rarely life-threatening, but it is a brain injury, and it can affect a person's ability to function and [their] quality of life,” said Michael DiLuna, M.D., chief of pediatric neurosurgery for YMG and director of the clinic. Dr. DiLuna works with Holmes on research to figure out why some children are more prone to suffer longer-term consequences. “Children might have difficulty with school work and be forced to limit other activities until their brains have healed. A teenager’s primary job is to be in school, so when they can’t tolerate being in school for more than a couple of hours, it’s something to be concerned about.”
Not all concussions require an intensive level of care. While recovery times vary greatly, many will resolve on their own within 10 days with rest—which usually means limiting computer work, reading, television, and listening to music. All concussions are still considered serious, however, and it’s important to be on the lookout for red flags:
- Loss of consciousness, even when brief
- Any loss of memory
- Headache
- Vision changes
- Difficulty sleeping
- Irritability, anxiety
- Such changes in medical status as headache, nausea, vomiting
- Foggy mind, increased fatigue, difficulty with schoolwork
Comprehensive approach
The Yale Clinic cares for patients from Little Leaguers to college athletes, who are usually referred to the clinic through the YNHCH emergency room, pediatricians, or other primary care physicians. Holmes and Dr. DiLuna give each patient a thorough neurological evaluation to assess motor skills, vision, mental status, and other functions; the examination can take up to an hour. Imaging, including a CT scan or MRI, may also be ordered for some patients.
Depending on the severity of the concussion, the clinic team may consult neurologists, who treat symptoms including headaches; or neuropsychologists, for cognitive difficulties. Physical therapists are available to help with impaired balance or coordination. Some patients require vestibular therapy, an exercise-based program for balance and coordination problems.
Each patient is then prescribed an individualized comprehensive treatment plan. “We recognize that concussions affect a multitude of systems—brain function, headaches, sleep...” said Holmes.
Getting kids back to their activities
Once initial concerns are addressed, Holmes recommends getting kids back to their activities as soon as they can tolerate them. The schedule will vary among patients. Instead of reading, some may need to listen to books on CD or have someone read to them. “You reintegrate slowly to see what they can tolerate. As far as sports, it’s a gradual reintegration. You gradually increase the risk and the duration,” she said.
In addition to seeing patients in the clinic, Holmes works closely with school nurses, coaches, and families to ensure care plans are followed. She doesn't hesitate to suggest that patients who have had more than one concussion reduce or eliminate the activities that are causing them. “I want kids to do what they're passionate about, but the child's brain is my first priority," she said. "My goal is to help kids get better and stay healthy. Most of them do. It just takes the appropriate amount of time and medical clearance to get them there.”
If she could send one message to parents of children involved in sports, it would be this: “If there is any question or doubt, get your child checked out. There is treatment and management that can help with concussions.”
For more information about the Yale-New Haven Children’s Hospital Pediatric Concussion Clinic, call 203-785-2809.