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To learn more about health and safety topics for children, go towww.RockyMountainHospitalForChildren.com

Heads Up…It’s better to sit out onegame than the entire season! We’veall seen it...a cartoon character gets hit on the head,stars appear and the character walks around in circles.Today we would call that a concussion. And while itmay be amusing to see on TV, it’s not so funny whenit happens in real life.

What may seem like a small bump on the headmay actually be the start of a much bigger prob-lem. Rocky Mountain Hospital for Chil-dren’s new Center for Concussion istaking its message to the street — and to theschools — in an effort to minimize thelasting effects of concussion dueto sports-related injuries. >>> continues

Now part of all HealthONE hospitals: The Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rose Medical Center, Sky Ridge Medical Center and Swedish Medical Center.

September 2010

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Karen McAvoy had just embarkedon a Centers for Disease Controlstudy of concussions in high schoolathletes when, on Sept. 18, 2004, the subject hit tragi-cally close to home.

As the school psychologist at Aurora’s Grandview HighSchool, she received a call informing her that 14-year-oldGrandview student Jake Snakenberg had collapsed on thefootball field after taking a fairly mild hit that morning. She’dlearn later that he had likely sustained a concussion the weekbefore, but without that diagnosis he promptly returned toplay. Jake died Sept. 19.

“It was a devastating story,” recalls McAvoy, now the directorof the Center for Concussion at Rocky Mountain Hospitalfor Children (RMHC). “It really shaped who I am, both pro-fessionally and personally.”

Fast forward six years, and McAvoy has dedicated her careerto urging parents, teachers, athletic trainersand physicians to work together to betteridentify and manage concussions in youngathletes. In November, she published a sweeping concus-sion management protocol, The R.E.A.P. Program

(Reduce, Educate, Accommodate, Pace), aimed at assuringthat young concussion patients don’t return to school or playtoo soon, and do all they can to avoid the potentiallydeadly Second Impact Syndrome (severeswelling that can occur when a still-injured brain is hit again)that killed Jake.

The protocol, now used in four Colorado school districts, isamong mounting nationwide efforts to change a somewhatlaissez-faire culture around youth sports concussions.

“We have gone from believing that concus-sions are no big deal to understanding thatthey can have very serious consequences,”says Dr. Susan Kirelik, medical director of pediatric emer-gency services for Rocky Mountain Hospital for Children atSky Ridge Medical Center in Lone Tree.

According to the Brain Injury Association of America, 1.6 to 3.8 million sports and recreation-related concussions occur in the UnitedStates annually, with football, basketball, cycling, soccer and playground activities the top causes. New researchshows that, contrary to popular belief, kids are quitedifferent than adults when it comes toconcussions.

“It seems that, especially in adolescence, there is somethingabout their brain that makes them vulnerable to not only hav-ing a concussion but also to having more complications,” saysKirelik, noting that kids also take longer to recover. “Theaverage adult recovery takes one-to-twoweeks, whereas kids can take three-to-five.”

Despite such facts, one 2009 study by the Center for InjuryResearch and Policy found that 40 percent of student athleteswho suffered concussions between 2005 and 2008 returnedto play too soon. Even more alarming, according to the study,15.8 percent who sustained a concussion and lost conscious-ness returned to play the same day.

Jake’s mother, Kelli Jantz, says she recalls her son com-plaining of tingling in his fingers after a gameone week before his death, but his symptoms soonsubsided and (while he told his friends) he never told his coachesor parents his head was hurting.

Jacob SnakenbergApril 19, 1990 – September 19, 2004

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On Sept. 18, Jake took a hit during warm-ups, but shruggedit off. “He looked at me and waved and everybody kept play-ing,” Jantz recalls. Moments later, Jake collapsed.

Since then, Jantz has been working closely with McAvoy toassure that Jake did not die in vain. Theirmessage to parents and coaches: Pay close attentionwhen a child gets injured, get them to adoctor if you suspect they have a concus-sion and make sure that concussion victims rest fromboth mental and physical exertion untiltheir brain heals.

“It hurts every day that he is gone,” says Jantz. “But if his ab-sence and what he went through can prevent something fromhappening to someone else, that would be an amazing thing.”

How to recognize and manage a concussion: Ask the right questions: Only 10

percent of kids lose consciousness when they suffer a concussion. If your child has a head injury, ask if they have these symptoms: headache,nausea, balance problems, blurry vision, sensitivity to light or noise, fatigue, brain fog. If they report several, see a doctor.

Recognize that symptoms can be delayed: “A lot of times we see concussion casescome in on Monday,” says Kirelik. “They play a gameon Friday, don’t do much on the weekend, then go toschool on Monday and use their brain to try to think.That challenges that whole metabolism and theirsymptoms really blossom.”

Rest: Insist that your childrefrain from both physical andmentally strenuous activitiesimmediately. Avoid loudgroup functions, video gamesand text messaging, and limitreading and schoolwork forthe first few days. Don’tallow them to drive.

Keep them out ofsports: Do not let them return toplay until they are completely without symp-toms. Once they return, start them off slow and easy. If symptoms return, pull them back out and wait.

Tell young players to speak up:Before the season starts, have a conversation with yourchild about reporting their symptoms to the adults intheir life. “We still have a culture that advises kids to‘suck it up’ and many of them think they are beingwimpy if they tell their coach they have a headache,”says Kirelik. “They are really putting their brains at risk.”

Stay positive: 90 to 95 percent of kids with a firstconcussion that is properly managed will completelyrecover. “It is the kids who have multiple concussionsor second head injuries while still healing who can goon to have real issues,” says Kirelik.

To read the REAP Project in full, log on to http://cokidswith-braininjury.com/blog/wp-content/uploads/2009/11/REAP-Project-Manual-Final.pdf.

Rocky Mountain Hospital for Childrenand its family of locations brings trusted experience andproven care to you and your children. For information onparenting, health tips and more, visit www.ParentPages.comor www.RockyMountainHospitalForChildren.com.

Center for Concussionis now part of Rocky Mountain Youth Sports Medicine Institute, a comprehensive service for the prevention, treatment and rehabilitationof sports injuries in children and adolescentslocated at Centennial Medical Plaza.

14000 E. Arapahoe Rd.Suite #300 Centennial, CO 80112

720.979.0845

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Physician Resources Guide Physician Referral Line: 1-877-752-2737 pslmc.com

Reginald L. Washington, MDFAAP, FACC, FAHAChief Medical Offi cer303-839-6100

Jack HT Chang, MDPediatric Physician Liaison303-839-6100

www.rockymountainhospitalforchildren.com

Adolescent MedicineChristine Gilroy, MD 303-869-2160Richard Miranda, MD 303-869-2160

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Cleft Palate & Craniofacial Clinic 303-320-7122

Congenital Deformities: HandLaurel Benson, MD 303-861-2663David Schnur, MD 303-830-7200

Congenital Deformities: LegLaurel Benson, MD 303-861-2663David Hahn, MD 303-837-0072

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Centennial Medical Plaza 303-699-3000

North Suburban Medical Center 303-450-4519

Presbyterian/ 303-839-6440St. Luke’s Medical Center

Rose Medical Center 303-320-2455

Sky Ridge Medical Center 720-225-1900

Southwest ED 303-932-6911

Swedish Medical Center 303-788-6911 Level I Trauma

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