Pediatrician calls for more attention to childhood concussions

By Judy Benson

New London — While much of the focus on sports-related concussions has been on professional athletes, Dr. Karen Laugel, a Shelton pediatrician who helped found The Concussion Corps to educate parents, schools and medical providers, believes more attention needs to be paid to the issue of head injuries in youth.
“A half a million kids under the age of 14 are getting TBIs (traumatic brain injuries) and going to the emergency departments (annually),” she said. Of those, she said, 75 percent had concussions.
Laugel spoke to about 40 school nurses, registered nurses, doctors and others during a program at Lawrence + Memorial Hospital Thursday co-sponsored by L+M and The Child & Family Agency of Southeastern Connecticut.
Dr. Fred Santoro, chairman of the L+M Pediatrics Department, said the program also was offered to emergency room staff and others at the hospital, “so that we’re all on the same footing with how we evaluate kids and when they’re ready to return to school.”
In her talk, Laugel noted that, contrary to common perceptions, about 30 percent of childhood head injuries occur during sports activities, while the rest happen due to accidents or other incidents.
“These are kids who are just playing the dangerous game of childhood,” she said. In describing a concussion to a young patient, she said, she often compares it to the brain being shaken “like a snow globe,” so that the neurons “leak.”
After taking the audience through a step-by-step process of how to evaluate a child’s physical, visual and cognitive functions to determine whether they’ve had a concussion and how far they’ve recovered, she advised doctors, school nurses, teachers and parents to create “concussion management teams” to monitor the child. She also listed accommodations a student may need in school and at home after a concussion, including using audio books, extended test-taking time and limits on computer screen time. Returning to sports teams too soon, she added, is an all-too-common problem.
“We want them to play, but it’s our responsibility to make sure they play safely,” she said. Youth recovering from concussions, she said, need to be taught to self-monitor and self-limit their activities.
“Tell them to remember the snow globe, that if they’re getting a headache after watching TV for three hours, they’re shaking the globe,” she said.
She advocates students returning to school with accommodations after three or four days, and adding aerobic non-contact exercise soon after. But rejoining an athletic team, she said, should wait until the child has “returned to full academics” including a complete restoration of cognitive abilities. Returning too soon, she warned, risks long-term damage, especially if the youth is reinjured. Concussions, she added, are not just a problem for high school-aged students who play football, soccer, ice hockey, lacrosse and other contact sports, but for a broad cross-section of ages involved in a variety of activities.
“Don’t forget your elementary and middle school kids,” she added.
Her talk came as the General Assembly is considering a bill that would require coaches and other leaders of youth sports activities to provide parents with information about concussions.
State Rep. Diana Urban, D-North Stonington, co-sponsor of the bill, said Thursday that the bill has advanced out of the Committee on Children and the Appropriations Committee, and she is now hoping to get it scheduled for a vote on the House floor. Urban is co-chairwoman of the Committee on Children.
On Wednesday she spoke at a news conference on the bill with former University of Connecticut quarterback Casey Cochran, who urged passage of the bill. Cochran, a UConn senior who also played for New London High School, quit football in August after suffering his 12th concussion. Parents, he said, need to be informed about the risks of concussions and “how dangerous they really are.”
Urban said the required information sheets are readily available online. Coaches will be able obtain and distribute documents that would fulfill the requirements from the Centers for Disease Control and the Connecticut Interscholastic Athletic Conference’s websites at no cost to the towns or school sponsoring the teams, she said.
“There’s no question there is more awareness, but many parents still are not aware,” she said. “The little ones, when they take a hit, their brain really flaps around.”
The bill requires that the information sheet describe the signs and symptoms of concussions, how to obtain proper medical treatment, the nature of concussions and their risks, and proper procedures for allowing an athlete who has had a concussion to return to sports. It would take effect on July 1.
Laugel urged audience members to get their school districts to develop concussion management policies and post them on their websites, to name staff to a concussion management team, and take advantage of online resources such as training programs on the Centers for Disease Control’s website.
Parents and medical providers also need to realize, she said, that youth may suffer setbacks as they heal from a concussion.
“Remember,” she said, “recovery is not always linear.”
Twitter: @BensonJudy

Kathy Sinnett APRN,
Nurse Practitioner & SBHC NP Coordinator

Child & Family Agency of SE CT’s
School Based Health Center at
Regional Multicultural Magnet School
1 Buckeley Place
New London, CT 06320

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