This is a post authored by J. Forrest Bennett, ARNP who works in the rehabilitation department and on the concussion team led by Dr Samuel Browd (@DrBrowd), medical director of Seattle Children’s Sports Concussion Program. Forrest has had the unique experience to care for children after concussions in the immediate time after injury and in weeks to months thereafter when symptoms are prolonged. His wisdom can help us all understand the opportunity we have to improve children’s recovery after a head injury. In this post he explains what happens to the brain cells during a concussion, what constitutes risk for concussions, and the 5 things all of us need to know about concussions. I certainly know more after reading this and suspect you will too. Please leave comments or questions if you have them.
Soccer is the highest risk sport for school-age girls.
What Happens During A Concussion?
A concussion is a complex process affecting the brain, brought on by biomechanical forces (like a blow to the head, car crash, etc.) The force is transmitted to the head and can result in usually short-lived symptoms such as headaches, brief loss of consciousness, nausea, and/or dizziness. These symptoms are believed to be due to a temporary shift in the neurotransmitters (chemicals that allow cells to communicate) in the brain, resulting in a mismatch where the brain needs more energy but receives decreased blood flow to the brain temporarily. This mismatch in blood flow is believed to last up to 10 days following an injury and helps explain the symptoms associated with a time-limited injury such as a concussion.
Unfortunately this also explains why diagnosing and managing concussions can be vexing. Unlike a broken bone, we do not have validated imagining or blood tests that enable definitive diagnosis. The best practice of diagnosing concussion currently relies on obtaining a detailed history and physical following an injury. Depending on the severity of the injury and initial presentation, a sideline assessment should performed to look for common post-concussive symptoms. If the initial injury is more severe one may need to be evaluated in the emergency department and imaging may be obtained to help rule out a more severe injury. Each traumatic brain injury is unique, and should be treated with respect. There is nothing more heart breaking than a traumatic injury being improperly respected and identified, leading to a delay in care and permanent deficits.
It can be challenging to determine which concussions are mild, severe and which may progress. Ultimately the goal is to prevent injuries, screen for potential head injuries when appropriate and diagnose and treat injuries in a timely fashion to limit their severity.
How To Prevent Head Injuries
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J. Forrest Bennett, ARNP, Rehabilitation
This is a guest post from J. Forrest Bennett, an ARNP at Seattle Children’s and Dr Samuel Browd (@DrBrowd) a neurosurgeon who, together with their team, care for children after concussions. Clearly, we’ve all heard more about concussion these past few years. Not just because of pro-football tragedies and lawsuits but also because of the increasing expertise the medical community is acquiring around how to care for children and young adults after getting hit in the head. We’re also learning how to prevent head injuries in the first place. Forrest and I first started discussing this last spring when I began to see his passion in getting great information out to families. He’s convinced the more we parents (and community physicians) know about what to do with head injuries the less children suffer. In some cases what we do in minute 1 or day 1 after an injury can really change how a child recovers. Take a peek at this awesome post and please post comments/questions if you have them. More content will also be published later this week.
There is an ongoing debate about how we should best assess, manage and prevent head injuries in sports. Given the complexity of the injury and the effects that a concussion can have on an individual there is no room for the outdated and dismissive terms such as “getting your bell rung” or a “ding to the head.” Being dismissive of head injuries can lead to premature return to play and can end tragically. These injuries really matter.
This isn’t to say that kids shouldn’t play sports of course. Sports promote cardiovascular health and play a crucial role in the character development of children and adolescents. Parents must balance the risk with the benefits of sports to promote healthy decision-making. I like to talk about an active risk-reduction lifestyle. Through outreach and education we can prevent debilitating injuries, identify concussions early, and provide care plans that stem from evidence to limit the impact injuries have on kids.
What Every Parent Should Know About Concussions
- Helmets do NOT protect against all concussions
- Helmets provide crucial protection against skull fractures and more severe brain injuries but you can still suffer a concussion even with all of the proper protective equipment.
- There is a right way to play sports
- Teach your kids safe ways to play sports and adhere to the rules of the game. For example: no tackling in soccer and no head tohead contact in football. HEADS UP trained coaches teach actively safe participation in sports.
- The majority of sport rules are intended to maintain a level playing field and enjoyable experience. Head to head contact in football is just one example of improper and unsafe play that has recently drawn national attention in increasing ones risk for injury.
Because injuries happen, a group of experts developed the Standardized Concussion Assessment tool- 3rd edition (SCAT 3). This tool can help guide trained coaching staff, athletic trainers and medical providers in the initial assessment, triaging, and monitoring of these injuries. Many concussions can be handled through the expertise of your pediatrician or primary care provider. Concussions with prolonged symptoms (lasting weeks to months) and\or more severe injuries frequently benefit from a team approach. Read full post »
Photo courtesy of Ananda Bandyopadhyay
Today’s post is written by Dr Alok Patel, a third year resident at Seattle Children’s. I met him last year as he immersed himself in training. Since then we’ve been syncing up, learning together about ways he can use his voice, his teeming passion, and his media channels to improve the health of populations everywhere. He’s peppered with ideas, brimming with enthusiasm (it’s possible he speaks faster than I do) and diligently working to carve out his path as a public advocate, storyteller, and pediatrician. He’s a self-described, “wannabe medical journalist [working] to bridge the gap between public health and everyday.” He’ll finish his training this summer and begin his career officially; I suspect we’ll hear lots from him. In the past year we’ve both attended powerful social media summits at The Gates Foundation. And we’ve both stepped away inspired to do more. Dr Patel is starting to tell his stories publicly. Take a peek at his story below – the final quote left me slightly breathless…
Turn on the news these days and it’s easy to feel like the world is falling apart. Globally, people are suffering from different diseases and even though public health officials are making great strides internationally, I often find my self wondering “what can I do to help?” And then I get overwhelmed by the idea of where to start.
Last month I had the opportunity to attend the Gates Social on Science Innovation, a workshop that unites people with two common interests, a love for social media and desire to enhance global health. Surrounded by “impatient optimists,” a software engineer, film director, marine biologist and elementary school teacher I was struck by the fact that we all have innovative ideas… and we all need help getting them off the ground.
I can’t speak for the other attendees, but my “awakening” of sorts took place during a presentation of New York Times Columnist, Nicholas Kristof. He was discussing the variety of stories he’s told, from the harsh realities of child prostitution, to the innovative games that are teaching anti-parasite practices on your phone. Then he said something that really resonated with me. Read full post »
When it comes to food allergies, expert parents are uniquely-positioned educators. They know the tricks of the trade and the ways to the oasis of safety in a culture that has yet to fully embrace supporting children with unique medical needs. Over the years in practice, it’s parent-food-allergy-experts that have taught me the greatest new lessons I now pass on routinely to patients. Marrying the life-threatening nature of food allergy to the concepts of strict avoidance to the use of medication to treat anaphylaxis will never be enough when supporting children, their families, and their schools. The essential advice may be locating the inspiration families need to be staunch, relentless, and tireless advocates for their children. Even when uncomfortable. It’s Food Allergy Awareness week and some just-in-time allergy info has arrived.
This post, this concept, this advocacy, this is Mom-to-Mom health care. Enjoy this post from the ever-brilliant mom and researcher, Susannah Fox (her bio below)
Once a year, I give a high-stakes presentation in front of a single audience member: my son’s teacher. I have 20 minutes to teach her how to save his life.
I need to explain the science of food allergy, list all of his many allergens, accurately describe the symptoms of anaphylactic shock, instill an appropriate sense of urgency and responsibility with one or two frightening stories, but also build her confidence so she does not tune out or give up prematurely. Read full post »
This is a guest blog from Lisa M. Peters, MN, RN-BC (in the video above). Lisa is mom of two children and a clinical nurse specialist for the Pain Medicine Program at Seattle Children’s Hospital. She holds a clinical faculty appointment in the Department of Family and Child Nursing at the University of Washington School Of Nursing. She is board certified in pain management from the American Nurses Credentialing Center and is a Mayday Pain & Society Fellow. Lisa has a passion for improving the lives of children in pain. I’ve learned so much from her already!
Pain is inevitable; suffering is optional. That’s a key message when I partner with parents who bring their kids in for procedures and hear them recount stories of standing by, feeling helpless, as they watch their kids suffer with pain and distress.
It does not have to be that way.
Parents seldom realize the power they have as advocates and as partners with doctors and nurses in managing, and even preventing, their children’s pain. Could that shot at the doctor’s office really be a different experience? Do a few moments of pain really matter in the long run? If I speak up, will they label me and my kid as “troublemakers”?
As a parent, you can make a big difference in your child’s experience with pain. Knowledge is power.
3 Things To Know About Pain:
Poorly treated pain is harmful, both immediately and long term.
Science continues to teach us about the consequences of poorly treated pain on our bodies and minds. There is evidence that it can change how our bodies process pain signals, especially during critical periods of development in childhood. This can lead to highly sensitive areas of our bodies or a generally louder experience of pain. Memories of painful experiences have been shown to shape how we respond; studies show that 10% of the adult population avoids seeking medical care when needed due to fear of needles. Read full post »
This is a guest blog from Dr. Mary Alison Higi. Dr. Higi is a naturopathic physician in her final year of residency at Cascade Natural Medicine specializing in pediatrics under Dr. Candace Aasan. She studied at Bastyr University where she earned her Doctor of Naturopathic Medicine. She emphasizes the importance of the physician’s role in preventative medicine and public health. Dr. Higi has a special interest in implementing Naturopathic Medicine programs for under-served communities.
I’m publishing this post because I think there is significant confusion about naturopathic physicians’ support of vaccines. I’m hoping this sheds a little light. Would love to learn more from you all about your experiences with naturopathic medical care and vaccines. Please leave comments!
I have frequently heard from parents, “You give vaccines? I thought you were a naturopath!” I can only reply, “Vaccination follows three of our most important guiding principles”
1. Premum non Nocere — First do no harm; weigh out risks and benefits and follow the least harmful path.
2. Docere — A physician should be a teacher to her patients.
3. Preventir — Practice preventative medicine.
By providing routine vaccinations to my patients I have the opportunity to help them weigh risks and benefits of vaccine preventable disease versus costly, painful and the often dangerous consequences of preventable infections.
When I counsel and give vaccines I get to teach about disease prevention and public health; I get to help patients prevent some truly life threatening diseases. So yes, vaccines are naturopathic! In that light, following our naturopathic principles, there are a few vaccination myths that I’ve heard so often, I feel compelled to dispel them:
This is a guest post from Liz Scott, mom to Alex, Patrick, Eddie and Joey. She’s looking for support and in doing so she is sharing her story. She talks about instincts and love, commitment and courage. Here’s more on how you may be able to help:
Some of you may be familiar with my place of work, Alex’s Lemonade Stand Foundation, a nonprofit dedicated to finding cures for all kids with cancer, where I am the Co-Executive Director alongside my husband Jay. If you are still reading this, you may be wondering why exactly I’m telling you all of this? The reason is simple, because like your very own Seattle Mama Doc, I too am a mother, and my daughter Alexandra “Alex” Scott battled childhood cancer from before her first birthday until the time of her death at the age of 8 in 2004.
I am hoping that through sharing her story with you, and my part in it, that you will join me in an initiative, The Million Mile Run, this September to raise the profile of National Childhood Cancer Awareness Month. Alex was my second child, born only a few short years after my husband Jay and I welcomed our first child, a son, Patrick. To say that we were experienced parents during Alex’s first year of life would be a gross overstatement, but something I learned quickly was to trust my instincts. Read full post »
This is a guest blog from Karen Ernst. Karen is the mother of three boys and a military wife. She sometimes teaches English and enjoys advocating for and working with children. She is the co-leader of Voices for Vaccines and one of the founders of the Minnesota Childhood Immunization Coalition.
The preschool class party was one of the last hurrahs for my then five year old. The entire family attended, including our ten-day old newborn, whose only interest was nursing. His lack of other interests turned out to be good fortune because another mother-son duo at the party were contagious with chicken pox and began showing symptoms the day after the party. Had the mother held my newborn or the child played with him, the results could have been fatal for our son.
Having immunized my older child, who played with his contagious friend, I was relieved that no one in our home contracted chicken pox and no one passed it on to our new baby.
While I was angry when the mother revealed that she’d purposely left her son unvaccinated against chicken pox, I felt proud that I had chosen well, I had protected both my children, and I had understood and agreed with what public health officials had proposed: that children need the varicella vaccine. I had both done what I was supposed to, and nothing bad happened. So that’s the end of the story, right?
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This is a guest blog from Emily Kramer-Golinkoff. I was lucky enough to meet her about a year ago & even luckier that she asked me to help her make a big impact with her final thesis for her Masters in Bioethics. Her story, insight, and strength are worth your time. She’s hoping to leave a big mark in understanding how to leverage the asset of empowered patients to advance science and healing. She’s working to integrate patient communities more intimately in the health system. Her post is about why she chose to be an empowered patient and it’s fairly clear why she’s attracted an entourage…
Truth be told, belonging to a disease community isn’t my clique of choice. An artist community, a running club, even a yogi enclave sound more appealing. But I’ve learned that when our hands are tied, we’re better off building muscles in our legs than spending all our energy trying to wrangle our hands free.
That’s the philosophy I’ve embraced as a 28-year-old with big eyes, a bright future, and an advanced, incurable and fatal disease called Cystic Fibrosis. Cystic Fibrosis (CF) is a progressive genetic disease that primarily affects the lungs and digestive system. It causes thick mucus to build up in the lungs, leading to life-threatening infections.
My winding path to patient empowerment started as a headstrong, sassy little girl who clashed with my pediatric CF clinic’s authoritative culture. My perpetual questions of “why?” and efforts to integrate my disease into my life were met with disdain and labeled “difficult.”
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This is post from my friend, Anne Gantt. I love this concept and am inspired by the idea of parents pumping iron at the park. I’m hoping we can move this conversation forward. Please share ideas from your own neighborhoods in comments.
As a stay-at-home mom, I spend a ton of time at our neighborhood park while my 2 ½ and 4 year-old children zip down slides, scramble over the jungle gym, or chase each other in the woodchips. While they’re running around like little olympic athletes, I mostly just stand there doing nothing. A lot of nothing. Sound familiar?
That’s originally why I daydreamed about putting fitness equipment for adults in our park. I’d love to get a little exercise without having to resort to taking a turn on the monkey bars. The interesting thing is that installing adult fitness equipment will improve the park…for kids. This truly can be a win-win.
The park in question is here in Seattle– University Playground— it has a big grassy field, tennis courts, and beautiful new equipment for kids. It also has one of the very few public restrooms in the whole neighborhood–thus attracting a crowd. It sits in a tenuous location, one block from Interstate-5 and smack in the University District, which means the park sees a lot of illicit activity. Even worse, the illicit (I’m talking drug sales, etc) activity tends to happen in the section of the park right next to the playground.
Believe it or not, I’ve picked up more than a couple of used needles out of the woodchips myself.
Our park’s unsavory elements definitely scare some people off. I recently talked with a neighbor who refuses to take his 4-year old grandson to the park out of a concern for safety. This, even though their living room window looks right out onto the playground.
Something had to change. Urban dwelling can be better than this. Read full post »