Head injuries and resulting concussions affect many children and teenagers every year. A concussion is a type of traumatic brain injury from a direct blow to the head or from a transmitted force causing linear or rotational acceleration. The definition of concussion has evolved over the last decade, and loss of consciousness is no longer a criteria for the diagnosis. Children and adolescents with concussions experience, on average, 10-14 days of symptoms. Evidence suggests this may be longer in younger children.
Though organized sports are thought to be the primary arena for injuries, head injuries and concussions can happen from any recreational injury, even an injury first thought to be a minor one. High schools in many localities have undergone extensive training in order to recognize concussions in athletes. Concussion rates are highest in football (American football - not soccer), Boys' ice hockey and lacrosse, and Girls' soccer.
Many schools use an evaluation tool called IMPACT --this test is composed of a series of questions, as well as mental and reflex performance measures -- designed to pick up on key nuances and signs resulting from a head injury. Athletes are given a baseline test at the beginning of the school year, or the beginning of the sports season, and further tests are done after injuries. The scores are compared with one another to look for impairments. Medical professionals find the IMPACT test useful as one tool in determining whether athletes are mentally able to return to school activities or sports participation. Another tool that is useful is the SCAT3 (Sport Concussion Assessment Tool). The SCAT3 has one section called the Sideline Assessment, designed to evaluate an athlete right away at the time of injury, as well as a symptom checklist (completed by the child) with severity levels for each symptom, a cognitive and memory assessment, and a physical balance and coordination test. Again, this test is useful when performed multiple times in an assessment of a child who has had a concussion.
Common symptoms of traumatic brain injury and concussions include:
Physical symptoms - dizziness, problems with balance, headache, nausea/vomiting, sensitivity to light or noise, visual problems
Cognitive symptoms - change in school performance, difficulty paying attention or concentrating, difficulty remembering, feeling confused about recent events, feeling foggy/"in a daze", forgetfulness, slowed response times
Emotional symptoms - irritability, increased emotions/moodiness, sadness, nervousness or anxiety, loss of interest in activities
Sleep/energy symptoms - drowsiness, fatigue, sleeping more than usual or insomnia/difficulty falling asleep
Following an initial evaluation, your medical provider will likely talk about putting your child on "cognitive rest" for a minimum of 5 days. This means absence from school and associated school work, as well as no sports or physical activity, no TV/computer/texting/video games/driving. When symptoms improve, a gradual return to activity can be coordinated. It is important to realize that the cognitive symptoms may remain even after the initial physical symptoms go away. Close coordination with medical providers, school personnel, trainers and coaches is important to give a child a good environment in which they can return to full functioning.
Monday, September 22, 2014
Wednesday, September 10, 2014
Enterovirus D68 - The New Respiratory Virus
A severe respiratory virus affecting children in Missouri and Illinois, and leading to a high rate of ER visits and hospitalization, has been identified as an Enterovirus and classified as Enterovirus D68. The CDC has a nice synopsis about EV-D68 on their website.
The Enterovirus family contains over one hundred viruses that typically circulate in the summer and fall, and usually cause gastroenteritis (stomach flu, vomiting and diarrhea). EV-D68 was first identified in California in 1962, and has rarely been reported in the US for the last 40 years. EV-D68 is unique in that it causes respiratory symptoms similar to common cold viruses as well.
Hospitals in Missouri and Illinois started seeing severe respiratory illness in school-age children earlier this month. At first, influenza was suspected, and due to the clustered nature of cases, cultures were sent to state and CDC laboratories. This is how the EV-D68 was identified.
The CDC is involved and is actively tracking cases and assisting affected states with testing. Regular hospital and commercial labs can isolate enterovirus from specimens, but cannot definitely type it as D68.
Symptoms: mild to severe respiratory illness characterized by cough and runny nose (typical cold symptoms) that can progress to difficulty breathing, wheezing and pneumonia-like symptoms
Transmission: EV-D68 is not frequently identified, so some questions exist as to the ways it would usually spread; however, since the virus is found in respiratory secretions (saliva, mucus, sputum) it may spread from person to person when an infected person coughs, sneezes or touches common contaminated surfaces. Since EV-D68 is an enterovirus, it may also spread by the fecal-oral route.
You can help protect yourself from respiratory illnesses by: washing your hands often with soap and water for at least 20 seconds, especially after changing diapers or helping children in the bathroom. Avoid touching your eyes, nose and mouth with unwashed hands, since viruses can exist on surfaces. Avoid sharing drinks, cups, eating utensils, washcloths and towels with people who are sick. Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone in the house is sick.
As with any other respiratory illness, if you or your children are sick, see a doctor if you have a high fever, difficulty breathing or lethargy. Monitor your children's breathing - if they seem short of breath, or are tiring and breathing fast, you should have them evaluated. Respiratory viruses can cause more severe infection in people who have underlying respiratory or lung diseases like asthma.
Update 9/17/14: The state health department in our state (VA) has confirmed that they are seeing confirmed cases here in Virginia. As in other states, children are presenting with respiratory symptoms similar to the common cold - runny nose, nasal congestion, cough and sometimes wheezing. As with many viruses that cause colds, symptoms can range from mild to more serious with difficulty breathing and wheezing noted. Fall weather, and the return of many children to the school setting, is usually associated with an increase in the spread of upper respiratory viruses.
Regular hygiene, good hand washing, and limiting your child's sick contacts (when possible) are important precautions to take.
There truly may be more widespread Enterovirus D-68 causing mild cold symptoms in children, in cases that would not prompt testing for specific viruses. As is usually the case, if your child develops difficulty breathing, or abruptly worsens during the course of an upper respiratory infection, they should be evaluated by their medical provider.
The Enterovirus family contains over one hundred viruses that typically circulate in the summer and fall, and usually cause gastroenteritis (stomach flu, vomiting and diarrhea). EV-D68 was first identified in California in 1962, and has rarely been reported in the US for the last 40 years. EV-D68 is unique in that it causes respiratory symptoms similar to common cold viruses as well.
Hospitals in Missouri and Illinois started seeing severe respiratory illness in school-age children earlier this month. At first, influenza was suspected, and due to the clustered nature of cases, cultures were sent to state and CDC laboratories. This is how the EV-D68 was identified.
The CDC is involved and is actively tracking cases and assisting affected states with testing. Regular hospital and commercial labs can isolate enterovirus from specimens, but cannot definitely type it as D68.
Symptoms: mild to severe respiratory illness characterized by cough and runny nose (typical cold symptoms) that can progress to difficulty breathing, wheezing and pneumonia-like symptoms
Transmission: EV-D68 is not frequently identified, so some questions exist as to the ways it would usually spread; however, since the virus is found in respiratory secretions (saliva, mucus, sputum) it may spread from person to person when an infected person coughs, sneezes or touches common contaminated surfaces. Since EV-D68 is an enterovirus, it may also spread by the fecal-oral route.
You can help protect yourself from respiratory illnesses by: washing your hands often with soap and water for at least 20 seconds, especially after changing diapers or helping children in the bathroom. Avoid touching your eyes, nose and mouth with unwashed hands, since viruses can exist on surfaces. Avoid sharing drinks, cups, eating utensils, washcloths and towels with people who are sick. Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone in the house is sick.
As with any other respiratory illness, if you or your children are sick, see a doctor if you have a high fever, difficulty breathing or lethargy. Monitor your children's breathing - if they seem short of breath, or are tiring and breathing fast, you should have them evaluated. Respiratory viruses can cause more severe infection in people who have underlying respiratory or lung diseases like asthma.
Update 9/17/14: The state health department in our state (VA) has confirmed that they are seeing confirmed cases here in Virginia. As in other states, children are presenting with respiratory symptoms similar to the common cold - runny nose, nasal congestion, cough and sometimes wheezing. As with many viruses that cause colds, symptoms can range from mild to more serious with difficulty breathing and wheezing noted. Fall weather, and the return of many children to the school setting, is usually associated with an increase in the spread of upper respiratory viruses.
Regular hygiene, good hand washing, and limiting your child's sick contacts (when possible) are important precautions to take.
There truly may be more widespread Enterovirus D-68 causing mild cold symptoms in children, in cases that would not prompt testing for specific viruses. As is usually the case, if your child develops difficulty breathing, or abruptly worsens during the course of an upper respiratory infection, they should be evaluated by their medical provider.
Subscribe to:
Posts (Atom)