In our latest video, we got the opportunity to interview Dr. Joseph Johnson who is a pediatrician not far from our office. We wanted to dive into his world and talk about youth sports injuries, more specifically concussions in the pediatric population.
We discuss what to look for when it comes to concussions and how to manage a concussion. We also discuss what you should look for when finding a pediatrician to manage your child’s concussion and we discuss general health for kids when it comes to sports.
Enjoy this and share with any of those that would like this video as well. Thank you. Here are a few questions that I’ve got from my, from patients and family here, and you as you. Uh, Pediatrician, your expertise on them, um, where we have our, under what conditions should a patient think about taking their child to see you or medical care from any sports injuries or anything like that.
So things that I would consider reasons to come in would be number one, if the child can’t walk or can’t use that particular limb because of the injury. Or if there’s significant swelling that doesn’t respond within a couple of days to things like ibuprofen and, uh, rest ice elevation, those, those types of things that we do for, for that.
Um, you know, with those are with acute injuries, there are some chronic things that people will have, They have back pain that lasts more than a week or two. It’s probably a good idea for, to come in for an evaluation to determine. What can be done to help with the healing process and also if there need to be limit limitations or restrictions placed on the, on the athlete related to the sports that they’re doing.
Okay. That’s what comes to mind on my head. Um, now this is more when I was taught at school with radiology and everything, I was taught that younger kids, cuz their bones are so growing when it comes to like a sprain or a break in the ankle. That court sort of injury. Younger kids, I was taught younger kids are more likely to break or have a high risk of breaking a bone.
Is that That’s true. Yeah, that’s true. And that’s the reason for that is because of growth plates. Growth plates. So when, when you’re looking at an injury related to a bone and a tendon and a ligament, uh, if there’s a growth plate in the bone, that’s the weakest part of. , the whole, the whole apparatus of the joint.
So if they’re an adult, they don’t have growth plates. The weakest part is not the bonus, the tendon or the ligament. But in a child who has growth plates in those areas, the weakest part of the, the joint is not the ligaments or the tendons, but the growth plate. And so you’re, you’re much more likely to have a fracture in a child because of the growth plate than you are to have a fracture in an adult.
They’re more likely to. Okay. And for that reason, I think they should get an x-ray fairly soon rather than putting it off longer. I, I do get x-rays soon. The only caveat with that is that sometimes in, in children, because many of their fractures are through the growth plate, which actually sounds scarier than it is, most fractures through the growth plate are not really a big deal unless they completely crush the growth plate.
So there’s no growth plate left over. But most, most fractures through growth plate are actually pretty mild. . But because of that, and because growth plates look dark on an x-ray, you may not actually see the fracture. And so sometimes we treat more based on tenderness to the bone. So if we can, the most common area that we see, this is the distal fibula.
Mm-hmm. , uh, and a lot of kids will have fractures there. If we did an MRI in all the kids, we would find the fracture, but we usually just treat based on bony tenderness. And if the x-ray’s negative. We assume that there’s a higher chance of a fracturing. We treat it as such because of the boney tendons. If the bone’s not tender, then we assume that it’s more likely a sprain and we treat it more like a sprain, but a lot of growth.
A lot of growth plate fractures, you’re not gonna see on an x-ray because it’s dark. Just like the growth. The growth plate is dark, just like a fracture line would be dark. Yeah. So what can parents do to help with if say it is just arain? What parents you to help with that? So I like for sprains, I really like ibuprofen.
Uh, for older children I actually prefer using ale or nap prin. I think it works a little bit better and you don’t have to give it as often as far as pain is concerned for medication. Tylenol I don’t like for in, for, um, generally for sports injuries unless they have a fracture. There is some evidence that using Tylenol, using ibuprofen or other NSAIDs with fractures actually, um, makes the healing go slower or not as good.
So if they have a fracture, I usually use Tylenol or other medications rather than NSAIDs. But as far as other things they can do, wrapping is very helpful. So ACE bandages are really helpful. Elevation of the, of the injur. Uh, extremity and then ice can be very helpful, especially in the short term and right after the injury had occurred.
Okay. Any, what about, uh, concussions or fear of concussions say, fell, fell off the playground or hit with a ball in the head? What, what should parents look for for that? So, concussions are difficult because, uh, unless they have a severe concussion, a lot of times more mouth concussions can be difficult to.
And, and to, to diagnose. But you know, if they, if they lose consciousness, the risk of significant injury is higher. It’s still not very high, but it’s definitely something that I would want to see a child for if the child seems confused afterwards. I’ve seen children who have had concussions who, who come in and they ask the same question over and over again.
So they’ll ask you the question, you’ll answer it, and then you’ll continue talking to them. And then a couple minutes later they’ll ask the very same question again. That’s a, that’s a sign of a more severe injury. And that’s a kid you’d. See sooner. So if the kid seems confused or is repeating themselves, if they, um, seem off balance, dizzy, they can’t walk straight or stand up well because of their concussion or because of their head injury, that’s a child that I would wanna see as well.
If it’s a newborn, uh, a child up to the age of one, if they have any mark or any uh, bruise on the head, those are children we generally want to see the same day as well, and we would. Being more aggressive and checking for, uh, brain injury and bleeding, uh, and skull fractures in those kind of situations.
For an older child, if they have a bruise, but they’re acting fine, um, and they’re not in a ton of pain crying, you can con, you can console ’em. Those children often can be watched for a day or two and seeing if they have persistent symptoms. So if they have persistent headaches, persistent dizziness, um, if they have struggles concentrating in school.
Because of, you know, especially if, if doing so causes them to have more headaches and dizziness, those are children that we would want to see, but they don’t necessarily have to be seen the same day if their symptoms aren’t severe. This the very first day. Okay. Okay. That’s good. Very good. Helpful. Sure.
All parents want to know that. So, um, couple things Are any advice on helping kids stay hydrated in the hot summer days coming up? So I generally tell my, my families to actually have their child take a water bottle around with them because people think they drink more than they actually drink majority of the time.
So if you can have a water bottle that the child takes with them, then they can actually measure how much they’re drinking. And, um, young children should probably drink about one to one and a half liters a day. and that’s outside of just, you know, what they, what they drink when they have their dinner.
You know, older children, depending on how active they are, they may two or may need two or three liters in a, in a day’s time in order to stay hydrated and not have problems, especially if they’re very active out in the sun. You know, I’d lean towards closer to the three liters for a teenager who’s, who’s doing, you know, football practice or soccer.
Even softball and baseball, even though you’re not running around as much, you’re still sweating a lot cuz it’s so hot outside. Yeah. So having a water bottle that they can actually measure how much they’re drinking and stay on top of it, is a much better way of doing things than just trying to guess or taking it from a drinking fountain.
Yeah. And those water, water bottles have been marks on it to give you the I do. Right. It’s, it’s just, it’s much easier to know how much I, you know, sometimes we specifically recommend a certain. And unless the child has a water bottle that they can measure that with, I don’t think they usually get that much.
Yeah. So I’m a big fan of you taking water bottles everywhere. Yeah. Yeah. Told me so many water bottles in our house we have done to do with. So , yes, we have a water bottle shelf and it’s always full and we usually have to steal from other shelves to put the extra water bottles in us too. Uh, and then as far as a lot of people, a lot of people ask also about, do we, do we need to use solutions?
Gatorade or Powerade or some of these electrolyte solutions. And the answer to that is unless the child is significantly active for more than an hour in their practice, they’re not gonna be losing enough salt to need. And those type of solutions. And those solutions tend to have a lot of sugar with them as well, which is important for hydration in order to absorb the salt.
But in general, you don’t really need the sugar. As much. And so unless they’re, you know, in two or three hour practices, they probably are just fine to use water the majority of the time. Yeah. All the little, little city leads, just the hour games, I don’t necessarily, Yeah, those types of games, water’s perfectly fine.
You wouldn’t need to do it anything more than that. Yeah. Um, so two more questions we got are mm-hmm. recommendations help prevent injuries. So I, flexibility is important. So stretching regularly, both before and after is very important for prevention of injuries. Um, children have a hard time doing this, but knowing your limitations, you know, don’t jump off a 10 foot wall and expect to not maybe get some injury that way.
Yeah. Um, so, but, but stretching is super important and I think that that’s a, a big thing Especi. , Uh, just jumping out of the car and running and getting on, doing what you’re doing, especially the older you are, the less, the more likely you’re gonna get injured just doing that. So spend the time to warm up before you actually get out and, and go crazy with it.
Yeah. Do you see any relation, have you seen any relation with youth that have played more, like specifically just one sport or those compared to those who play like a variety of sports? Yes, I, I’m not a big fan of the way sports are nowadays because it’s, it’s easy to specialize in a sport when you’re very young, and that’s never a good thing because you’re using the same groups, muscle groups over and over and over and over again, and when you do that, you tend to have much more likelihood of.
An overuse injury. So things like a, a little league or shoulder where they actually, because again, they have growth plates, those joints are weaker and they’re more likely to have growth plate injuries just from the overuse of that throwing over and over again, even like a quarterback, or it doesn’t have to be a baseball pitcher.
Uh, and the other thing about, um, youth sports nowadays is that many, many players that are specializing are not just on one team. They’re on multiple. So they might have a, they, you know, in baseball for instance, they might have a pitch count for their, their one league, but they don’t have a pitch count for the entire week when they’re playing in three different leagues.
And, um, and that can lead to significant overuse injury and a shortened sports career a lot of times. Because if you get one of those, you have to basically completely stop and sometimes when you come back again, you’re more at risk of having it happen again. So I’m a, I’m a big fan of, of seasonal sports.
And applying, trying a lot of different types of things because it, they use different muscle groups and that allows you to rest one muscle group while you’re using a different type of muscle group. And I think that’s, I wish that that was the way sports were nowadays. Uh, and I think that if somebody decides to specialize like that, they really need to be careful that they’re, they’re doing exercises that also strengthen other muscle groups rather than the specific one.
That, that, that can create a big problem. And baseball is probably one of the biggest problems with that just because it’s such a, so commonly it’s, it’s whatever arm. I’m a left hander, so that’s why I’m using my left hand. But, um, they’re using that, that group and it’s, it can be really bad for them long term.
And a lot of kids, I, I think, you know, there are some kids that you’re on sports are great for, cuz they really like the sport and it’s great, but a lot of kids just want to go out and have a good time. They don’t wanna be a profess. , there are some concerns about mental health related to specializing in sports as well, both anxiety, depression, uh, related to that.
And, and so I get, I’m a big fan of, of trying a variety of different sports for a number of reasons, both physical and mental as well. I completely agree that having a more variety, not not one sport for the whole year, but playing different sports helps goes a lot longer, long term. As far as health and just body awareness and being more of math.
That’s right. So I’ve, I see this agree. Um, one more thing. You told me that you see a lot of kids with Torrah clo and you find that, that you find a lot of that related to their sleeping patterns. Can you expand a little more on that? . Yeah, so it, so the two common areas we see toca is in newborns who are inside their mother’s womb for nine months and they can get their heads in funny positions that make it hard for them to move.
But the second one is with a child that doesn’t sleep with their neck, uh, in a good alignment with the rest of their body. So if they’ve got a really thick pillow on their next kind of kink this way, or they’ve got a thin pillow in their next kind of kink this way, depending on how they. That can create a lot of stress on the neck.
And we see kids who will come up and they can’t even, you know, they’ll come in and they can’t even move their neck because of, of the pain that they have from it. And the muscle spas, I mean, we have to work through physical therapy or, you know, chiropractic therapy can be helpful for this as well. Um, you know, massage heat.
Uh, and just kind of stretching to get that mobility back and it can sometimes take a couple of weeks for that to happen. So, so looking at how the child is sleeping and, and making sure that their neck is in good, their head is in good alignment to the rest of their body and their neck isn’t, kinked is really important.
Yeah. Have a good pillow, good height, depending what they sleep on their back or their side. For me, what I’ve seen both have sleep on their side has to be a little bit thicker than when they’re on their back. They’re pass a bit. Uh, it’s just a matter of knowing how your child prefers to sleep and making sure that their pillow is appropriate for whatever, whatever position they happen to be in the most commonly.
Yeah. That’s great. I agree. So thank you very much. We Hey, you’re welcome. Glad to help you and happy to do it. Good to share this, share your information with us. So,