Stanley O. Skarli, MD

Division Chief, Pediatric Neurosurgery

Helen DeVos Children's Hospital

A study recently published in Pediatrics on the true meaning of the word "concussion" raises some very important points. The article found that using the label "concussion" rather than "mild brain injury" may be "less alarming" to parents, but it also implies a transient injury with "no significant long-term health consequences."

This is quite misleading. We've all heard about chronic traumatic brain injuries in professional athletes that result in significant morbidity and/or early mortality, including suicide. While these cases get the major press, those of us who focus on children's brains have felt for a long time that head injuries in general have been ignored both by coaches and parents who want their kids to just "shake it off." This can be dangerous-as can relying on the player's self-reported assessment as to readiness to return to play, as this study demonstrates.

The reality is that any head trauma should be taken seriously-for two reasons. One is the cumulative effect of head trauma, including dementia, parkinsonism, and depression. The other is the rare but lethal complication called second impact syndrome in which a second, often less intense impact to the head following a supposedly resolved first impact results in death.

Community pediatricians are on the forefront of this issue since they are the ones most likely to see children after a head injury or to hear from parents who want to know when it's safe for their children to head back into the game. Unfortunately, there is a common misperception that a true "concussion" only occurs if the child lost consciousness. The reality is that any alteration in behavior, mentation, level of consciousness or symptoms-even a headache-signifies a concussion. The child is still symptomatic until every symptom clears. The longer the symptoms last, the more severe the concussion is likely to have been. Parents should also watch for personality and emotional changes, or any changes in school performance.

One positive thing that's occurred as our understanding of the long-term effects of concussion improves is that more coaches and school systems conduct preconcussion evaluations. These evaluations serve as a benchmark for sideline assessment after a head impact. Such neuropsychological testing can, at times, provide even more information than a scan on the player's condition.

I'd like to hear from you about your own experiences with pediatric concussions and how you handle non-patient specific situations. Comment below or e-mail me at  

stanley.skarli@devoschildrens.org.

Tom Peterson, MD
Medical Director, Quality and Healthier Communities

Spectrum Health and Helen DeVos Children's Hospital

We're starting to see numerous studies that suggest that cell phones and texting could be used to encourage healthy behavior in children and adolescents, or to improve treatment adherence in children with chronic conditions.

For instance, a study published in the Journal of Nutrition Education and Behavior compared outcomes in children ages 5 to 13 who monitored pedometer steps, consumption of sugar-sweetened beverages and minutes of screen time via text messaging or paper diary against a control group that did no monitoring. Participants who texted were less likely to quit the study (28%) than those in the diary or control groups (61% and 50%, respectively), and significantly more likely to adhere to the self-monitoring than the paper diary group (42% vs 19%, P<.02).

Other research is examining the use of cell phones to improve self management in children with asthma, to remind adolescent girls to take their birth control pills, and to assist in smoking cessation, weight loss and sunscreen use.

Here at Helen DeVos Children's Hospital, we want to be on the cutting edge when it comes to using cell phones and other digital technology to improve children's health. When the new Healthy Weight Center opens this year, we plan to look at multiple options of incorporating such technology into programs, research studies, and other healthy lifestyle sustaining efforts. Until now, children and adults traditionally recorded their activities and food intake by logging every action or consumption into a written diary. 

But if texting technology works well for chronic sustainability lifestyle issues, those things you have to commit to all day long, every day, whether that's not snacking, eating the right type of foods or moving regularly, we plan to utilize any types that help improve our outcomes.  In the age of social marketing, texting, and endless downloading capabilities, the sky is the limit. 

We're very excited to have the opportunities to engage in exciting research like this, and plan to use whatever we can to help our families and children succeed..

What do you think about using texting to encourage healthy habits in children and adolescents?