Pediatric Concussions: Early Recognition and Treatment

Pediatric Concussions: Early Recognition and Treatment



my name is Heather O'Reilly I'm a member of the u.s. women's national soccer team and I'm a three-time gold medal Olympian I've been playing soccer for 22 years now and it is such a huge part of my life it is so important to stay fit and stay healthy but while doing that you need to stay safe it is just so crucial to stay educated about different injuries and concussions in particular I was at school and I was playing kickball with my friends I was trying to catch the ball and I get had to have another boy then when I fell down I hit my head on that a spot and he came home from school that Danny was really off and when he was doing his homework he was even writing his letters backwards which was very unusual for Aiden we kept him home from football took him to the doctor the next day and then the next day you know the doctor said oh he has a concussion you can't see it on a blood cast you can't see it on a scan but it's a very real injury what's most important is that we distinguish it from a common belief that a concussion is loss of consciousness concussions due to a rapid rotation or spinning of the brain and an athlete gets struck in the head and it spins very quickly when it spins it puts a stress on the brain that causes it to stop functioning symptoms for concussion usually fall into four categories the first category is physical it can be dizziness headache balance problems nausea visual problems the second category is usually cognitive problems memory problems attention issues the third group of symptoms is usually emotional or mood symptoms and kids tend to appear irritable easily frustrated sometimes anxious sometimes nervous sometimes tearful for no reason the fourth category is usually disturbance of sleep kids have a hard time falling asleep or waking frequently in the night and in the end they feel as though they don't get good rest the first thing we do for a child that had a concussion is put them at rest and there's really two types of rest there's physical rest it's avoiding things that are physically demanding running or bicycling or anything that really would count as exercise the second type of rest is called cognitive rest basically the avoidance of activities that demand concentration or focus reason or memory for children the obvious thing is their schoolwork will try to reduce their schoolwork or eliminate it for the first few days and then when we reintroduce it we reintroduce it gradually reading for pleasure even though it's fun it's still demands concentration video games are really nothing but reaction memory and focus same thing is true of playing musical instruments playing games like chess and so while they're recovering we try to minimize those activities the doctor said no recess no gym limited play make sure he doesn't have a headache can he was good the whole week two weeks later he was at a football game he kept getting hit play I had a play at halftime he said my head hurts and I told the coach his head hurts but he was the quarterback at the time so they kept him in the game by the end of the game he vomited walking off the field couldn't really describe how he felt just that he was here but not really here my head was killing me I felt like I was out of this world baby named me after multiple head injuries each of which did not seem terribly significant but in some it made him have a lot of symptoms he was really incapacitated for a while mostly by headaches he had tremendous school intolerance and he was one of the slowest to recover I've had recently it can be really difficult to know when a child has sustained a concussion and when they're safe to return to play there's no MRI scan to determine the severity of a concussion we have to use all the tools available history taking physical exam and we also have neurocognitive testing that we can do a number of people who sustained concussion a sustained long-term neurocognitive injury in other words they have a higher chance of having dementia depression Parkinson disease problem with memory Alzheimer's and the like you're playing volleyball and I missed one of the boss so I was running over to get the ball I was bending down and then a girl probably twice my size she kind of like did a hockey check-in to me and I fell back to the floor and my head hit my arm I was very confused I wasn't exactly sure of what just happened but then I just got up and I continued to play I didn't go to a teacher because I was confused I didn't think anything was wrong with me but I was feeling very dizzy afterwards but this is awesome my second concussion in one year I got my first one in a softball incident last spring so this one was much worse than my last one a number of repetitive low-level concussions can really accumulate and cause big problems a rare side effect but devastating consequence of head injury and children is second impact syndrome a child returns to play prematurely and then through a second injury as a devastating head injury that results in sudden death fortunately if an athlete sustains one or two concussions over the course of their career they're very unlikely to have any long-term problems most athletes recover from a concussion within about a month the real dangers of concussion occur when is not recognized and it's not treated properly sports injuries get a lot of the attention and are ones that we typically think of with concussions where the vast majority of them actually happen outside of the sports arena a lot of them are slip and fall sometimes assault and then a lot of just simple accidents more often concussions and children are missed perhaps they even take a fall at a playground and they don't come home saying mom or dad and have a concussion they get back to sports activity perhaps too early what we're trying to do is raise awareness about these issues concussion occurs commonly and if recognized we can change the natural history for that child in a very positive way I've been around many teammates who have had concussions in a contact sport there are risks the most important thing for athletes is to communicate if you're not feeling especially if it has something to do with your head although every athlete wants to stay in the game and prove that they're tough with concussions it's important to just communicate your symptoms and know when to sit out sometimes work hard have fun but be safe if you were ever confused in a situation like this immediately go to an adult I probably would have gotten help much quicker than I did I didn't really think there was anything wrong with me at the time I would have done everything differently I would have not let him watch TV I would have not let him play video games if a child hits their head even though they might seem okay you still need to limit their activity and you have to monitor them sometimes you don't want to see because they're kids and you want them to have fun and go out and play but if you don't let them rest in the beginning you could end up the way that we ended up the brain needs to rest Hayden whoo nice going

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