Concussion, CAP4Kids, Zika Virus – PediaCast 338

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  • Join Dr Mike in the PediaCast Studio as our sports medicine team drops in for an update on concussion. The CAP4Kids crew also stop by to fill us in on their important program, which features hundreds of healthcare and social service resources for families. Finally, we’ll consider a big news-maker in South America—the Zika virus. How dangerous is it for pregnant women? And could the United States be its next stop? Be sure to tune-in for more details!

Topics

  • Concussion
  • The Concussion Movie
  • Chronic Traumatic Encephalopathy (CTE)
  • CAP4Kids
  • Zika Virus

Guests

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Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital.

It's Episode 338 for February 3rd, 2016. We're calling this one "Concussion, CAP4Kids, and Zika Virus". I want to welcome everyone to the show.

Lots coming your way this week, so I don't want to spend too much time on introductions or we'll go really long because we have a lot to pack in. We're going to do two interviews for you this week. First, our Sports Medicine team, with co-host, Dr. Eric Bowman, they'll be dropping in to the studio.

There is a new concussion movie out. You may have heard about it with Will Smith. We're going to talk about concussions and we'll mention the movie as well and give you the thoughts of our Sports Medicine team. We're going to refresh you on the definition and cause of concussions, what to expect in terms of symptoms, best practices for treatment and returning kids to the classroom and playing field — or court, as may better describe at this time of the year — following a head injury.

Then, we're going to reload the studio with another round of guests this time from the CAP4Kids program. Now, you're probably asking yourself, what in the world is CAP4Kids? Well, the CAP in CAP4Kids stands for Children's Advocacy Project. In a nutshell, CAP4Kids is a wonderful set of websites for those looking for help in social service resources, I mean to the tune of hundreds of resources in your local community — things like health topics, medical coverage, finding a job, finding a place to live, paying utilities, putting food on the table, and many, many more. Things we often take for granted but also things that in the blink of an eye, we may find ourselves struggling with as we attempt to provide for ourselves and our family.

0:02:22

So this is an important topic and I think that will be an enlightening interview, whether you find yourself in need and all of us may find ourselves in need at some point or another, or whether you're in a position to help those in need or you know someone who could use help. Maybe you're in a position to let your pediatrician know about this resource and then they'd be able to help others or your school's teacher or guidance counselors.

So we just want to get the word out about CAP4Kids because it is such a great resource and lets you know what things out there to help people in specific communities. Not only will we let you know where to find CAP4Kids, but some of the specifics on what you would find there, how you could use it. CAP4Kids is not in every metro area. It's in about 13 metro areas across the United States right now. But we'll let you know, if it's not in your area, how you can be an advocate for getting a CAP4Kids program up and running in your neck of the woods.

And then, we're going to wrap things up with some news parents can use at the end of the show with some information on Zika virus, which you may or may not have heard of. If you haven't heard of Zika virus, I think you probably will hear pretty soon like at the end of this program, but in lots of other places as well. It is spreading like crazy in South America and could easily make its way into the United States by summer.

Zika virus is not really an issue for children and adults. It's the unborn that's the problem. It could cause some types of birth defects where you see microcephaly and an underdeveloped brain. We don't for sure yet. There's been an increase in microcephaly to the tune of thousands of cases in the last few months in babies or unborn babies, babies being born down in South America, at the same time that the Zika virus is spreading. And some of these babies who have died, they're finding the Zika virus in their brain. Again, we don't know for sure if they're just associated or if one thing causes the other. There's still a lot of mystery about this. So, we're going to talk more about it coming up at the end of the show.

0:04:38

Don't forget, PediaCast is your show, so if there's a topic you'd like us to talk about, it's really easy to get in touch. Just head over to the contact page and shoot me a line and we'll try to get your comment or your question on the program.

Also, I want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you do have a concern about your child's health, make sure you call your doctor and arrange a face-to-face and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at PediaCast.org.

All right, let's take a quick break and I will be back with more on concussions, CAP4Kids and the Zika virus right after this.

[Music]

Dr. Mike Patrick: Dr. Eric Bowman is a sports medicine physician at Nationwide Children's Hospital and frequent co-host of PediaCast when we cover topics of interest to student athletes and their parents. He's brought a couple of colleagues to the studio today — Dr. Jim McDonald who is no stranger to the program and Dr. Steve Cuff. They're here for discussion surrounding the new Concussion movie and reminders for parents, coaches and teachers on the cause of the concussions, how they're treated and best practices for returning student athletes to class and play following a head injury.

So, concussions?

0:06:23

Dr. Eric Bowman: Thanks, Dr. Mike. I appreciate it, and thank everybody again for tuning in and hopefully we're able to bring some nice sports medicine topics for you guys. I got a couple of my colleagues here today, like Dr. Mike said, and we just wanted to talk about concussions a little bit in general.

It's kind of a hot button topic, I think, anytime you look at it. It's something a lot of parents get concerned about. So we just wanted to take a chance today and go over some concussion information. Obviously, a little over a month ago, there was a movie that came out called Concussion, right? It's the story of the NFL and things like that. We just wanted to get an opportunity, given the timing of the movie and the fact that concussions are so imminent in sports and things like that, we just wanted to have an opportunity to really talk.

So I want to say thanks guy for coming in and joining me today.

Dr. Steve Cuff: Good to be here.

Dr. Jim MacDonald: Great to be here.

Dr. Eric Bowman: Absolutely. You guys, obviously, are no strangers to concussions. It's something we see pretty regularly in our job as sports medicine physicians. I think where I kind of wanted to start more than anything is just kind of refresher for everybody, are you guys able just to share what is a concussion? What exactly is it? Just so people have a reminder and understanding of what we're dealing with.

Dr. Steve Cuff: I think there's a lot of different definitions. I definitely think of it as traumatic brain injury, mild traumatic brain injury. I like to explain it to my families as a more of a functional change in the brain as opposed to structural. I think a lot of parents has a little misconception and I think of it as a bruise to the brain. Maybe microscopically, there's some structural change, but really it's more of functional injury, a change in energy demands and a change in blood flow.

Dr. Eric Bowman: So it's definitely, you know, one of the things parents ask me a lot, well, if it's not bruise, if it's functional injury, what can you do to look for it? Is there something we can do imaging-wise or testing-wise or that sort of thing? Is there anything you guys can use for that?

0:08:12

Dr. Jim MacDonald: Well, let me ask that by also kind of following up with what Steve just said. So the technical definition of the concussion — there are actually probably a couple — but one is, after a direct or indirect blow to the head, a change in baseline neurological status. It's pretty broad. It kind of gets to little bit to your question, which is, one way you can look for it is look for those changes in neurological function after that type of injury.

It still leaves a huge amount of room for interpretation, doesn't it? Back in the day, the one neurological symptom we really paid attention to is loss of consciousness. That's sort of literally and figuratively a no-brainer. But since then, we found that actually things like amnesia, forgetting things, are actually much more important than loss of consciousness.

Then, we count neurological changes like change in sleep patterns, post-head injury, direct or indirect. So it gets kind of complicated.

And then, that intersects with maybe the real question you have which is can we look for it with an X-ray? Can we look for it with an MRI? Can we look for it with a blood test? And the answer is no, no, no, no, no.

And so, it largely still is what's called a clinical diagnosis. It's based on somebody with knowledge — like, say, Dr. Kuff, you, Dr. Bowman — interpreting what they see and hear in terms of history and physical and then using some tools which I'm sure we'll get into including like computerized testing.

But it's still very difficult, and the Holy Grail would be an imaging study or a blood test, don't you think?

Dr. Eric Bowman: That would be great, but we're not there yet. I think that's the thing that's important to understand. There's a lot of research going on to try to get us to that point, but we're definitely not there yet.

So I guess just for clarifications, Jim, you said specifically that you don't have to have loss of consciousness for it to be a concussion.

0:10:09

Dr. Jim MacDonald: Very specifically, no.

Dr. Eric Bowman: OK.

Dr. Jim MacDonald: And it doesn't even look like that's predictive. So we call that a prognostic indicator which in plain English is, Hey, if my child has loss of consciousness, does this mean this is a worst concussion? Is this a severe concussion? Is this going to take longer to recover from? And the answer is no.

That's actually quite surprising, but that holds up in a variety of studies including some work we've done within our own institution looking at kids with loss of consciousness. And some of the most rapid recovery I've seen have been in those kids. And some of the longest recoveries I've seen are in the kids who kind of who've come off the field and don't really remember who they are or where they are. They didn't lost consciousness and were still dealing with it sometimes two months down the road.

Dr. Mike Patrick: The brain is obviously a pretty complicated organ and there's a lot happening on the microscopic level we may not even really fully understand. There's lot of chemicals, and neurotransmitters and chemical inside cells and between cells helping them to communicate with each other. And so, with concussion, something is happening down there that causes blood flow changes, functional changes.

So it's real the symptoms then, right, that you'd say after a head injury, you have this prolonged symptoms and that's how you know if the concussion's there or not.

Dr. Jim MacDonald: If I just echo what Steve earlier, we all have little gimmicks with our families, I'm sure, the ways we talk about it but I usually use that phrase. It stands to reason the brain and it how it responds to injury would be very complicated, right? A lot more different than what could happen to my bicep muscle? Like, "Aww, a little bruise," no "Aww, a sprain." A lot can happen to the brain.

Dr. Eric Bowman: So I guess, the thing you're trying to say is that now all concussions are the same then.

Dr. Steve Cuff: Yeah, exactly. Even within the same person, two different concussion may look totally differently, so let alone across a spectrum of athletes. The common things you see, headache is almost always there. Dizziness is a very common symptoms, sensitivity to light and noise, difficulty concentrating, remembering, sleep problems that Jim mentioned. Later on, starting to see some emotional changes at times.

0:12:23

So each and any symptom that I just mentioned, you can have one. You could have 15, 20. It really varies from person to person and from injury to injury.

Dr. Eric Bowman: It sounds like unfortunately that even if you had one or more concussions in the past, that really doesn't have any bearing on how your symptoms may or may not develop on your newest concussion, your most recent head injury.

Dr. Steve Cuff: I think that's true in general. I think there are couple studies out there to show that you get a second concussion within a year, that the symptoms tend to build but worsen and last longer. Anecdotally, I have patients who I've seen who had pretty bad initial concussion and then they get another one a year or two later, and they recover quickly. Others who had a pretty mild initially and their next one is much worse.

So studies would say, the more you get, the easier to get them and the worse they tend to be. But I think in the real world, that isn't always the case. I don't know what Jim's experience has been.

Dr. Jim MacDonald: No, I like what you just said, Steve. I think there is some evidence that demonstrates that spacing concussions out, if you will. Obviously, you don't want another one at all if possible, but if it's your destiny to have another one, spacing that out. That's why management's appropriate and ensuring that the patient's fully recovered before returning them to sport.

But aside from that, it's possibly linking with maybe the next one being worse. Again, one of my gimmicky phrases is just like snowflakes. How many snowflakes have fallen in history? Like trillions right? Supposedly, no one is ever been the same. It's like you've seen one concussion, you've seen one concussion.

Dr. Eric Bowman: They're all different.

Dr. Jim MacDonald: I can use all sorts.

[Laughter]

Dr. Steve Cuff: Gimmicky phrases there?

Dr. Jim MacDonald: They keep on coming out on me.

0:14:03

Dr. Eric Bowman: And I guess the other thing that's important to talk about too is obviously as sports medicine physicians, we deal with athletes getting back to their sport. But it sounds like concussions also are more than just sports. I mean, we have school in our age group especially that we're working with and that our parents who are listening would have concerns with.

It sounds like a lot of the symptoms, not only are little boys or little girls not getting back to football or softball or whatever it is that may be but there's also some issues with school that may be going on there too that we have to be careful it.

Dr. Steve Cuff: Yeah, I think that must always be the primary focus, before we get them back to sport, we sure make sure that they're functioning in their daily life. And that's not always, unfortunately, the student's first concern, but hopefully, it is for the parents. Again, this is another situation where everyone's different. I think there are some kids who have pretty mild symptoms afterwards. They're able to continue school without much difficulty. There is other kids who may need a few days or a week off or at least need some accommodations. Some half days to start with, the ability to take breaks during the school day and rest, wearing sunglasses to help with bright lights and decreasing screen time, both at home and in school.

Sometimes, you've given them extra time to take tests and take them away from loud chaotic environment like a lawn trim or music classes. Certainly, we wanted to avoid gym class, if they had that phys ed, if they're still symptomatic.

And so, there's ways we try to help them get back into school and make it easier for them. I think there's also some more recent evidence that's come out that said that complete mental rest probably isn't the best treatment, whereas maybe five or ten years ago, we were saying, OK, let's shut everything down and complete mental rest, complete physical rest.

There's some evidence to show now that may not be the best treatment. So modified activity is probably just as good as complete mental rest. But, we should monitor them and make sure they are limiting screen time and we do want the brain to rest.

Dr. Jim MacDonald: I agree. I think the keyword is accommodate not shut down these days. Again, reflexive learning, this is a moving target. It reflects a lot of research and Steven said that it has gone on over the last several years, because yeah, I would have much more prone to shut my patient down five years ago. We found that actually probably creates a lot more problem.

0:16:21

You talk about the emotional changes post-concussion. You want to make an adolescent depressed, shut them down from hanging with their friends, going to school, socializing, those kind of things.

Dr. Eric Bowman: So it sounds like the big thing really. Let's watch their symptoms. Let's make sure we don't do things to make them worse. Let's still obviously try to keep as much as a normal life as possible.

Dr. Mike Patrick: And the more that kids just sit around doing nothing, the more they're likely to notice that they have a headache or that they feel a little dizzy.

Dr. Jim MacDonald: Oh, you know, you're right. Navel gaze it, right?

Dr. Mike Patrick: Yeah, yeah.

[Laughter]

Dr. Jim MacDonald: For sure. For sure.

And we, actually, as doctors, a lot of times one of our interventions is give them a symptom log to record their symptoms every day. And if every day, someone asks me am I irritable, that probably by itself will be irritable.

Dr. Steve Cuff: Irritable, right.

Dr. Mike Patrick: Yeah, yeah, yeah.

Dr. Jim MacDonald: One other thing, I don't know if you're going to get to it, but one thing I really want to make sure listeners know as well to think about especially with their adolescent children who get concussed. And we've talked about that "return to sport", we usually package what we just talked about with the phrase "return to learn" is "return to drive". We're paying a lot more attention to it, really.

And, you know, in our kids who are in Ohio, 16 or above — but maybe some of them is even 15 with learner permit — most of these kids have slowed reaction time after concussion. What's one of the biggest dangers for a young adolescent driver is getting behind the wheel of the car. So we're paying a lot more attention to that and recommending early on that these kids don't drive.

Dr. Eric Bowman: Absolutely, with my clinic, that's one of the things I talk about with my parents and kids is as you get older, yeah, your reaction time may naturally slow but you have experience on your side, right? As a young new driver, you don't have that experience. Oftentimes, I use the phrase "If you have that child or animal run out in front of your car, what are you going to do if you don't have the reaction time to stop in time?"

0:18:10

So I think it's something that's really important. I know they want to drive. I know it's a big thing for them, but I agree that it's something we really want to make sure that we address and safe not only for them, but for the rest of us on the road as well. So, it's important.

Dr. Mike Patrick: In talking about symptoms of concussion, speak a little bit to the baseline testing. Is that something that's really important that all student athletes should do before they participate?

Dr. Jim MacDonald: Who wants to fill that one? That's a…

[Laughter]

Dr. Steve Cuff: Yeah, this is an area of controversy. I think some of the testings, especially the computerized testing had become very popular due to a lot of good marketing. I think it does have its place. It can be a helpful adjunct in our diagnosis and management, but again, it's never the neurosite testing or the computerized neuro kind of testing have never been shown to change outcomes. I think we have to be cautious of that. Parents thinks that they're come in and we're going to diagnose their child with a concussion because they have this testing.

That's just not the case. We talked about earlier, it's a clinical diagnosis. At times, it can help us with the management and following them along. So I do think it has its place, but I think we have to be careful that it's not overblown.

Dr. Mike Patrick: Yup, absolutely.

Dr. Jim MacDonald: And I sincerely mean this, I think we all also feel that because of the 20+ odd symptoms that can happen plus concussion, that fall in the areas like Steve is talking about — like sleep issues, emotional issues, physical issues, balance issues — baseline, the change from their baseline symptoms becomes important.

So here, again, one of my cheesy lines, but Doctor Mom is sometimes the best judge of baseline. When a mother tells me their son doesn't look right, he's acting slow, that means a lot to me. That means a lot to me. Mom usually knows and I'll pay a lot of attention to that. I would rate that more important than the computer, to be honest with you.

0:20:13

Dr. Steve Cuff: Yeah, Jim's exactly right. The one place that can help sometimes is if you get a kid who you know they really want to get back to play, and you thinking no. He says he's totally fine. I'm not sure I believe him. Tell him to take the test, and you can have some objective evidence that "Look, this is how you performed on this test six months ago. This is how you did today. Even though you're telling me you're feeling good, you're still slowed down. Your short-term memory isn't quite there." And I think you can use that to try to convince even a skeptical parent sometimes too who also may wants to get their kid back as quickly as possible.

I don't mean to say that it has no place. It does. We just have to be careful how we use it.

Dr. Eric Bowman: Absolutely. I think that's a great way to put it. I, oftentimes, will explain to parents that it's just another tool in my toolbox. As I'm looking at getting your kid to sport or whatever activity they're in, it's one more thing I can use. It's not the only thing. It's one of several thing that I use.

We've talked about Doctor Mom, and we've talked about just a list of symptoms that concussion can cause and that we can see in our kids. Are there any concerning symptoms that a parent may see that say, All right, this makes me a little bit nervous. This makes me a little bit more concerned that this may be something more than just a concussion. I threw out there that obviously, if they're really concerned they should have been seen by a physician obviously. But, is there if a parent is looking at their child after a hit to the head or a concern, is there anything that you would be really more aware of I guess, or a little bit more suspicious of?

Dr. Jim MacDonald: The major thing that comes to mind — but even this, it can be hard potentially for a lay person to figure out — but altered level of consciousness. One of the things we do on the sidelines very quickly is, so again, sort of medical jargon are like Glasgow Coma Scale. So it's like something that any doctor who's involved in head trauma will do, and if we're diagnosing someone with concussion, we'd very quickly arrive at their Glascow Coma Scale numbers are normal. I'm not worried about skull fracture, bleeds into the head, cervical spine injury, et cetera.

0:22:26

As a doctor, I don't think the altered level of consciousness is that subtle but I would still say for a lay person, that can be hard. But, bottom-line, it's things like "Johnny doesn't just not remember things. He's having trouble answering me. His speech is slurred." I think sometimes, not always, vomiting post head injury can be very concerning. Now, some of it has to do with the dizziness and let's say you're driving away from that football field and he got motion sickness. But vomiting post head injury, especially it doesn't resolve except for that one episode, that's very concerning to me too and I think a parent should pay attention to it.

You know, sometimes, I have parent come in and say sure, I look at my child's pupils. I wouldn't recommend doing that directly, but there's a side of a blown pupil which usually isn't subtle. avid Bowie, rest in peace, but if you look at close up of his photos, he's got the classic blown pupils. One of his pupils is enormous compared to the other one. He did have a distant head injury as a young guy. But my whole point to that is if your child's pupil's blow at one side compared to the other and that's like distinctly different than you'd ever seen…

Dr. Mike Patrick: It's probably not going to be their only symptoms.

[Laughter]

Dr. Jim MacDonald: Precisely, actually. That's exactly right. That person would absolutely also have altered level of consciousness. It would not be the only symptoms. You're exactly right. But those are some of the things that occurred to me. I don't know if Steve here…

Dr. Steve Cuff: The only thing I'd add is a rapidly worsening headache in the short term. Otherwise, I agree. Maybe you give kid one episode of vomiting, but if they're continually vomiting, their speech is slurred, they really are uncoordinated and they're stumbling when they're walking, I think those are the big concerns to me. I think you do need to watch him for a short period. I think a couple of hours is usually adequate.

We've gotten away from, again, waking kids up during the night after a concussion. Because where we talk about, it's an energy crisis in the brain so they really need that sleep. So you don't want to be waking them up every hour to check on them. But I think you do want to keep an eye on them for the first couple of hours after the injury and make sure that they're not deteriorating rapidly. After that, you can be pretty assured that they're going to be OK.

0:24:33

Dr. Mike Patrick: I would just add neck pain into the conversation. That doesn't go along with the concussion but if there's enough energy to cause a concussion, you do still worry about their cervical spine. So, probably ought to at least be seen by an athletic trainer and maybe a physician if they have persistent neck pain with it.

Dr. Steve Cuff: That's a great point. We want to focus on the brain unless a major neck injury. So I'm glad you brought that up.

Dr. Eric Bowman: Absolutely. And Mike, you brought up the use of an athletic trainer. One of the topics we did here recently was the sports medicine team, right? That was one of our previous PediaCast. And I think it's just really important to understand that, as physicians, we're there and a lot of times there's physicians on the sidelines of events and things like that. But, to be honest, athletic trainers are usually our frontline. They're the ones who were there who have the skills and the training and the ability to recognize a lot of these things.

So if your young person has an athletic trainer at their high school, it's really really important to take advantage of that person and utilize them. So, that's one of the things we definitely want to throw out there as well.

Dr. Jim MacDonald: For sure.

Dr. Eric Bowman: So, I mean, we're talking about all these concussions and all these injuries, and one of the questions I get asked in the clinic a lot — I'm just curious is you guys do as well and whether or not you have a number on this — but, I have people go, "How many concussions are too many? What is that magic number? Or is there one?" What do you guys have to say about that?

Dr. Steve Cuff: It's interesting. There's a myth out there, especially within the Ohio high school realm, that Ohio high school has a rule that you have three concussions and you're done. They have parents and kids come in all the time and ask about that.

0:26:02

First of all, it's not true. I don't think there is a magic number for most of us. I think we look at a lot of different things. Personally, the three main things I look at are the injuries happening more closely together? So maybe you had one in seventh grade. Then you have one in tenth grade, and you have one six months later. If they're starting to get close together, it makes me think a little bit.

Are the symptoms getting worse or lasting longer each time? And then, finally, is it taking less trauma to cause the injury? So, when you get the kids who's had a few concussions and they're not paying attention, they walk into a the door jam and they give themselves a concussion. For that, to me, that's more concerning.

So factor all those things in as well as the type of sports they play and maybe have a conversation at that point about taking either a prolonged period off or switching sports, something that may be less of a risk.

Dr. Eric Bowman: The Concussion movie starring Will Smith and Alec Baldwin and some other actors came out looking at concussions in general. There had been things that had come up in the media since that time. In particular, Dr. Bennet Omalu, the doctor who was played by Will Smith, he wrote an editorial in The New York Times advocating the end of youth football under age 18. Period. That it needs to just be done.

But then, again, to his counterpoint, Dr. Julian Bailes who is played by Alec Baldwin in a movie has also been on national radio talk shows like ESPN's Mike & Mike and that sort of stuff basically saying, "Hold on here. Maybe we shouldn't quite go that far yet."

I guess the big thing is this raises a really interesting question. We have young athletes who are potentially at risk for concussions. Obviously, we've talked about what a concussion is here and some of the things we need to look for. What are your, guys, thoughts on these opinions? Where does this overall kind of sit? Where do we sit with youth sports and concussions and Dr. Omalu versus Dr. Bailes and that sort of thing? I know a vague big question there but…

[Laughter]

0:28:07

Dr. Jim MacDonald: A couple of things — one is, so Will Smith is Bennet Omalu. It's the story of his discovery for lack of better phrase. It's a little more subtle than that, but this discovery of chronic traumatic encephalopathy in Mike Webster fame as Pittsburgh Steelers center, his chronic traumatic encephalopathy, CTE. It's neurodegenerative disease. One thing to be quite clear about it is the science on that is still very unclear. There are associations between head injuries and specifically NFL football players and the development of this entity that is not causation yet. It's right now, I want to emphasize no different in saying, I've got tall people on the basketball court playing NBA. Wow, playing basketball must cause people to be tall." No, there's an association, not cause-effect relationship.

That said, there is I think reasonable concern and this come from even animal studies, as well as epidemiologic studies, that repetitive blows to the head may be associated with the development of CTE. So, that's not even concussions. Let's be clear about this. We're talking about hits to the head that may not even be concussions may — and I want to emphasize — may in a long term cause CTE.

I think what I walked away from the movie with this is that at the end of the day, my opinion would be with the Dr. Bailes, that it is way too soon to say this is the end of youth football. I would say that it is time to apply called the precautionary principle in public health, that is there is a suspicion that repetitive head blows might cause this concerning long term illness. Let's do something about it. Let's make youth football safer.

So I do applaud efforts to reduce head impacts and exposure to head impacts that is blossoming in the research world, and they range from things like helmetless tackling drills which we can talk about this time to emphasizing flag football while young kids are learning fundamentals of football, et cetera. But in no way, would I say yes to the idea of shutting down youth football at this stage.

0:30:25

I think what needs to be put in the balance is all the benefits of youth football. How many millions of kids in this country stay physically active, learn important life skills, learn discipline, that absolutely needs to be put in the balance between this very, very potential causation between head injury and CTE.

So anyway, anyway, that's my long-winded answer.

Dr. Steve Cuff: Yeah, I would agree with what Jim said, and just add on to that, it makes a really juicy story in the media that makes this correlation between what's now America's most popular sport and the problems that some of these athletes are having later on. But the only thing that I try to put in perspective for my parents is we don't have any evidence that there is any long-term problem from kids playing football and having concussions. Jim mentioned a couple of studies of maybe there's a little bit of change in function and some computerized testing. But as far as development of CTE for kids who play football and concussions, no evidence of that yet to my knowledge.

Now, could that change in five or ten years? Possibly, we probably need to start following a cohort of kids into adulthood and see what happens.

But, I totally agree, Jim, it's not causation, there may be a correlate there, but the only thing we have to think about — even if we can prove CTE was caused by playing football, you have to think that we treat concussions much differently now than we did even five, ten years ago in professional athletes. It's only recently that you see an athlete actually pulled out after they had a concussion and having to be tested and be symptom-free before they go back. A lot of these guys that had the CTE, they played through concussions. They probably played through entire seasons with concussions. They might have had 10, 20 concussions in their career.

0:32:13

So to make that jump from these professional athletes who were treated much differently to how we're treating concussions today, especially in kids I think is a big jump. I think it's a little bit of an overreaction to say "Hey, no kids should play football until they're 18 now." Obviously, every family's going to have their own threshold for what they're willing to risk. I think it becomes that family discussion that earlier Jim mentioned before. How many concussions are too many? The same thing, there are going to be families who never want their child to play football or play hockey or do a contact sport like that. And there are others that are going to be willing to take that risk because of the benefits of team sports and things like that.

I think we need to try to inform them the best we can and let them make an informed decision.

Dr. Eric Bowman: I think it's a great way to put it. It is. It's important to understand, you look at the statistics, at the number of youth and even high school football players we have out there who are going to make it to the NFL, it's such a small, small number.

Dr. Jim MacDonald: Exactly. Isn't it like there are 3.5 million youth football players and 2,000 players in the United States?

Dr. Eric Bowman: Right. Right.

Dr. Jim MacDonald: Infinitesimal, the number that are going to go play this year after year for a career.

Dr. Eric Bowman: Exactly, exactly. So again, I agree with you guys completely. That correlation of, you know what, maybe if you're taking close to a hundred thousand hits in your lifetime by going out and playing a career in the NFL, that's one thing. As opposed to the son who's going to be playing just high school football and once that senior night's over, they're done and they're not playing anymore. So I think it's important to understand that, and that there's a big difference there.

Well, thanks guys. I really appreciate that. I know it's a really interesting and hot topics for a lot for a lot of people, so having that correlation is really good.

I guess, as a final question to summarize, I think I know your answer just based off what I heard here, but essentially, what I think I'm hearing you say is that, sports are safe. Our kids are OK to play sports and to play contact sports and that a lot of times even as you alluded to, Jim, that the benefits will oftentimes outweigh the risk. Is that essentially what you're saying here?

0:34:16

Dr. Jim MacDonald: Yeah, and I guess sort of follow up on two things. One is, I think we can make them safer. I think specifically contact sports can be made safer. And, if it's done with science and not hype and advocacy based in science. Is it really crook aside, for instance? There had been concerns about heading soccer balls, right?

Dawn Comstock's done some great work on "Hey, you want to reduce concussions in soccer, it's not about heading. It's about contact, person to person." In other words, if you want to make soccer safer in terms of reducing concussions, it doesn't look like the heading is the issue. So if someone would do in good conscience, say, "Hey, we got to ban heading in soccer. It's going to make it safer." Not necessarily so.

So these things need to be researched. The big thing in football is, will it be safer in football if we teach kids to tackle at age 14, wait to some number like that or wait to some skeletal development? It's unclear. I mean, there's some real concern based on some research and other sports is you delay that, now you're going to increase injury rates because kids will not know how to do that fundamental task, which they should learn when their bodies are lighter. Don't hit the ground so hard. Don't hit each other, at like age eight.

So all these things need to be based in science. But I think we can make football safer, but absolutely, I think the benefits including your physical activity in sports outweigh the dangers.

I think the public health crisis over time is not youth football. It's childhood obesity. It's childhood inactivity. Keeping kids active in sports that they want to engage in and that you as a parent feel good with, big thumbs up to.

[Music]

0:36:27

Dr. Mike Patrick: Dr. Daniel Taylor is a pediatrician at St. Christopher's Hospital for children and an associate professor of Pediatrics at Drexel University College of Medicine, both in Philadelphia. He created CAP4Kids as a comprehensive online directory of community resources for parents and anyone else who takes care of children and teenagers in the Philadelphia area.

We'll get into the specifics of CAP4Kids in a moment, including how it works and why you should care even if
you aren't in the Philadelphia area. But first, let's welcome Dr. Taylor to the program who joins us by phone. Thanks for taking time to talk with us today.

Dr. Daniel Taylor: Thank you so much, Mike.

Dr. Mike Patrick: Really appreciate it.

Dr. Daniel Taylor: You're welcome. It's my pleasure.

Dr. Mike Patrick: Yeah, absolutely. We also have a couple of guests in the studio. Dr. Emily Decker is medical director of the Columbus Ohio CAP4Kids site. She's a pediatrician at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University College of Medicine.

A warm welcome to you, Dr. Decker. Thanks for stopping by.

Dr. Emily Decker: Thank you.

Dr. Mike Patrick: Really appreciate it. And we have Leslie Hill-Ali in the studio. She is a social worker at Nationwide Children's. She's on the front lines, sometimes down the trenches, bridging the gap between families and the community resources they need but didn't necessarily know were there. Leslie manages the Columbus CAP4Kids directory keeping it up to date with useful resources, answering questions and linking resources to those in need. We really appreciate you joining us as well, Leslie.

Leslie Hill-Ali: Thank you for having me. I appreciate it.

Dr. Mike Patrick: Yeah, thanks.

So let's start with you, Dr. Taylor. What exactly is CAP4Kids in a nutshell?

Dr. Daniel Taylor: You synopsized it pretty good when you were talking to Leslie. CAP4Kids is an online resource that lists existing community-based organization, as well as parental information to help families be the best parents they can be. But mostly, it's an online website that anybody can access who has Internet via mobile device or on their desktop, iPad, whatever they have to find resources to meet their needs.

0:38:35

There are over 21 different what we call Parent Handouts on pretty much the topics that most parents and families and children would use if they knew they existed. It's broken down both in topics as well as many subsections under each topic. That's, in a nutshell, what CAP4Kids is.

Dr. Mike Patrick: And the CAP of CAP4Kids stands for the Children's Advocacy Project, correct?

Dr. Daniel Taylor: Correct.

Dr. Mike Patrick: OK, Children's Advocacy Project. So how did this program get started?

Dr. Daniel Taylor: So, I graduated residency a long time ago, back in 2001starting at St. Christopher's Hospital where I am today, 14 years ago. So I started working with the children that I work with, which is mostly lower income population in Philadelphia. I realized that the tools that I were taught in medical school weren't nearly enough for me to help with many of the social determinants of health that our families and children were facing.

So I reached out to my colleagues, some of the physicians I work with who are more experienced than I to try and find resources such as after-school programs for kids or resources for kids with incarcerated parents, any resources like that. Back then, the colleagues I was asking, they would go to their Rolodex.

[Laughter]

Dr. Daniel Taylor: I don't know if all your listeners even know what the Rolodex is anymore. But they went to a Rolodex and look up some information that they thought still existed and possible contacts that they thought existed. I would either call if I had the time or give the phone number to the parent. We didn't have a social worker at the satellite office that I was initially working at.

0:40:33

So, this is, unfortunately, all I could offer many many of our families and most of them had pretty significant social determinants of health. I thought this is not good enough. So, I looked all around Philadelphia to try and find resources, one place, one-stop shopping where I could find those resources for my families and there wasn't anything that existed.

Dr. Mike Patrick: Yeah, kind of like a Yellow Pages of social resources. Although, I guess there are probably listeners out there who don't remember what the Yellow Pages are either.

[Laughter]

Dr. Mike Patrick: But it is great having all of these resources in one place, and I know when you're a primary care pediatrician in particular, there's just so many needs that your families have. Not being a social worker, it can be tough to figure out what resource would meet a particular need in a specific situation. And so, just being able to tap in to all of the different resources in a community in an up-to-date list just must be a remarkable thing.

Dr. Daniel Taylor: Yes, it has really transformed the way I practice medicine. It transformed the way many pediatricians in the cities that have CAP4Kids practice. All of us — and this is to Leslie, who's a social worker at Columbus, Nationwide Children's — all of us would love to have a social worker side by side with us with every single visit. But in reality, many social workers including ours are working more in crisis situations, situations where the family is having crisis that day or have had significant trauma or significant behavioral issues, and they work with those kids.

0:42:15

But, like Emily Decker and I work with, we work with lots of families where we kind of know if there's not some intervention in their life now, that the likelihood of them having a healthier outcomes, more safe outcomes, more happiness later on, is diminished. So what we try to do is ensure that we know all the resources in the community and help families and children and then be able to ask those tough questions of parents to identify a need, and then be able to link them up with that resource once we do identify the need.

Dr. Mike Patrick: Now, you're in Philadelphia and we're here in Columbus and both of these cities have CAP4Kids sites. And we'll talk more about how parents and other caregivers and pediatric providers can find the CAP4Kids resource, but what other cities currently have a CAP4Kids?

Dr. Daniel Taylor: Initially, it started down in Philadelphia. We worked very closely with our parent university, Drexler University, College of Medicine and Drexel University College of Media Arts and Design. There are global Web developers. We initially went to them, talked about what we envision for the website. It's gone through five versions now, and Columbus has the most up-to-date version and they're testing out for us right now. Emily would probably talk about that in a little bit.

Once we started using it, once we — pediatricians, social workers, parents, teens– started using it in Philadelphia, we realized that many other cities where we had colleagues, where we had family members, they didn't have anything like this as well. It wasn't unique to Philadelphia.

So we thought that we would make CAP4Kids as a template for other cities to start CAP4Kids website very easily. All the work was done on the backend from a computer coding standpoint. They would just have to input their local content to it. So we made it on the second version to be a template so other cities could very easily start a CAP4Kids website there.

0:44:24

Dr. Mike Patrick: Good. And what are some of those cities where you have sites?

Dr. Daniel Taylor: So some of the cities — right now, we're in 13 different locations around the US — we're in Hawaii, we're in Saint Louis. We're in Rockford, Maryland. We're in Pittsburgh, Pennsylvania, Wilmington, Delaware. Penn State has a website with that whole area in the center of Pennsylvania. We have a website in Kansas City, New York City and Miami, as well as Columbus and Philadelphia where I'm on the phone today.

Dr. Mike Patrick: Great. So what are some of the resources? Dr. Decker, as medical director of the Columbus CAP4Kids site, what are some of the resources that are available for parents, caregivers and providers?

Dr. Emily Decker: Sure. We have a wide range of resources that are arranged around 21 categories of need that Dr. Taylor talked about. So for example, we have education resources, everything from after school programs and summer camps to programs for kids with special needs and early intervention programs. We have safety resources — everything from toy safety and Internet safety to resources to help prevent child abuse and domestic violence.
And then, there's also concrete resources, which are actually the most utilized resources on our websites. So things like food, shelter, housing, those really necessary resources that people are looking for especially in today's economy.

Then, of course, healthcare resources, low-cost healthcare, dental services, pregnancy services.

So just on the Columbus site, we have over 2,000 resources that are in the community. When we started this website, really our primary goal was to improve the overall wellness of families in the community.

0:46:16

Dr. Taylor mentioned that, the social determinants of health because we know that economic conditions and social conditions can affect people's health. Things like lack of adequate food, lack of access to housing, poor housing conditions, those can all cause chronic stress and then in turn cause negative health outcomes. So we really wanted to help people with that. For example, if I have a patient that comes into the office with asthma but they're exposed to smoke at home, they live in a poor housing condition or don't have stable housing, their asthma may be much worse than the average patient. And it's difficult to treat if we don't address those other things that are impacting their life.

So when an asthma patient comes to the office and their parents are smokers, we try to connect them with Quit Smoking resources for example or give them resources to improve their home conditions, because that's going to impact their asthma on a much bigger scale.

And then, the website also has a whole section on laws and definitions. We realize that in the office, patients really struggle to navigate this healthcare system which is very complex. They may have a language barrier. They may not understand medical terminology, but sometimes it's just hoops that these patients have to jump through to get services. So we put on the website a list of definitions for patients, like what is an IEP? What is SSI? How did they access these services?

There are also sample letters that parents and patients can print out to request an evaluation at school, things like that.

Dr. Mike Patrick: So, really, it helps with health literacy, too. In particular, as providers, there are things that we just take for granted or that we automatically know what this means, but there are lot of families who need more information or like you said, “What is an IEP?"

0:48:15

[Laughter]

Dr. Emily Decker: Right. Exactly.

Dr. Mike Patrick: Yeah, absolutely. Leslie, as a social worker, what are some of the biggest resources, the most helpful ones that are on the CAP4Kids site that parents may not think about but they're really important and helpful?

Leslie Hill-Ali: I think that, in my capacity as a social work resource coordinator, with the Social Work Department and with CAP4Kids, a lot of the resources that families look for would be after school care, child care resources, early intervention services. A big question comes in where we have a need for special needs or autism, and the category on the Columbus site is really big for special needs on autism, from advocacy to technology, to respite for families, caregivers, and the child.

We have Healthy Lifestyle to help with healthy nutrition and weight — part of the President and his wife's initiative for healthy weight for children. We have teen resources for safe dating, places where teens can go for resources on health, on education, drop-out prevention services, safety resources. We have pregnancy and new baby resources where new mom, whether they're teen moms or otherwise, they can go and find help with diaper resources, place to go for at-home care.

The unique thing about the CAP4Kids website is that if you have a family that's in front of you and they present you with a question or a need or an incident, it may not just be that particular problem that they're dealing with. But you direct them to the website and is there for them to be self-sufficient.

0:50:10

So they didn't want to tell you about maybe a domestic violence issue. They just want the ask where the food pantries were. But they can get on CAP4Kids to find the food pantries but also see that there are resources and help available for domestic violence. Or they may need legal aid.

Or they may need help with immigration and resources. We do have a large section on that immigration and resources, refugee services, which ties in to the website being able, with one click, you can translate to any language. Not any language but several of them.

Dr. Mike Patrick: Lots of them.

Leslie Hill-Ali: Yes. And the whole page on the website will translate into language selected. It can be printed off that way, hand it to families, and it helps with the language barrier. Here in Columbus, there is melting pot of ethnicities and cultures and languages. The language barrier keeps a lot of people from even asking because they don't know how to ask. Excuse me, keeps a lot of people from helping from helping because they don't know how to help. So if you're able to at least address the language, then you can further help people and direct them to where they can go, among other things.

Dr. Mike Patrick: Yeah . As I was exploring the site to prepare for this podcast, I was just amazed at the number of resources. Even help with housing and paying utilities and other bills. Just as you explore the site, there's just so much that you can discover. I like what you were saying, Leslie, that they may go there for one thing but then as they're exploring, find out other resources that they need.

Dr. Decker, when you're seeing patients who have these kind of need, or even there's not necessarily a need that identified in an exam room, do you let folks know about this resource and encourage them to explore it?

Dr. Emily Decker: Absolutely. We all do as pediatricians because like Leslie said, somebody may not ask you for a need they have. Statistically, we know that families have a lot of needs. They don't always say that they have those needs in the office. So we think it's really important to give them those tools and resources to empower them.

0:52:21

That being said, also, the website, it's really important for us to look at the resources and evaluate them critically and decide what's a good resource and what's not because parents may have a really hard time in the community choosing valuable resources. There's a lot of resources out there, but it was really important for us to find trusted resources, reliable resources.

Dr. Mike Patrick: Yeah, absolutely. So obviously, this is going to b something that's helpful for families and parents and also for providers in terms of pointing them in the right direction.

Leslie, what about community and service leaders? Who should know about this resource and share it with folks?

Leslie Hill-Ali: I think that anybody who is part of community can benefit from the resources on CAP4Kids. And when I say that, we do lot of outreach outside of the healthcare community. We go to schools and we present CAP4Kids and we demonstrate on how to use the website and we make printed material available to schools.

We meet with the principals, counselors, school nurses. We meet with mental health agencies around town, parks and rec, anyone that we can think of that may have some type of contact with children and with families and caregivers, which is everybody. That's who can benefit from it, to work as a community to help those and help folks be more self-sufficient.

0:54:03

Dr. Mike Patrick: And faith-based organizations as well.

Leslie Hill-Ali: Absolutely.

Dr. Mike Patrick: And then, when you're trying to get the word out about this, I think that one way to do that is just through parents' word of mouth as well. So if you're listening to this right now, you may not have a specific need that comes to mind where a CAP4Kids resource is there. But you probably do come into contact with teachers and with folks at your church or in a community organization, and of course, your pediatric providers as well and your providers.

So folks who see other people who might have those needs, so if you help to raise awareness and let those people know that Hey, this is a resource that's available, then just even as a listener to this program, you can be an advocate and help spread the word.

Leslie Hill-Ali: Absolutely. I have a friend who works in HR at one of major corporation here, and she uses CAP4Kids as a resource to help mentor and direct some of her employees on different issues they come to her with.

Dr. Mike Patrick: So hundreds of resources, how do you guys keep this all up to date because if you're asking someone to trust what's available at CAP4Kids, you want to make sure that it's the right phone number, the right contact information, the right person. With hundreds of resources, this must be a pretty big job keeping everything in line.

Dr. Emily Decker: Yeah, that's a good question. It's a tall task. We literally update the website every day. Sometimes, many times a day. But we also have at our fingertips a big network of social workers and pediatricians and the organizations are very good about contacting us and letting us know when things change.

We also do a systematic review of the entire website every few months, so we get on the phone, call all of these organizations, verify the information, check the website links. We take it seriously because it's very important to parents to have up-to-date information. And that was really the whole goal of the website, to keep this as up to date as possible. Sometimes, we can have a thousand people going on to the website a day, just for one city. So we want that information to be accurate.

0:56:19

Dr. Mike Patrick: We've talked about there being 13 cities that have CAP4Kids, there are going to be a lot of listeners who live in a city where CAP4Kids is not available. How could folks in other places use this resource to help connect themselves with resources in their own community? Any ideas there?

Leslie Hill-Ali: As far as the Columbus site, we focus on Central Ohio in the Columbus area. However, there are counties outside of Columbus that we may have resources listed for. We have state-wide resources that may be pertinent to patients and those in the community and national resources list that can help folks, that can connect them to those resources that may bring them down to a state level, to a city level, but they can still access those resources and get the services that they need.

Dr. Mike Patrick: I should mention all of these can be accessed at CAP4Kids.org. And that's the number 4 so C-A-P-4, the number 4 Kids — CAP4Kids.org.

Dr. Dan, what if someone is in a city that does not have CAP for kids but they're interested in getting that organized, how would they go about doing that?

Dr. Daniel Taylor: That's my dream, and Emily and Leslie are in on this dream, is that CAP4Kids does disseminate to all the communities nationally who doesn't have a resource like this. So if a community, let's say Los Angeles who doesn't have a CAP4Kids website is interested in it, they can just directly email me and my information is on the website. My email have a CAP4Kids manual that goes about the process of how to start a CAP4Kids website in their community. They would contact me. I would send them the manual. They will look over the manual and we would go from there.

0:58:13

We've really tried to ensure that CAP4Kids websites are managed by pediatric hospitals, usually academic hospitals because CAP4Kids is set up specifically for academic pediatricians to kind of be the leaders of CAP4Kids working with their social workers, working with the other pediatricians and their trainees to then disseminate it to the entire community. So, if it was just one individual who wants to start it, who isn't a pediatrician or isn't at an academic institution, it's not the same mission that we all have as a general pediatricians working in the community. So to ensure that we kind of stick to the mission of linking families in need with the social service agency that serve them, we try and keep it within the pediatric community, managed by the pediatric community but then used by our entire location.

Dr. Mike Patrick: Absolutely. You just may hopefully find a partner at a pediatric academic institution who maybe someone in the community who's interested in getting it started, it's just a matter of finding the right fit. But if they contacted you, you may be able to help them find the fit at a particular academic center in a particular city.

Dr. Daniel Taylor: Exactly.

Dr. Mike Patrick: Great. Well, we really appreciate the three of you stopping by and talking about CAP4Kids. We will have links in the Show Notes, so folks go to PediaCast.org and look for the Show Notes for Episode 338. That's this episode. We'll have links to the main CAP4Kids landing site and then also the Columbus site. Although from the main site, you can get to any of the 13 regions that are included in CAP4Kids.

So, Dr. Dan and Leslie and Dr. Emily Decker, thanks all of you for stopping by. Really appreciate.

Dr. Emily Decker: Thank you, Dr. Mike.

Leslie Hill-Ali: Yeah, thank you so much.

Dr. Daniel Taylor: Thank you.

1:00:14

[Music]

Dr. Mike Patrick: The US Centers for Disease Control and Prevention has issued a travel alert for people traveling to regions in certain countries where Zika virus transmission is ongoing. The alerts are in place for Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

This alert follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy.

Until more is known, and out of an abundance of caution, the CDC recommends special precautions for pregnant women and women trying to become pregnant. Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who must travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.

Likewise, women trying to become pregnant should also consult with their healthcare providers before traveling to these areas and also strictly follow steps to prevent mosquito bites while away.

1:02:05

Because specific areas where Zika virus transmission is ongoing are difficult to determine and likely to change over time, the CDC will update this travel notice as information becomes available. You can check the CDC travel website frequently for the most up-to-date recommendations.

I'll include a link to the CDC travel website in the Show Notes for this episode, 338, over at PediaCast.org so you can find it easily.

Currently, there is no vaccine to prevent or medication to treat Zika. Four in five adults and children who acquire Zika infection may have no symptoms at all. The problem here is for unborn babies. Illness from Zika is usually mild and does not require hospitalization, but travelers are strongly urged to protect themselves by preventing mosquito bites, and again especially for pregnant women or women trying to get pregnant.

The CDC says you can protect yourself from mosquito bites by wearing long-sleeved shirts and long pants, using EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus or IR3535. They add to always use these products as directed on the label.

Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant and nursing women and children older than two months of age when used according to the product label. Oil of lemon eucalyptus products should not be used on children under three years of age.

Also, use permethrin-treated clothing and gear such as boots, pants, socks, and tents. Stay and sleep in screened-in or air-conditioned rooms.

In addition to these recommendations, the CDC is working with public health experts across the US Department of Health and Human Services to take additional steps related to Zika virus, including the development of interim guidance for pregnant women, as well as sharing additional information about Zika with public health officials, clinicians and the public at large. In addition, efforts are underway across US Department of Health and Human Services to develop vaccines, improved diagnostics and other countermeasures for Zika.

Some background on the Zika virus and the current outbreak — CDC scientists tested samples provided by Brazilian health authorities from two pregnancies that ended in miscarriage and from two full-term infants who were diagnosed with microcephaly and who died shortly after birth. For the two full-term infants, tests showed that Zika virus was present in their brains. Genetic sequence analysis showed that the virus in the four cases was the same as the Zika virus strain currently circulating in Brazil. All four mothers reported having experienced a fever and rash, which are symptoms consistent with Zika virus disease during their pregnancies.

1:04:48

Locally acquired Zika was first reported in Brazil in May 2015, and the virus has since been reported in 14 countries and territories in Latin America and the Caribbean including again — in case you missed it during the beginning of this story — Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

According to Brazilian health authorities, more than 3,500 new cases of microcephaly in newborns were reported in Brazil between October 2015 and January 2016. So that's 3,500 cases in the last three to four months.
Microcephaly is a birth defect characterized by a small head and underdeveloped brain. Some of the affected infants have had a severe type of microcephaly and some have died. The full spectrum of outcomes that might be associated with infection during pregnancy and the factors that might increase risk to the fetus are not yet fully understood. Health authorities in Brazil, with assistance from the Pan American Health Organization, CDC, and other agencies, have been investigating the possible association between Zika virus infection and microcephaly in infants.

However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy.

1:06:14

In the past, outbreaks of Zika virus infection have occurred in Africa, Southeast Asia, and the Pacific Islands. Zika virus is transmitted to people primarily through the bite of an infected mosquito. While four out of five of those infected with Zika virus will not have symptoms, one in five will show signs of illness including fever, rash, joint pain, and conjunctivitis or pink eye. Other commonly reported symptoms include myalgia or sore muscles, headache, and pain behind the eyes.

The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low, again in children and adults. It is dangerous for the unborn or so we think.

Guillain-Barre syndrome has been reported in some patients with probable Zika virus infection in French Polynesia and Brazil. Guillain-Barre is a neurological, kind of autoimmune disease. After you get a viral infection, your immune system starts to attack some nerves. So research efforts will also examine the link between Zika and Guillain-Barre syndrome.

So if this is the first that you've heard of the Zika virus, stay tuned. You're going to hear a lot more as the coming weeks and months unfold and the virus continues to spread. As you hopefully gathered from the story, again, Zika virus isn't much of a concern to children and adults once you're born. The worry here is developing babies inside mom. In that respect, this is similar to rubella, which is another viral disease and one that we protect against with the MMR vaccine, measles, mumps and rubella.

The rubella component of the MMR isn't necessarily to protect children and adults, because rubella's not really all that dangerous after you've been born. It's really given to eliminate rubella from the community at large so that pregnant women don't get it and they give it to their developing fetus. Because, like what appears to be the case with the Zika virus, rubella has the potential to cause severe disease including deadly and life-altering birth defects in the unborn.

1:08:20

So definitely more on Zika virus to come . In the meantime, be sure to heed the CDC travel warning. I'll put links in the Show Notes for this episode, 338, over at PediaCast.org again to the CDC travel advisory page.

The CDC also has a general Zika virus information site, which includes more in the current outbreak along with great information for parents, parents-to-be and providers on such things as Zika virus transmission, symptoms, prevention, current geographic distribution, fact sheets and posters and more details on what's known about Zika virus and pregnancy. Again, those links will be in the Show Notes for you — Episode 338 — over at PediaCast.org.

[Music]

Dr. Mike Patrick: All right, we are back with just enough time to say thanks to all of you for taking time out of your day to make PediaCast a part of it. Really do appreciate that.

Also, thanks to our many guest at this episode — Dr. Eric Bowman, Dr. Jim MacDonald and Dr. Steve Cuff from the Nationwide Children's Sports Medicine team. Appreciate them stopping by to talk about concussions. And the crew from CAP4Kids — Dr. Dan Taylor, Dr. Emily Decker and Leslie Hill-Ali — also appreciate them sharing their expertise with us and their resources.

PediaCast is a production of Nationwide Children's Hospital.

1:10:04

Don't forget, you can find us in all sorts of places. We're in iTunes, your favorite podcasting apps, iHeart Radio, and of course, the landing site, PediaCast.org where you'll find hundreds of past episodes, Show Notes, transcripts, our terms of use and a handy contact page to ask questions and suggest show topics.

We're also on social media including Facebook, Twitter, Google+ and Pinterest with lots of great content you can share with your own online audience.

Make sure you let your pediatric providers know about our podcast for them, PediaCast CME — stands for Continuing Medical Education. Similar to this program, we turn up the science a couple of notches and provide free Category 1 CME credit for listening. Shows and details are available at PediaCastCME.org.

Thanks again for stopping by, and until next time this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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One thought on “Concussion, CAP4Kids, Zika Virus – PediaCast 338”

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