Kids' Wellness Matters Podcast Ep. 1: What Parents Need to Know About Concussions

October 19, 2023

Concussions have a major impact on the daily lives of millions of children each year. In this episode, Jaqueline Turner, APRN, Division of Orthopaedic Surgery and Sports Medicine, discusses the importance of concussion prevention and management for young patients and offers insights into rule changes in youth sports to help prevent these injuries. She highlights the need for parents and caregivers to be informed on the signs of concussions and how early diagnosis and treatment can lead to faster recovery.

“We want early treatment, because studies have shown that if the child or the athlete is evaluated, diagnosed, and treated earlier, then they have a shorter recovery and they're back to their activities quicker than someone who maybe waited some time before they got evaluated.”

- Jacqueline Turner, MSN, APRN-NP, FNP-BC

Topics Covered

[00:00:29] Hosts Nina Alfieri, MD, and Rob Sanchez, MD, discuss how common it is to see young patients with concussions and why swiftly treating children with such brain injuries is critical to healthy development. Sanchez introduces Jacqueline Turner, APRN, an expert on concussions in the Lurie Children's Pediatric Concussion Program.

[00:02:18] Turner discusses her background and work with young patients that have sustained a concussion through sports and other activities or accidents.

[00:03:14] Lurie Children's Pediatric Concussion Program sees children ages six to 24 and focuses on patients with persistent post-concussion symptoms and offers them critical support and treatment.

[00:04:19] Concussions are a form of mild traumatic brain injuries, resulting from a forceful impact to the head or body that causes the brain to move within the skull, affecting neurotransmitters and functional brain connectivity, causing a wide range of symptoms.

[00:07:32] After a suspected concussion, parents should watch for warning signs such as loss of consciousness, memory problems, vomiting, balance issues, confusion, fatigue, or unusual behavior that may require immediate attention or a trip to the emergency room.

[00:9:57] While many think of football when they think of youth concussions, Tuner says they are common in any team sport or “ball” sport with equipment. She says it is important to note that Lurie Children’s studies have found girl's sports always has a higher incidence of concussion compared to their boy counterparts, but the reason why is unknown.

[00:10:59] Treatment of concussions involves relative rest for 24 to 48 hours, reintroducing daily tasks for short periods of time and carefully monitored return to school and physical activity. Turner notes experts no longer recommend cocooning patients in a quiet, dark room isolated from others because they’ve found that actually leads to a longer recovery.

[00:13:29] Typical recovery timeline for concussions is around four weeks. It’s important to have early evaluation and management to prevent prolonged recovery and repeat concussions. Once you do get one concussion, you are more at risk for getting more.

[00:16:01] Rule changes in youth sports in addition to education measures by parents, teachers, and coaches contributes to the prevention of concussions and repetitive head injuries in children.

Episode Transcript

[00:00:00] Nina Alfieri, MD: Welcome to Kids' Wellness Matters. I'm Dr. Nina Alfieri.

[00:00:06] Rob Sanchez, MD: And I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world renowned Ann & Robert H. Lurie Children's Hospital of Chicago.

[00:00:14] Nina Alfieri, MD: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult. Because kids' wellness matters.

[00:00:27] Rob Sanchez, MD: Hey Nina, how was clinic this past week?

[00:00:29] Nina Alfieri, MD: It was a great clinic, you know, the best thing about being a pediatrician, as you know, is you never know what's going to walk in your room, and I had a teenager who actually came in after a concussion from playing sports, so we got to spend a lot of the visit talking about protecting her brain and preventing reinjury and it seems like this is a great time to talk about this topic with the return of going back to school and kids playing more organized sports. So I'm excited to dive into this today. I actually had a patient once tell me, he was a young boy and he said, brains are so important. They're at the top of your body. And I thought, how smart. He's exactly right.

[00:01:08] Rob Sanchez, MD: So true. He's going places. He knows what's going on.

[00:01:10] Nina Alfieri, MD: He is definitely going places. But the thing about concussions is that there's a lot we can do to prevent them. And then there's a lot that you need to know about how to take care of your brain after a concussion.

[00:01:20] Rob Sanchez, MD: Yeah, absolutely. It's sports physical season right now, and so there's a lot of sports that we think about. There's football, hockey, field hockey, lacrosse, soccer. It spans the range of ages. You know, we talk about it for young children, high school age students and kids. The development is so important and it doesn't just stop,as they grow into their adult bodies, it keeps going, right?

[00:01:39] Nina Alfieri, MD: You're right. You know, one of my favorite factoids to tell families is that even though the brain looks structurally adult around mid teen years, your brain actually keeps developing well into your 20s. So we focus a lot on infant brain development, which is so important. But there's this whole aspect of protecting and helping enrich your brain, even up until your mid 20s and past then, really. So we got a lot to cover today and I'm excited to get into it.

[00:02:03] Rob Sanchez, MD: Absolutely, we're going to be talking about prevention, which is really key, but as you mentioned, you saw someone who was after the fact, and we know that that time after concussion to allow for appropriate recovery is so vital, because right after it, they're most susceptible to reinjury. So, we're definitely going to talk about that and make sure we're letting parents know what's most important about this topic.

[00:02:23] Nina Alfieri, MD: I love it.

[00:02:24] Rob Sanchez, MD: Our guest, Jacqueline Turner, is an Advanced Practice Nurse, here at Lurie Children's and part of our Concussion Program's experienced team of specialists. We are excited to share her expertise today. Welcome.

[00:02:42] Jacqueline Turner, MSN, APRN-NP, FNP-BC: Thank you very much for having me. I'm excited to be here.

[00:02:44] Rob Sanchez, MD: You and I, we both work at Lurie Children's. We definitely have fields that overlap, but we've never gotten a chance to talk before. Can you tell me a little bit about the work that you do at Lurie Children's and where you're involved in the care of children?

[00:02:56] Jacqueline Turner, MSN, APRN-NP, FNP-BC: Yeah. So, I work in our concussion program taking care of children, adolescents, teenagers, occasionally college-age students and athletes that have sustained a concussion either through sports or another type of injury. And we see patients all throughout their recovery course. So, sometimes within the first few days of the injury, sometimes within the first few weeks or a lot of the patients that we see are unfortunately the ones that are not recovering, that are continuing to have persistent post-concussion symptoms greater than four weeks after their injury.

[00:03:26] Rob Sanchez, MD: Truly a valuable program, the concussion program at Lurie Children's. When did you start working with them and how did you join on and help with that important work?

[00:03:33] Jacqueline Turner, MSN, APRN-NP, FNP-BC: I've been here for seven years now been really involved in not only the clinical side of taking care of these patients, but also in the research studies that we're doing on concussions in youth. We see ages 6 through 24 through college-age. And a lot of the focus of our program is returning them to school and, and returning them safely to their physical activities and their sport.

[00:03:54] Rob Sanchez, MD: You mentioned that you start at age six and parents might be wondering, "Okay, well, what if I'm concerned about my little one who's younger than that?" And I'll say as a general pediatrician, we typically field a lot of questions about head injuries. And you are always encouraged to speak to your general pediatrician about that. We'll help walk you through the support steps, things to watch out for, and some of the symptoms. To start off, could you explain what concussions are and why concussions in kids can be especially dangerous?

[00:04:19] Jacqueline Turner, MSN, APRN-NP, FNP-BC: So, a concussion is a subset of a mild traumatic brain injury and it's caused by either a blow to the head or sometimes to the body with the force transmitted to the head that makes the brain move back and forth in the skull. And we think that there is a change in blood flow and there's a metabolic cascade and neurotransmitters. Sometimes, I like to say those little nerves and axons are stretched a little bit, aren't communicating as they should. So it's a functional brain injury, meaning it doesn't show up on any kind of conventional imaging like CT scan or MRI, but we see a wide range of signs and symptoms displayed.

[00:04:53] Rob Sanchez, MD: So you mentioned like a cascade, so it's not even just the initial injury. But what you're saying is that there's actually stuff that happens even after that, that's connected to it?

[00:05:02] Jacqueline Turner, MSN, APRN-NP, FNP-BC: Right and so that leads to the many range of physical symptoms that patients can experience afterwards. And there's alteration in blood flow, which leads to issues with exercise tolerance, can affect cognitive abilities like school, sleep behavior and emotions. There's a lot of different areas of kids' lives that can be affected.

[00:05:20] Rob Sanchez, MD: What do we know about what happens to the brain, during or after a concussion you know, after that injury occurs?

[00:05:27] Jacqueline Turner, MSN, APRN-NP, FNP-BC: So I like to explain to patients that the brain has problems functioning. So doing everyday skills can be more taxing on the brain. It tends to get more fatigued. So if you think of that brain as a battery, the battery life just gets drained a lot quicker, and then you need to recharge that battery a lot more often. So things that are visually stimulating can be hard for the brain to tolerate, especially in louder or longer situations. So reading can be very challenging, and comprehension. Loud environments, such as the school and hallways or assemblies, concerts can be hard for the brain to take in all of that stimuli. And so everything with concussion works very well with shorter increments, whether that's in an environment or a challenging task, and then taking breaks throughout.

[00:06:06] Rob Sanchez, MD: So, after an injury to the head occurs, what are some of the signs and symptoms of a concussion that parents should look out for?

[00:06:13] Jacqueline Turner, MSN, APRN-NP, FNP-BC: Some of those warning signs that we want parents to look out for that notify us that there might be more of a structural injury to the brain, something that you would want to get evaluated right away is, if there's loss of consciousness or trouble remembering events before, during, after the injury. If there's repeated vomiting, a lot of trouble, with walking by themselves, or not making sense when they're talking, appearing really confused or else very tired, sleepy, lethargic. If we observe any of those signs, then we would recommend that they get evaluated right away in an emergency room.

[00:06:45] Rob Sanchez, MD: And so it gets to the point of like whether or not parents should head directly to the ER if they suspect a concussion. Is there ever a reason to wait it out, where you don't have to go directly to the ER?

[00:06:56] Jacqueline Turner, MSN, APRN-NP, FNP-BC: I think if you're not, seeing any of those warning signs or symptoms it's okay to monitor them for those symptoms, but we still recommend that they either see their pediatrician or maybe an urgent care within a day, maybe two at the most of the injury, because we want to first get the correct diagnosis that can have a lot of impact on whether they can go back to sports and returning to school. But then we also want early treatment because studies have shown that if the child or the athlete is evaluated, diagnosed, and treated earlier, then they have a shorter recovery and they're back to their activities quicker than someone who maybe waited some time before they got evaluated.

[00:07:29] Rob Sanchez, MD: How do you diagnose and treat a concussion?

[00:07:32] Jacqueline Turner, MSN, APRN-NP, FNP-BC: So first we look at what was the force to the body or the brain. And did they experience any neurological symptoms either immediately or maybe in the minutes, hours, days after that injury that could let us know that the brain was injured. Like I said, there's not any neuroimaging that we could do, like a CT scan or an MRI that helps us to diagnose. It's more getting the story from the patients and then doing a physical exam, there's not one test that you could do that diagnoses a concussion, but evaluating their memory, their balance, their visual system and their eye movements. And then more just talking to them of what things have been harder for them to do since the injury.

[00:08:07] Rob Sanchez, MD: What are some of the questions that you might commonly ask or things that parents should know to recall or bring up when they're concerned about a concussion?

[00:08:15] Jacqueline Turner, MSN, APRN-NP, FNP-BC: I always try and get as many details as possible of how were they hit, what were the forces, if it was a fall from how high, or who and what they collided with if it was in a sports activity. And then asking right away those immediate symptoms. So, any loss of consciousness or memory problems, vomiting or seizures did they have brief headache or brief dizziness, nausea, blurred vision? Some say I got my bell rung or I felt a little bit stunned, which is a side of a concussion. And then how did those symptoms develop over that day and then in the days since that I've seen them as well.If it did happen in a sporting event, I want to know, if they stopped playing right away or if they continued playing because a lot of that information can let us know if they're at risk for persistent symptoms versus expecting a recovery within the usual four week time frame.

[00:09:03] Rob Sanchez, MD: The concussion program at Lurie Children's is within our Institute for Sports Medicine. But it's important to share that kids can experience concussions from all sorts of bumps, blows, or jolts to the head. What are some of the common causes of concussions in kids? And how does that change as children age?

[00:09:19] Jacqueline Turner, MSN, APRN-NP, FNP-BC: So in the younger children we'll see injuries more in P.E. class, recess, the playground, that's just the activity that they're more involved in. but sometimes just from slips on the ice or falls off scooters or bikes. And then as they get older within more of those contact sports, the team sports with balls that are a little more physical. But then we also see motor vehicle accidents, pedestrian versus motor vehicle, and sometimes physical altercations.

[00:09:43] Rob Sanchez, MD: In talking about sports, you know, football is certainly a sport that many people think of when we talk about concussions and athletes. But it isn't the only sport that puts kids at risk. Can you tell me a little bit about the sports that pose maybe a higher risk of concussion?

[00:9:57] Jacqueline Turner, MSN, APRN-NP, FNP-BC: Yeah, so it's more of those team sports that you involve other bodies and ball sports and where there's more equipment. So, lacrosse, ice hockey, soccer, wrestling, cheerleading but I think it's really important to note that we found through multiple studies that when you compare a boy's sport and a girl's sport of the same sort, so say girl's soccer and boy's soccer or girl's softball, boy's baseball, the girl's sport always has a higher incidence of concussion compared to their boy counterpart.

[00:10:27] Rob Sanchez, MD: That's so interesting. Did you have any insight as to maybe why that is?

[00:10:31] Jacqueline Turner, MSN, APRN-NP, FNP-BC: We're not sure. There's some thought that maybe just the girl's body type, that there's weaker neck muscles, that they could stabilize less and so the forces are causing their head to move more. Sometimes girls might be a little more forthcoming with their injuries and get diagnosed more. Is there a part of that like puberty or hormones has to play? We're just not sure.

[00:10:50] Rob Sanchez, MD: Let's say that someone does develop a concussion in the setting of playing sports. What is the protocol for a head injury that occurs during a sports activity?

[00:10:59] Jacqueline Turner, MSN, APRN-NP, FNP-BC: So if there's ever a suspected concussion the recommendations are to remove that child from play. So whether it's recess, PE class, a practice, a game, they should not be allowed to return to play that same day. That is one, to prevent subsequent head injury happening from that day which it's very rare, but there could be some very permanent devastating consequences from that. But then also just to rest them right away so that we could try and prevent them from having a longer recovery. We want to get them better within the soonest amount of time possible. Then the recommendations are 24 to 48 hours of relative rest. So no longer are we cocooning them in a quiet, dark room totally isolated. We're actually finding that that leads to a longer recovery. And so relative rest means taking it easy around their house. Doing their normal daily activities, probably avoiding screens, no school, no school work. It's okay to go for a light walk, but no intense aerobic activity. But after 24 to 48 hours, we actually want to reintroduce them to their daily activities. So trying to do a little bit of schoolwork at home, make sure they can tolerate that before going back to school. It's okay to reintroduce screens. Screens are the lifeline of our pediatric patients to their friends and social media, and so we don't want to completely cut them off from that, but it's okay to reintroduce screens if it's not making symptoms too much worse. And then just gradually helping them get back to school. And so that's where that early evaluation with a healthcare provider is helpful because hopefully they can get some good guidance on safely returning to school within the first couple of days after the injury in a modified fashion. So maybe altered attendance, a half day or just going for a few classes, taking a lot of breaks in a quiet location throughout the day. And then communicating with their school and teachers that they're going to need extra time to complete their work. Maybe reducing their work to the overall essential items. Either delaying testing or having some extra time for testing, just what we call general academic accommodations so that they're not overwhelmed by the school environment and by their workload as they transition back to school. And then we also counsel them on how important it is for early reintroduction of physical activity, that there's been a lot of research studies that have shown not only is it safe, but it's actually beneficial to start some light aerobic activity. So going for a walk riding a stationary bike at a really leisurely pace can actually reduce symptoms and then help them recover faster compared to if they were completely sedentary throughout their recovery.

[00:13:17] Rob Sanchez, MD: As you mentioned, should be light activity. We don't want to reintroduce full context too soon because we're worried about repetitive concussions. Repetitive concussions are a major concern for young people, could you explain why?

[00:13:29] Jacqueline Turner, MSN, APRN-NP, FNP-BC: Yeah. So, once you do get one concussion, you are more at risk for getting more. There is no number of concussions that anyone has that would disqualify them from continuing to participate in their sport. And that's where our expertise our multidisciplinary team can really help is to individually evaluate each student or athlete's concussions, the amount of time it took them to get better looking at how they sustained their concussion, which activity it is they want to get back to, and then also looking at their pre injury history of if there are any factors that might place them at risk for a persistent symptoms. Our main focus is making sure the brain is fully recovered and that their concussion symptoms have completely resolved before they're getting back into that higher risk activity.Any head trauma to the brain is still very vulnerable during their concussion recovery. So we want to avoid exacerbating symptoms and prolonging the recovery as well.

[00:14:22] Rob Sanchez, MD: Is that something that takes a little bit of education on and, and explanation

[00:14:26] Jacqueline Turner, MSN, APRN-NP, FNP-BC: Yeah we do have that conversation a lot. A lot of education on what a higher risk activity is because one might think, well, if they're not playing football or ice hockey where their purpose is colliding with another player, but there are still other players on the field or bats or balls, that still is a higher risk environment. We really want them to avoid another head injury before they're all the way recovered. And then have a discussion with us of what their return to sport will look like depending on how long it took them to get better, the symptoms that they had their prior medical history, and their prior concussion history as well.

[00:15:00] Rob Sanchez, MD: In general, when do you find that students are fully back to their capability to be full day classes, back to their usual performance? Obviously, it probably depends on the level of the injury, the severity of the concussion, but can you speak to what parents might anticipate there?

[00:15:14] Jacqueline Turner, MSN, APRN-NP, FNP-BC: So a typical concussion recovery is within four weeks of the injury. But unfortunately up to 30 percent of kids we're finding take longer than that time to get better. And so with that early evaluation, that early management the early reintroduction gradual reintroduction to physical activities and school work even if that is just a class period or two where they're just more there to see their friends, to check in with their teachers, but to get them out of the house, to get structure in their day, to get over that nervousness of getting back into the school environment. I'm finding if they wait too long, there's a lot more anxiety and hesitation about how they're going to feel. And, just getting them back at whatever their capacity is.

[00:15:53] Rob Sanchez, MD: What are some tips that you can leave with parents today to prevent concussions throughout childhood and also avoid repeat concussions?

[00:16:01] Jacqueline Turner, MSN, APRN-NP, FNP-BC: So, recommending that the parents, the athletes, the officials, the coaches, that everyone has education on what is a concussion, how to recognize a concussion and how to treat it especially in that immediate period. That is how important it is to pull them from play and not allow them to go back if they have any suspicion at all that they have a concussion. And then, there has also been a lot of focus on rule changes and rule changes in youth sports. So, delaying the age for body checking in ice hockey, decreasing the amount of contact practices and contact events in youth football. And then new studies are looking at the use of mouthguards to prevent concussions or doing some kind of neuromuscular training just to get the body knowing where it is to help from an overall prevention perspective.

[00:16:48] Rob Sanchez, MD: Jackie, I want to take a moment just to thank you so much for spending your time with us, for sharing all of your wonderful knowledge and the work that you do, and for helping to keep our children safe We're super appreciative to have you at Lurie Children's to have as a resource for our patients, but also very much appreciate being able to share that information with families about what to look out for and what to keep in mind if they're concerned about concussions for their children.

[00:17:09] Jacqueline Turner, MSN, APRN-NP, FNP-BC: Yeah. Thank you so much for having me. It was a pleasure to be here.

[00:17:12] Rob Sanchez, MD: Thanks for listening to Kids' Wellness Matters.

[00:17:17] Nina Alfieri, MD: For more information on this episode and all things kids' health please visit luriechildrens.org.