On July 18, an article was published (http://bloom.bg/olNHUS) that discussed the long term effects of brain injuries in football players. It's scary stuff. It is especially scary, because one of the men interviewed stated, "You don't play football without getting a concussion." I don't know if that statement refers only to professional players, or if it includes middle and high school athletes. So, I did some research on head injuries in athletes and children.
Statistics
I found that roughly 40% of all traumatic brain injuries in children occur during sports and recreational activities, and that 80-90% of these head injuries are concussions. A concussion is a mild form of brain injury. If your child is a football player, here is some good news: the majority of traumatic head injuries occur during bicycling, skating and skateboarding. Many of the head injuries sustained during these 3 sports are lethal. I also found that only 35% of cyclists wear a helmet every time they ride. This means that many of these injuries are preventable. I couldn't find statistics for how many skaters and skateboarders wear helmets, but from interviewing clients I know the percentage is much lower.
Cycling, skating or skateboarding injuries can be prevented by wearing a helmet. Football, on the other hand, isn't played without a helmet. (At least not organized full contact football). This results in less serious injuries, such as a concussion. In fact, football participation is the leading cause of concussions. There are over 40,000 concussions suffered every year among American high school football players. (Note to my son: yes, that is American high school players and American football). Multiple concussions can occur to the same player. Multiple head injuries in the same season can have serious consequences. These include, but are not limited to learning difficulties, memory problems and changes in personality.
Prevention and Diagnosis
What is a parent to do? Well if your child is a cyclist, skater or skateboarder, have them wear a helmet every time they participate in their sport. Make sure it is the right helmet (http://1.usa.gov/pwzRR3) and that it fits correctly. If your child plays football, it is not as simple as that. They're already wearing helmets. Fortunately, helmets are improving. There is a lot of research happening in this field right now. Talk with your coach and your school to see if their helmets are up to date. The next step is early detection of a concussion. Injured players are screened at the sidelines to see if they have a concussion. If so, the player does not return to play until symptoms have resolved. This means symptoms need to be completely gone, not just mostly better. Sometimes these symptoms are very subtle. This is why coaches and trainers have screening tests they can administer right after an injury. However, these screening tests are not always administered correctly. According to recent research (http://bit.ly/o2XM5Y), the key is for every athlete to have one of these screening tests at the beginning of the season, before they have an injury. This gives the coach a baseline for comparison. (I recommend this be done for all competitive middle school and high school atheletes).
What to Expect
As a parent, I would like to know what to expect if my child is said to have a concussion. First, let me say that this is a clinical diagnosis. This means that there is no test that will confirm the diagnosis. A CT scan or MRI will be normal. If these tests are done, they are done to make sure there isn't a worse injury. Symptoms of a concussion can be headache, dizziness, confusion, unsteadiness, difficulty concentrating, amnesia or drowsiness. Males are more likely to get amnesia, while females are more likely to have drowsiness. These can also be symptoms of a more serious injury. If your young athlete has any of these symptoms after a head injury, have them evaluated.
Many parents are not told how long these symptoms can or should last. Most parents expect their child to wake up perfectly normal the next morning. That's not always the case. The headache from a concussion usually lasts 24-48 hours, but can last 4-5 days. However, if your child has had a concussion and the headache lasts more than 48 hours, they need to be evaluated again. Also, athletes shouldn't return to athletic activity until all symptoms are gone.
Closing Thoughts
I know this hasn't been a very positive or uplifting post. However, I do hope that it has been empowering. My quest is to help you see how to prevent a serious head injury in your young athlete. I also hope that you will find ways to work with your child's coaches and trainers to detect concussions early and get appropriate treatment.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
Tuesday, July 19, 2011
Tuesday, July 12, 2011
Sports and Heat
This past weekend, we had "feels like" temperatures of 103 degrees. Rumor has it, temperatures were even warmer on Monday. It doesn't look like this is going to go away before the dog days of August.
I spent Sunday sitting outdoors at a local sporting event. A 21 year old young man who was a member of our party developed signs of heat exhaustion after 2 hours. He had headache, fatigue and muscle cramps. Even though I am much older, I didn't start feeling the effects of the heat until I had been out for 4-5 hours. I was tired, and starting to fall asleep in my chair. Okay, I was also starting to get irritable. However, I was drinking 12 oz of water (and other fluids) every hour, and I may be in better shape than the young man.
This weather can be particularly dangerous for athletes who are practicing outdoors. We need to keep this in mind as we send our youngsters off to sports camps. Heatstroke is dangerous and can kill. Heat exhaustion is the early stage of heatstroke. Risk factors for heatstroke are dehydration, fatigue, poor fitness and lack of acclimatization to the weather. Once the temperature is over 98 degrees (and humidity is over 55%), children should rest 5-10 minutes after every 25-30 minutes of activity. I strongly recommend encouraging them to drink water during these breaks.
Your children may not get heatstroke if they are swimming. However, they can still get dehydrated. This puts them at risk for developing heatstroke during later activities. It is easy to forget this risk, since they are wet and less hot while in the pool. They have less evaporative water loss through their skin, but their bodies still use more water than on a cool day. Also, they are exercising in that water, even when they are just playing. Have them stop hourly for something to drink.
Football seems to have the highest risk of heatstroke, with 27 deaths over the last 10 years. Much of that increase in risk is due to their need to wear protective equipment. If temperatures are over 98 degrees and the humidity is over 55%, these kids should be in only shorts and t-shirts with helmet and shoulder pads. As the humidity rises over 80%, they should remove all safety equipment to continue activity. This also means they have to alter their activity, as they are not wearing safety equipment. There are differing recommendations about when to stop activity, with some references saying you don't need to stop until humidity is 100%. I wouldn't wait that long.
If a child or teen is having headaches or muscle cramps, these could be signs of heatstroke. Move the individual to a cool place and give plenty of fluids. Water is best. Juice can also help, but avoid caffeinated beverages. This is one of the few times when I recommend a sports drink with electrolytes. (However, the majority of their fluid intake should be water). If their body temperature is 102 degrees or more, immerse them in cold water (and consider calling 911). A great way to do this is with a plastic wading pool, ice and lots of water. You want to immerse the person in cold water, except for their face. Nausea, vomiting and dizziness can also be signs of heatstroke. If the child is also dehydrated, they may have difficulty sweating. The skin will be red, hot and dry. If the person has rapid breathing, a rapid pulse, seems confused, disoriented or is hallucinating, call 911 while you are cooling them in the wading pool.
Let's keep our kids safe while they enjoy the activities they love. For additional information, contact your Personal Medicine provider.
Dr Nan N
House Call Pediatrician, Overland Park, KS
Fireside Pediatrics
State of the art care for your child in your home
http://FiresidePediatrics.com
www.PersonalMedicine.com
I spent Sunday sitting outdoors at a local sporting event. A 21 year old young man who was a member of our party developed signs of heat exhaustion after 2 hours. He had headache, fatigue and muscle cramps. Even though I am much older, I didn't start feeling the effects of the heat until I had been out for 4-5 hours. I was tired, and starting to fall asleep in my chair. Okay, I was also starting to get irritable. However, I was drinking 12 oz of water (and other fluids) every hour, and I may be in better shape than the young man.
This weather can be particularly dangerous for athletes who are practicing outdoors. We need to keep this in mind as we send our youngsters off to sports camps. Heatstroke is dangerous and can kill. Heat exhaustion is the early stage of heatstroke. Risk factors for heatstroke are dehydration, fatigue, poor fitness and lack of acclimatization to the weather. Once the temperature is over 98 degrees (and humidity is over 55%), children should rest 5-10 minutes after every 25-30 minutes of activity. I strongly recommend encouraging them to drink water during these breaks.
Your children may not get heatstroke if they are swimming. However, they can still get dehydrated. This puts them at risk for developing heatstroke during later activities. It is easy to forget this risk, since they are wet and less hot while in the pool. They have less evaporative water loss through their skin, but their bodies still use more water than on a cool day. Also, they are exercising in that water, even when they are just playing. Have them stop hourly for something to drink.
Football seems to have the highest risk of heatstroke, with 27 deaths over the last 10 years. Much of that increase in risk is due to their need to wear protective equipment. If temperatures are over 98 degrees and the humidity is over 55%, these kids should be in only shorts and t-shirts with helmet and shoulder pads. As the humidity rises over 80%, they should remove all safety equipment to continue activity. This also means they have to alter their activity, as they are not wearing safety equipment. There are differing recommendations about when to stop activity, with some references saying you don't need to stop until humidity is 100%. I wouldn't wait that long.
If a child or teen is having headaches or muscle cramps, these could be signs of heatstroke. Move the individual to a cool place and give plenty of fluids. Water is best. Juice can also help, but avoid caffeinated beverages. This is one of the few times when I recommend a sports drink with electrolytes. (However, the majority of their fluid intake should be water). If their body temperature is 102 degrees or more, immerse them in cold water (and consider calling 911). A great way to do this is with a plastic wading pool, ice and lots of water. You want to immerse the person in cold water, except for their face. Nausea, vomiting and dizziness can also be signs of heatstroke. If the child is also dehydrated, they may have difficulty sweating. The skin will be red, hot and dry. If the person has rapid breathing, a rapid pulse, seems confused, disoriented or is hallucinating, call 911 while you are cooling them in the wading pool.
Let's keep our kids safe while they enjoy the activities they love. For additional information, contact your Personal Medicine provider.
Dr Nan N
House Call Pediatrician, Overland Park, KS
Fireside Pediatrics
State of the art care for your child in your home
http://FiresidePediatrics.com
www.PersonalMedicine.com
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