Early Childhood Concussion: What Parents Need to Know – PediaCast 607
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Show Notes
Description
Dr Sean Rose and Miriam Beauchamp visit the studio as we consider concussions in young children. We explore the challenges of making this diagnosis in babies, toddlers, and preschoolers. What do symptoms look like? And how can families play a key role in recovery? Tune in for answers to these questions and more!
Topic
Early Childhood Concussion
Guests
Dr Sean Rose
Pediatric Neurology
Nationwide Children’s Hospital
Miriam Beauchamp
Professor of Psychology
University Of Montreal
Links
Neurology at Nationwide Children’s Hospital
Concussions in Early Childhood (University of Montreal)
Early Childhood Concussion: State-of-the-Art Review (Pediatrics)
Frequency and Predictors of Persisting Symptoms 1 Year After Early Childhood Concussion (Pediatrics)
Episode Transcript
[Dr Mike Patrick]
This episode of PediaCast is brought to you by Pediatric Neurology at Nationwide Children’s Hospital.
[MUSIC]
[Dr Mike Patrick]
Hello, everyone, and welcome to another episode of PediaCast. We are a pediatric podcast for moms and dads.
This is Dr. Mike coming to you from the campus of Nationwide Children’s Hospital. We’re in Columbus, Ohio. It’s episode 607.
We’re calling this one early childhood concussion. What parents need to know. I want to welcome all of you to the program.
We are so happy to have you with us. You know, concussions are not just a concern for athletes and older kids. They can happen in infants, toddlers, and preschoolers as well.
But recognizing and managing concussions in these very young children is not always straightforward. So, in this episode, we will explore the unique challenges of diagnosing early childhood concussion, what symptoms look like in little ones, how families can play a key role in recovery, and what we know and still don’t know about long-term impacts for these kids. Of course, in our usual PediaCast fashion, we have a couple of terrific guests joining us in the studio to discuss the topic.
Dr. Sean Rose is a pediatric neurologist at Nationwide Children’s Hospital, and Dr. Miriam Beauchamp is a professor of psychology at the University of Montreal. Before we get to them, I do want to remind you the information presented in every episode of our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.
If you’re concerned about your child’s health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org. So, let’s take a quick break.
We’ll get Dr. Sean Rose and Dr. Miriam Beauchamp settled into the studio, and then we will be back to talk about early childhood concussions. It’s coming up right after this.
[MUSIC]
[Dr Mike Patrick]
Dr. Sean Rose is an associate professor of pediatrics at the Ohio State University College of Medicine and a pediatric neurologist and co-director of the Complex Concussion Clinic at Nationwide Children’s Hospital. He is also trained in sports neurology, which is very great for the conversation we’re going to have today. Dr. Miriam Beauchamp is a professor of psychology and a neuropsychologist at the University of Montreal, and she is the Canada Research Chair in Pediatric Traumatic Brain Injury at St. Justine Hospital Research Center. Together, Sean and Miriam are advancing our understanding of brain injury in the youngest and often most overlooked patients.
That’s what they’re here to talk about, early childhood concussion. Before we dive in, let’s offer a warm PediaCast welcome to our guests, Dr. Sean Rose and Dr. Miriam Beauchamp. Thank you both for stopping by the studio today.
[Dr Sean Rose]
Thanks so much for having us. I’m really excited to talk about this topic of concussion in young kids.
[Dr Miriam Beauchamp]
Yes. Thank you for the invitation. It’s great to be here. And I think we have a nice discussion ahead.
[Dr Mike Patrick]
Yeah, I do, too. Sean, why don’t we start with just sort of the basics? Why is it that diagnosing concussion in young children is so challenging?
You know, we see concussions a lot and we hear about them in older kids, especially as they play sports. But we also know that young children hit their heads a lot. And so, you know, what is what is it about concussions in these young ones that make it so challenging to diagnose?
[Dr Sean Rose]
I think the most difficult thing is that young kids have more difficulty reporting their symptoms. We rely so heavily on how a patient reports feeling to diagnose a concussion. You know, it is a clinical diagnosis.
And in young childhood, you know, it’s hard for them to say, you know, I feel dizzy or I have trouble concentrating or I’m confused. Things like that. You know, in older kids, we use symptom checklists.
You know, there’s a list of common symptoms of concussion. And those most commonly used checklists are just not really very applicable to young kids.
[Dr Mike Patrick]
Yeah.
[Dr Sean Rose]
We also have guidelines in older kids and guidelines on how to diagnose, how to remove from play, how to manage acutely and then get back into activities in older kids. But those guidelines usually don’t apply very well to young kids.
[Dr Mike Patrick]
Yeah. Yeah. I would imagine, too, that physicians have a little bit of a difficulty actually calling it a concussion, even though it is.
We may just, you know, for example, on a diagnosis in an urgent care or an emergency room, just say, oh, they had a head injury. Then that also makes it more difficult to do research down the road because, you know, we’re not appropriately labeling kids. Do you advocate for actually calling a concussion a concussion in these young ones if that’s what we think is going on?
[Dr Sean Rose]
Yeah, absolutely. I think it’s important to get the right terminology, the right diagnosis. We did a study looking at thousands and thousands of kids presenting to ERs across the United States.
And we found that most of these kids under age six are leaving the ER with a diagnosis of unspecified injury of head. That’s the actual terminology that’s used and very uncommon for kids to have a diagnosis of concussion. Even within that young age group.
So, as they get a little closer to four and then five and then six, they are a little bit more likely to be given a diagnosis of concussion. So, I think that that reflects the uncertainty of the medical provider on calling it a concussion. But that also leads to some uncertainty with the family.
You know, what to expect. You know, what is it that happened to my kid’s brain? Is that a brain injury?
Is it not? And what to expect over the next few weeks after that.
[Dr Mike Patrick]
Yeah. Yeah. Miriam, then what is it about concussion that would, especially in these young kids, that would make us think about labeling it as a concussion?
What sort of symptoms would sort of drive us toward that diagnosis in these young kids, especially right after a head injury?
[Dr Miriam Beauchamp]
Yeah. And maybe where I can start is to say that, you know, when Sean mentions that the concussion label gets used a little bit later, it’s not that we don’t think concussions exist in younger children. It’s really that, as he mentioned, people are uncertain, so they won’t use that label.
But we certainly expect that these kids will have symptoms that are somewhat similar to what we would expect in older children, adolescents and adults. So physical symptoms such as nausea, balance problems, headache, sensory problems like seeing double, for example. Cognitive problems like feeling confused or having difficulties paying attention or concentrating.
And more emotional or behavioral problems like irritability or feeling anxious and maybe even some symptoms of moodiness. I think the big difference in these kids is the way those symptoms manifest. So, we think that they experience these same symptoms, but the way that they’re going to show or say that they have them is going to be quite different.
And Sean touched upon this. You couldn’t expect a one-year-old or a two-year-old necessarily to say, oh, mom or dad, I feel confused today or I’m feeling dizzy. Those, you know, they may not have any words to say that, or they might not have the sophisticated vocabulary or mental skills to know what even feeling confused or feeling dizzy might be like.
So, what we’ve seen is that they have a lot more behavioral manifestations, things like tantrums or moodiness, irritability, definitely, or comfort seeking, you know, wanting to be in their parents’ arms, wanting their favorite stuffed animal, staying close to their parent. But these are all ways that they can generally show that they’re feeling unwell without necessarily specifically being able to say, this is the way in which I’m feeling unwell.
[Dr Mike Patrick]
Yeah, yeah, that totally makes sense. And I think a lot of us, I think it’s something that we don’t really think about because, you know, a kiddo comes in after hitting their head, which is very common, by the way, because kids fall a lot and their heads hit things. And so, you know, we think, oh, OK, it’s a head injury.
And we go through our usual script, our injury script of the things that we need to tell parents. But really, concussion ought to be a part of that. And I will admit that this is not something that I work in an emergency department and I can’t, you know, there’s a lot of kids who I call head injury and don’t really mention concussion.
But I do see the value in doing that. Sean, can you can you explain a little more why it’s important to actually use that word not only in our charting, but also with the family?
[Dr Sean Rose]
Well, once a concussion is diagnosed, the implication is that, you know, the brain is currently injured. You know, there are physiologic changes within the brain, mostly electrolytes and chemicals that are not in the correct concentrations where they’re supposed to be. And during that injury, the brain is more vulnerable to additional injury.
And so, in older kids, we have them step back from contact sports and a brief period of rest and then gradually getting back into activities in younger kids that that might look a little different. But I think the important thing is that, you know, if a kid is going to then go into some kind of risky activity, you know, climbing up on into trees or on ledges and things like that, that would be a particularly risky position for them to be in right after sustaining a concussion. So, I think the main thing is initial safety.
But as you mentioned earlier, you know, from a research standpoint, it’s also important for us to know how often this is happening. And be able to, you know, identify kids with a concussion so we can have a population that’s consistent for research purposes, whether that’s interventions in the future or just following symptoms over time.
[Dr Mike Patrick]
Yeah. Yeah. How common do we think concussions are in these young kids when they hit their head?
[Dr Sean Rose]
Well, that’s a tricky thing to identify. But when we look through a large database of ED visits, this age group, we found over 300,000 kids in the US each year are presenting to the ED with minor head injury that we think are likely concussions. So that’s significantly higher than had previously been seen.
Again, if we just use the diagnosis of concussion, we get a much smaller number. But using these other diagnoses, these unspecified injuries that that ED providers are more commonly using and looking at, you know, head injury in the ED, then we get to over 300,000 per year.
[Dr Mike Patrick]
Yeah. Yeah. And I think that speaks to, again, how common it is that kids hit their head.
And we do, you know, they get a goose egg on the forehead and come in to see us in the urgent cares in the emergency department. We just see a lot of those kids. And a lot of them are fussy and clingy and, you know, they just aren’t maybe eating as well, all things that would point toward concussion.
And yet many of us, you know, don’t often use that word. We just say, oh, yeah, they have a mild head injury. From a parent standpoint, Miriam, what can parents do to kind of advocate for their kids and just say, hey, you know, I guess it is just ask, hey, could this be a concussion?
[Dr Miriam Beauchamp]
Yeah, great question. And we really do think, and our data from our research also shows the importance of the parental role in this situation. You know, of course, we have our medical providers, but parents know their kids well.
So, when we ask them, you know, is your child acting normally? Is your child, you know, do you recognize their behavior? They’re actually pretty good about telling us, you know, what’s different or if it’s increased or different.
So, without putting the onus on them completely, we do think that it’s important that they be aware of what they should be looking out for and so that they can perceive any changes that need to be addressed and attribute those. Also, understand that, as Sean mentioned, it is a brain injury. And so, I think the challenge for them is that, as we’ve said, a lot of these behavioral manifestations are also common at these ages.
If we think of the terrible twos, we think maybe of irritable kids who might have temper tantrums. And, you know, but the point is that these kids, you know, are showing significantly greater behavioral outbursts and problems than would be expected just in normal, typical development. So, what we do need to do is also just to educate parents about what is a concussion, what to expect, and that it’s possible in the days and the weeks following the injury that their child may be showing these changes in behavior and these symptoms so that they can identify them and report them if they need to.
[Dr Mike Patrick]
Yeah, yeah. I think at this point, it’s really important to point out that CAT scan is not going to help us diagnose a concussion. In fact, it’s not going to be useful at all.
Sean, can you kind of explain what’s happening in the brain with a concussion and why a CAT scan is not indicated to rule it in or rule it out?
[Dr Sean Rose]
Sure. So, a concussion is, as I mentioned, it’s primarily electrolytes and chemicals. So, inside and outside of each brain cell, the neuron needs the right concentrations of all those electrolytes and chemicals.
And when that concentration, that differential, is altered, then the neurons just can’t send their signals very well. Signals are not moving through. The large networks of the brain are just not functioning very well.
I often use the analogy of rush hour on the highways. So, you know, 5 p.m., there’s just way too many cars on the road. They’re not moving through very well.
And that’s a problem with how the brain is functioning, a functional brain injury, rather than a structural brain injury. So, a structural brain injury would be, you know, if there was a bridge that was blown up and that’s why the cars can’t get across. That would be more like bleeding in the brain, stroke, you know, fracture, things like that.
That’s what you can see on brain imaging, like a CT and an MRI. And we don’t expect to see abnormalities on imaging in a concussion.
[Dr Mike Patrick]
And symptoms of those structural brain injuries where we say, well, maybe we should get a CAT scan just to make sure there’s not a brain bleed or a skull fracture, are going to be prolonged loss of consciousness when you hit your head, several episodes of vomiting. Maybe when we see in the urgent care, the ED, we do, you know, have them drink or eat a little something and they just can’t tolerate it. And so, they’re persistently vomiting.
And then, of course, kids with concussions can be irritable, but when it’s extreme irritability and a kid is just cry, cry, cry, cry. And even as we examine them, they don’t, you know, the usual soothing techniques don’t help. Then we say maybe they have a really bad headache and that’s why they’re so irritable.
And that kind of goes along then with the PCARN rule that we use in pediatric emergency medicine to determine the chance of a structural brain injury. And we know that the amount of radiation that kids get exposed to with CAT scans, we don’t want to cause more problems down the road because we know the more radiation we’re exposed to, the more likely we can get brain tumors and those sorts of things. So, I think it’s important for parents to understand that a CAT scan is not going to be helpful in diagnosing a functional brain injury, which is what a concussion is, because it’s going to look normal, even though the chemicals around those neurons may be altered.
And it’s more like rush hour traffic up there in the brain than regular open roadways, for sure. So, Sean, then what does your research tell us about persistent symptoms in young children with concussion?
[Dr Sean Rose]
So up until recently, most research has focused on older kids and persisting symptoms. And we’ve known for quite a while that about a quarter to a third of older kids will have ongoing symptoms at least past four weeks from their injury. And that’s the cutoff where we consider it to be a normal recovery if they feel back to normal within four weeks but persisting symptoms if they have ongoing symptoms past four weeks.
Dr. Beauchamp and I recently did a study looking at this young age group and identified 28% of young kids under age six will have persisting symptoms past four weeks. And even out to a year, we still see 16% of kids that will still be indicating symptoms. You know, their parents are identifying changes in their behavior and symptoms that would not be typical for them.
[Dr Mike Patrick]
Yeah. And you guys presented your research in a paper in the journal Pediatrics called Frequency and Predictors of Persisting Symptoms One Year After Early Childhood Concussion. So, this is something you do see kids even a year after their concussion that you still see symptoms?
[Dr Sean Rose]
We do. Yeah. And in some kids.
And in that study, we can compare it to two different control groups. So, we compared to kids that came to the ED with an orthopedic injury, so an injury to the arm or leg. And we also compared to a healthy control group.
So, kids from daycare centers, you know, that were not injured. And even though, you know, some of the kids with orthopedic injury, you know, did seem to still have some symptoms a year later because, you know, they had an injury and their parents are identifying symptoms. We did see a higher rate in the group with concussion and significantly higher than in the healthy population.
[Dr Mike Patrick]
And if you’re going to have these symptoms that are prolonged, I guess that’s another really good reason to say the word concussion and mention it to parents as we do our education. With an initial visit after a head injury, because if their child is having some issues, you know, a few months later, they may not even remember that head injury. And then that makes it even more difficult to try to figure out what’s going on with a kiddo if we don’t know about that history of a concussion at the onset of the symptoms.
So just sort of having that conversation right there at that first visit is I guess that really does make it important. Miriam, what kind of symptoms then do you see in kids far out? Like what would make a parent think, oh, maybe these symptoms are because of that head injury that occurred a month ago or more?
[Dr Miriam Beauchamp]
In the longer term, it really becomes about behavior. Initially, we’ll see those more physical symptoms, those more, you know, sleep problems, for example, and, you know, the nausea and headache or signs that they may have a headache, like holding their head or rubbing their head. But as we go out past this sort of one month marker, it’s more about both what we call internalizing and externalizing symptoms.
So externalizing, as the name suggests, are things that are actually fairly easily observable, things like acting out or having tantrums or, you know, I guess you could say sort of difficult behavior with quotes around that. And internalizing things are more about withdrawal or feeling more anxious, for example, or the child may be isolating themselves a little bit more often if they’re not feeling well. And I think what your comment really speaks to the notion that concussion, you know, we often call it an invisible injury.
So, when we’re out past a month post-injury or more, it’s actually kind of easy to forget that the child’s had that injury. You know, parents’ lives are busy and everybody’s lives are busy and other things happen in the interim. And it’s not like when a child, you know, Sean mentioned orthopedic injuries, if a child breaks their arm and their arm’s in a cast for six weeks or more, or they have crutches or something like that, there’s actually a visible reminder, let’s say, of the injury.
And it might be easier for a parent in that situation to say, oh, you know, my child is being more difficult today or doesn’t seem to be feeling well. It must be because of, you know, they might be in pain or they’re feeling uncomfortable because of their injury, whereas we don’t have that reminder in a certain sense with concussion.
[Dr Mike Patrick]
Yeah, yeah, absolutely. Sean, when older kids, especially if they’re playing sports, present with a concussion, you know, we say you need to not participate in your sport until you have follow-up and you’re cleared by a physician to return to sports, and that’s done in a supervised way. For these younger kids, should we, you know, a lot of times it’s like, well, only see your regular doctor if they’re having problems or you’re concerned.
Should all of these kids maybe have a follow-up appointment to kind of reinforce that, hey, they just had a brain injury, and they need to be followed up again, or is it something in these younger kids that we can say just as needed? What do you think about that?
[Dr Sean Rose]
Absolutely. I think that every brain injury, so a concussion is a brain injury, you know, should be followed by a medical provider. Now, different medical providers may have different recommendations, especially in this younger group, but, you know, the idea that we need to at least initially protect the brain and prevent further injury is important.
What that looks like over the next few weeks, though, we don’t have, you know, evidence-based recommendations at this point. We think that in younger kids, they may be better at self-limiting their activities. You know, because if you think about maybe a high schooler who’s in a sports season, they have a concussion.
There may be competing interests on whether they’re going back into play. They may lose their position on their team if they stay out too long. They may be, you know, away from their social life if they’re away from their team.
They, but on the other hand, they may be anxious about their symptoms. And if they start to try to do some exercise and then there’s an anxiety response and that can amplify symptoms, then they may step further back from exercise. In younger kids, my hope is that there’s not as many of those complicating factors.
Mary may be able to think through that a little bit more detailed than I am, but I think that self-limited exercise, again, making sure that they avoid risky situations. May be more appropriate for the younger kids.
[Dr Mike Patrick]
Yeah, yeah. And I think if you have a follow-up visit, it kind of sticks in your head a little bit more that, hey, there was this significant event. And then if down the road there continue to be problems, maybe you will think about that.
Not that that’s necessarily a good reason to, you know, for the expense and the, you know, increased volume for primary care offices. And there’s a lot of things to think about in all of this. But it is something, you know, to consider as we’re thinking, evaluating our own practice patterns for sure.
Miriam, how can families then support these kids moving forward? Like if they continue to have symptoms, what can moms and dads do to sort of alleviate the stresses on the family and the kiddo?
[Dr Miriam Beauchamp]
Good question. I mean, there’s certainly, I’ll address the what can moms and dads do after, but I think there’s something that we can do in the interim. And, you know, we’re talking about also not overburdening our systems of care, which is, I think, a concern.
But there’s a fairly, you know, basic component of just education and reassurance as well that I think is currently not necessarily being addressed. A lot of concussions, and this is regardless of age, will actually resolve over the course of two weeks to three weeks or a month after injury. But often people are given information, you know, during the acute period, whether it’s in the emergency or urgent care or maybe even by their family doctor.
And so, they know what to expect and they know what signs to look for, for when they need to return, you know, if this is persisting or things like that. Currently, because of the lag in research and knowledge in these younger kids, I don’t think that that’s being systematically done in the same way that is done for older children. So, we may actually be able to help parents even just about giving them information about, you know, what to expect in their child.
And that will actually empower them to begin with. And they may see that their child actually within a few days or weeks is better and they don’t need to return or to consult. But I think it’s about giving them that information that, you know, what point do I need to go back and speak to a professional about how my child is and whether they’re back to their normal activities or not.
So, it’s about what they can do, but it’s about what we can do for them, I think.
[Dr Mike Patrick]
Yeah. Yeah. Yeah.
And I love that you mentioned that parents know their kids. Like if your mom radar is going off, that it’s subtle, but there’s just a little bit of a difference that that’s something to voice and to talk to your child’s doctor about, right?
[Dr Miriam Beauchamp]
Absolutely. Absolutely. And again, like without putting the onus completely on them, we do need to be listening to what they have to say about their child’s behavior.
And it’s a tricky question, right? Because we don’t want to make parents overly anxious about these when we know that, you know, we talk about this quarter to a third of kids who have persisting symptoms. But the flip side of that is that, you know, three quarters of the kids or two thirds of the kids actually do get better.
So that’s also about, you know, making sure parents know that, that most kids will get better and not making them overly anxious because that can actually contribute to their child, you know, maybe not getting back to their usual activities.
[Dr Mike Patrick]
Yeah. Yeah, absolutely. For the older kids, Sean, you know, the recommendations in terms of rest after a concussion have sort of changed as new evidence presents itself over even the last 10 years.
You know, there was a time when we would say, no school, you know, lay on the couch, maybe listen to some music that’s not too stimulating. And then we discovered that too much rest actually could make symptoms last longer. So, I guess it’s even more difficult in these younger kids to know what to do in terms of rest.
But you also mentioned that these young kids often limit themselves in terms of like, I don’t feel right. I’m not going to be as active as I was. But from a, from a family standpoint and for moms and dads, what should we do in terms of thinking about rest for these kids in the immediate days following the concussion?
[Dr Sean Rose]
At this point, we can try to extend what we know about older kids down to younger kids. You know, we will get more and more data and evidence in younger kids. But right now, at least from the injury standpoint, we know that after one to two days of trying to rest.
So, trying to avoid screens, you know, less cognitive activity, some less physical activity just for one to two days. After that, we recommend gradually getting back into normal activities. And so, whether it’s school or daycare in these younger kids, my recommendation would typically be to, you know, if they are having quite a lot of symptoms, okay to stay home for a day or two.
But then trying to get back in at least to a partial day and kind of seeing what they’re able to tolerate. Maybe with some accommodations and special allowances, you know, whether that’s, you know, being in a less busy area of the room or building, you know, especially if their school demands and academic demands, you know, fewer assignments and things like that. At the daycare setting, it might be that they’re able to engage in some of the more fun and interesting activities, but maybe then take a little bit of a break, especially if kids are going out and, you know, climbing way up onto the play structures.
And, you know, we don’t want that in the first few days of the injury. But I think kind of a practical, reasonable approach is to think about how we manage older kids and see how that might apply to the younger kids.
[Dr Mike Patrick]
Yeah. You know, one thing that I love about all of this is that this is an area that has really not been well studied. And then you guys come along and you’re like, hey, what about these younger kids?
Miriam, you know, just in general in medicine, there’s so many areas like this where it just it takes people recognizing that there’s something that we don’t know a lot about and then making that a passion. Can you talk a little bit about how you became interested in younger kids with concussions and why it’s so important for individual physicians out there who have questions that think, you know, we don’t know enough about this to dig in and try to find answers.
[Dr Miriam Beauchamp]
Yeah, that’s a great question. And I think there are multiple parts to my answer in the sense that there’s really a historical component for me that historically we’ve always said, you know, little kids, they just bounce back, doesn’t matter what we do to them. And to some extent, that’s true in the sense that young children’s brains are really evolving very rapidly.
They’re changing exponentially. They’re learning new things. And so, they do have some adaptability and flexibility.
But that doesn’t mean that when we come and we disturb that development, there’s not going to be some sort of consequences to it. So, this was when I first started into this, you know, there was very much this notion that, oh, we don’t need to pay any attention to those kids because they’ll just bounce back. And I don’t think that’s entirely true.
I think there’s two sides of that story. So, there’s that historical notion. And then there’s also the prevalence.
You know, Sean mentioned the numbers in the U.S., but when we, because those kids hadn’t been studied, often when we look at the statistics or the data that shows what is the occurrence of these concussions, we often would say, for example, they’re most frequent in adolescents or young adults. But that was leaving out the entire zero-to-five-year age range. So often the graphs that we look at as researchers or the statistics that we tell the general public about are actually leaving out this younger age group.
So, in fact, we’re not including them. And when we look at including those kids, they actually have the highest rate of presentation to the emergency department for these types of injuries. So that was a big motivation to say, hey, you know, these injuries seem like they’re very frequent.
We don’t understand them. And we can’t just say these kids are fine if we haven’t actually investigated whether they’re fine or not. And, you know, I think that they’ve been left out also because people find it challenging to assess these kids and to find measures and tools that will be appropriate.
And maybe my last point is just about age differences. You know, we’ve always said in the pediatric world, we shouldn’t treat kids just as little adults, but that’s even more so true at the youngest age ranges. The changes between a six-month-old, a one-year-old, a two-year-old, a five-year-old are just huge changes.
You know, as we get older, we change less. And so, we can sort of bulk people together a little bit more. So, I think all of those reasons have really driven me to want to do work in this area.
[Dr Mike Patrick]
Yeah, yeah. And there’s so much more to do, I feel, because one question that I have, and you’ve probably asked yourself this, too, and I’m not sure there is an answer at this point. But are there long-term implications for a child who’s had a concussion in early childhood, especially as we think about things like learning difficulties and ADHD?
And are there, you know, anxiety, depression? Are there implications for a concussion in early childhood that we have to think about much farther down the road?
[Dr Miriam Beauchamp]
I would say that for now, we don’t really know, to be honest, you know, to be fair, to be honest, we have data a couple of years out showing that there may be persisting behavioral manifestations and problems. But we don’t really know what these kids look like in the much longer-term years later. I want to be reassuring, too, saying that in older kids, you know, again, most of the kids recover, most go back to optimal levels of functioning.
And I think there’s no reason to think that younger kids will have very severe outcomes in terms of their development. I think we can absolutely say to parents that, you know, the prognosis is very good for these children. We have a study, the study that I collaborate with Sean on, that we’re starting to look four years post-injury just to see if there’s anything that we can find there.
And there may not be. And I think that that will be a great finding if we can say, no, these kids look just like their same age peers a few years out.
[Dr Mike Patrick]
Yeah, yeah. And then, Sean, if both parents and primary care docs are concerned that symptoms are lasting more than a month, do you recommend referral to a complex concussion clinic for these kids, just like we would with the older ones?
[Dr Sean Rose]
Yeah, it can be hard to find the right provider to get answers and help from, though. I think most concussion clinics, you know, most of our infrastructure right now is built for older kids. And the question about sports and, you know, things like retirement from sport and such.
So, in younger childhood, you know, they may have to get creative on where they seek this care, you know, whether that’s a neurologist or a neuropsychologist or, you know, a primary care doctor who has, you know, looked into this and is more familiar with these outcomes. But most of the persisting symptoms that we see can be addressed. Just like in older kids, you know, we treat headaches, you know, we treat vestibular problems.
For these younger kids, if it’s more behavioral, there are counseling, whether that’s family counseling or individual counseling. There are ways to address and improve symptoms. And so, I definitely would encourage families to seek care if they’re concerned for whether it’s acute or chronic symptoms after a concussion.
[Dr Mike Patrick]
Yeah, yeah. So, from a parent standpoint, and for this particular podcast, our primary audience is moms and dads. It’s just really understanding that these symptoms can persist for a little while.
That’s normal. We want to make sure that kids don’t hit their head again while they’re recovering from the first concussion. And so just knowledge is power.
And, you know, understanding that if your child’s not acting in the way that you would normally expect, then let someone know. And your child’s doctor is a good place to start with that. But I think we’re doing a good job in terms of just getting the word out there and starting to raise awareness about this issue in the younger kids.
So very interesting, fascinating conversation. We are going to have lots of links for folks in the show notes. So, if you head over to pediacast.org and look for the show notes for this particular episode, you’ll find Neurology at Nationwide Children’s Hospital. We have a link to a very nice resource on concussions in early childhood from the University of Montreal. And then the journal article that we had mentioned before that you guys wrote, Frequency and Predictors of Persisting Symptoms One Year After Early Childhood Concussion in the journal Pediatrics. And then there’s also a review, Early Childhood Concussion State of the Art Review.
So, if you want to really dig deep into the science of this, you can check out those links. And we also have pediatric providers who listen to this podcast. This may be interesting information for you to dig into as well as you take care of your young patients.
And again, we’ll have links to all of those things in the show notes over at pediacast.org. So once again, Dr. Sean Rose, Pediatric Neurology at Nationwide Children’s Hospital and Dr. Miriam Beauchamp, Professor of Psychology at the University of Montreal. Thank you both so much for stopping by today.
[Dr Sean Rose]
Thank you so much for having us. I appreciate that you were interested in this topic and gave us a chance to share about it.
[Dr Miriam Beauchamp]
And same for me. Thank you for inviting me. And I think this is just a great way also to let people know and give them some resources.
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[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. We really do appreciate your support. Also, thanks again to our guests this week, Dr. Sean Rose. He is a Pediatric Neurologist at Nationwide Children’s Hospital. Nationwide Children’s Hospital and Dr. Miriam Beauchamp. She is a professor of psychology at the University of Montreal.
Don’t forget you can find PediaCast wherever podcasts are found. There may be an easier way for you to subscribe and listen. We’re in the Apple podcast app, Spotify, iHeartRadio, Amazon music, Audible, YouTube, and most other podcast apps for iOS and Android.
Our landing site is PediaCast.org. You’ll find our entire archive of past programs there along with show notes for each of the episodes are terms of use agreement and that handy contact page. If you would like to suggest a future topic for the program, or if you just want to say hi, I love hearing from listeners on the contact page reviews are also helpful wherever you get your podcasts.
We always appreciate when you share your thoughts about the show and we love connecting with you on social media. You will find us on Facebook, Instagram threads, LinkedIn X, and blue sky. Simply search for PediaCast.
Don’t forget. We also have a podcast for pediatric providers. It is similar to this program.
It’s called PediaCast CME. We turn the science up a couple notches, and we offer free category one continuing medical education credit for those who listen. And we have credit not only for physicians, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers and dentists.
And it’s because nationwide children’s is jointly accredited by all of those professional organizations that we can offer the credits you need to fulfill your state’s continuing medical education requirements. Shows and details are available at the landing site for that program. PediaCast CME.org.
You can also listen wherever podcasts are found. Simply search for PediaCast CME. And one more podcast that I host is called fame cast.
This one is a faculty development podcast from the center for faculty advancement, mentoring and engagement at the Ohio state university college of medicine. So, if you are a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you. And you can find FAMEcast at famecast.org and wherever podcasts are found by searching for FAMEcast. 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.
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