Scott Webb (Host): Concussions in sports are common and especially so in youth sports. And my guest today is here to discuss the signs and symptoms of concussions and best practices for parents after our kiddos have been diagnosed. And I'm joined today by Dr. Deli Yara Bodu. He's the medical director of immediate care with Southern New Hampshire Health.

This is On Call with Southern New Hampshire Health. I'm Scott Webb.

Scott Webb: Doctor, it's nice to have you here today. I was telling you, I've got a couple of kids, they played sports. We've been to the emergency room for lots of things, including concussions. So let's start there. What exactly is a concussion? Because I think a lot of us think we know, but maybe we're wrong, and why are children and teens particularly vulnerable to them?

Dr. Dilip Yarabothu: a concussion, it's essentially a type of mild traumatic brain injury caused by a bump, a blow, a jolt, anything that makes the brain move suddenly in. Side the skull so that movement can temporarily disrupt how the brain functions. Now kids and teens are more vulnerable because their brains are still developing, their neck muscles are weaker and they often return to sports a little too quickly 'cause they don't realize they're actually still symptomatic.

Scott Webb: Yeah, that checks out in my experience from concussions I had playing sports with my kids is there's that temptation, right? Rub some dirt on it, get back out there, so to speak. You know, and, and a lot of times, And we see this in professional athletes where these concussions, symptoms can linger sometimes for years, sometimes causing, you know, athletes to have to retire and, and So, It makes me wonder, doctor, like what are some of the common signs, symptoms we should look out for?

You know, when it comes to. Our kids, if they've had a head hit, and especially maybe the ones that don't show up right away, like, what might we not notice

Dr. Dilip Yarabothu: Some of the symptoms are gonna show up immediately, but other's can appear hours later or even the next day. And most of those, signs and symptoms are headache, of course, pressure in the head. There is dizziness or balance problems. Sometimes you can ask nausea, maybe even vomiting, this vague fatigue or just seeming off.

There's light sensitivity, sound sensitivity, trouble focusing, remembering, or thinking clearly. Sometimes you can have mood changes like irritability, anxiety, even sadness, and uh, of course there's gonna be sleep changes. So sometimes sleeping more or less or just maybe just not being able to fall asleep, trouble falling asleep. One of the big things parents notice is, you know, this isn't my usual kid right now.

Scott Webb: Yeah, that, that sounds right. And I had that experience with my son where I was like, something like we didn't even realize that he'd had a head hit or that it was severe enough to have caused a concussion. But I could just tell something was off. Like it was like someone had replaced my kid with someone, some other version of him, you know?

Dr. Dilip Yarabothu: Yep. Absolutely. You got it.

Scott Webb: Yeah. And my experience was that, I never was unconscious. I don't think that ever happened to either of my kids. And I think that maybe that's one of the myths we can bust doctor, is that there's a sense, I think, You know, the prevailing whatever in the wind and social media that, you know, if the kid doesn't lose consciousness, then it's probably not a real concussion or a severe concussion.

And maybe you can bust that myth for us.

Dr. Dilip Yarabothu: Yeah. So most concussions happen without any loss of consciousness. Actually. You know, a child can be awake the entire time and still have a concussion. Let's make that clear. Symptoms like a headache, confusion, dizziness, or memory issues are often more important than whether they passed out or not. And you know, speaking of Mets, there's another.

Pretty common one out there. You know, people ask me a lot, is it okay if I let them fall asleep after a concussion? So this kind of comes down to many years ago, doctors were worried that sleep could mask the signs of a serious brain injury, like a brain bleed.

But we now know that sleep itself doesn't cause harm. It's actually pretty important for brain recovery. It's. Absolutely safe to let them sleep as long as they've been properly evaluated and they don't have any red flag symptoms, which I'm sure we'll touch on in the near future., So that being said, it's reasonable to check on the concussed individual periodically in the next like 12 to 24 hours, especially overnight.

But you don't need to wake them up every hour on the hour. That's actually gonna be pretty detrimental in terms of brain recovery.

Scott Webb: Yeah, it's so good. We have experts because a lot of the stuff you're saying, I was like, oh, right, right. We, we were worried about letting them fall asleep And then if they did fall asleep, we would wake them up to check on them. So, uh, it goes so great to have your expertise.

And you talked about the 12 to 24 hour period, but what about right afterwards, those first few hours, you know, after something happens at school or sports or just goofing around with their friends, like, what do we do those first couple hours?

Dr. Dilip Yarabothu: Yeah, so the first step, and arguably I, I would say the most important step is to stop the activity immediately, especially sports, you know, then you can keep things calm and quiet, encourage rest, but they don't need to stay in bed all day. Avoid prolonged screen times, And this may worse, And the symptoms.

Use simple pain control like acetaminophen or ibuprofen if needed. Watch closely for worsening symptoms over the next several hours. And, definitely wanna keep them home from sports until they're properly cleared. But if you're unsure, it's always reasonable to get checked out.

Scott Webb: Yeah, And we found that, if you send a kid back to the sport in which they injured themselves or had a concussion, there's always that temptation of, well, maybe you can do this or maybe you can do that. So we found that just keeping them home, as you're saying, like keeping them away from that sport for a bit was best for our kids anyway.

Dr. Dilip Yarabothu: Yep. Yep.

Scott Webb: And you touched on the red flag symptoms. Let's talk about some of those, like there's the typical ones you're talking about, signs, symptoms. what are some of those red flag symptoms? And if we see that our kiddo is experiencing some of them, you know, should we go straight to the ed?

Should we go to immediate care? What should be our plan of action?

Dr. Dilip Yarabothu: working as both an emergency physician as well as an immediate care provider, I've seen a ton of concussions over the years, but I've also seen a handful of head trauma that resulted in more than just a simple concussion. So that being said, you should probably go to the ER and bypass immediate care if you have any of these.

So essentially a worsening or severe headache repeated vomiting. Increased confusion, sleepiness or heart to wake up. Obviously if you have a seizure, weakness, numbness, slurred speech or trouble walking, unequal pupils is also a huge red flag. Or vision changes. For example, neck stiffness with worsening symptoms. 'cause at that point you may also end up needing a CT of your cervical spine.

Loss of consciousness. A child who's getting worse rather than better, and essentially any dangerous mechanism, like a high speed crash or a fall from height. So that's more of a judgment call. Basically, you wanna keep a low threshold for going to the ER when it comes to infants and very young children as well.

Scott Webb: Yeah. And you know, obviously there's no one-size-fits-all case by case, but you give us a sense of some of the red flags there. And speaking of immediate care, so if there are, may be less severe head injuries, although we're diagnosing those as ourselves and we're not doctors, but we're doing our best.

Right? Listening, listening to a podcast like this and getting a sense of what to look out for. So maybe at, at immediate care then what kind of concussion evaluations or guidance can we expect there?

Dr. Dilip Yarabothu: immediate care, it's, it's great for those cases where the patient is stable, but symptoms suggest a concussion. Families can expect a careful symptom review and neurological exam balance, coordination, memory checks. Guidance on rest school adjustments and activity restrictions. A clear plan for follow-up and return to play timing and red flag educations, you know what to watch for as the days progress.

Most of these head injuries do not require ct, but at Medicare, we're the ones that are gonna decide whether imaging is or ist

Scott Webb: Right, right. And put our, uh, faith and trust in the hands of the experts. Uh, I wanna get a sense from me, doctor, like how long can we expect symptoms to last? I was just saying, You know, it's not a one-size-fits-all, and maybe it's not, but generally speaking, You know, how long can we expect the signs and symptoms, how long do we need for proper recovery, return to play, return to school?

Give us a timeline, if you will.

Dr. Dilip Yarabothu: Yeah, no, This is a super common question that we get from the parents as well too. So most kids improve within one to two weeks, but sometimes it can take longer. You know, a proper recovery means a gradual return. This is not like an all or none. So that means they may return to school first with some adjustments if needed.

There'll be some light activity as the symptoms are improving. Slowly increasing physical and mental activity step by step., But no full sports until symptom free and cleared. You know, the goal is to steatotic progress without symptom flare up.

Scott Webb: Yeah. And so what happens then, doctor, if we, either we or coaches or however it happens, but if our, You know, kiddo gets back to sports or normal activities, quote unquote, You know, a little too soon, what could be some of the downsides?

Dr. Dilip Yarabothu: one of the main things is making the symptoms worse or prolonging the recovery. You know, there's also a serious danger called second impact syndrome, where a second head injury happens before the brain is healed. It's rare, but it can be catastrophic. Essentially, after a significant concussion, the brain is in a vulnerable metabolic state, so a second impact, even a minor one, can trigger the loss of the brain's ability to regulate blood flow, which can result in rapid brain swelling.

As you can imagine, This is life-threatening Now. It's almost exclusively seen in children in adolescents, which is why we really try to push the no sports,, no return to sports while symptomatic approach. Like I said, it's rare, but This is why we're more conservative with children. Even without that, returning too soon increases a chance of another concussion, longer symptoms, trouble in school due to poor focus and fatigue.

Scott Webb: Yeah. And that makes me wonder, doctor, like, you know, I know with like ACL injuries, if you've had one, maybe you're more susceptible to another or the other leg or whatever it might be. Right? So in terms of framing, in terms of concussions, once you've had a concussion, is there any science behind this question anyway of like, are you more prone to future concussions and, you know, if a child has had.

One or more like what are some of the long-term effects that parents should be on the lookout for?

Dr. Dilip Yarabothu: most children recover fully, but repeated concussions can increase a risk of longer recovery times, more severe symptoms with each injury, headache and sleep issues, mood changes, and attention and learning difficulties. So the more concussions a child has especially close together, the more cautious we have to be.

Scott Webb: Yeah. sort to give you a chance here at the end, doctor, like. If you could just sum it all up, the most important message you want parents to remember or know about head injuries and when to seek help, what would it be?

Dr. Dilip Yarabothu: This is hard. Obviously, like you said, you know, each family is different. Each kid is different. I think, we also have to trust the parents as well too, because who knows their. Children better than the parents. So trust your instincts. If your child seems off, slow down, get them evaluated.

You know, there's always another day for sports, You know, like it's you. You gotta focus on what is important right now, and if it's a head injury, just. Take a time out. So the key rule is when in doubt sit them out, especially with sports, early recognition and proper rest and recovery prevents complications down the roads and helps a kid get back to normal safely.

You know, then that's, that's really the bottom line is you don't want to end up just pushing them through having that second impact. And then next thing you know, you're weeks and weeks with symptoms rather than just a couple

Scott Webb: Right. It may be, you know, we we're all maybe guilty, quote unquote of, you know, this, oh, this game is so important. You know, it is like, okay, it's not, it's just a game. Right. And as you say, when in doubt, sit them out. I love that. Appreciate your time and your expertise today.

Thanks so much.

Dr. Dilip Yarabothu: Yeah. No, absolutely. Thank you for having me.

Scott Webb (Host): And for more information, go to snh health.org/immediate care.

Host: And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is On Call with Southern New Hampshire Health. I'm Scott Webb. Stay well, and we'll talk again next time.