Twenty-six minutes and 29 seconds: that is how long 15-year-old Grant Ketzle was without a heartbeat and the moment that his mother walked into the room at Cook Children’s Emergency Department – Prosper. Tiffany Ketzle saw her son lying on the treatment table, receiving chest compressions. As a nurse practitioner, she knew the magnitude of what those minutes meant and she recognized the level of care given to her son in one of the hardest moments of her life.

“Is my son alive?” It was a question she asked, but was hard to answer as the medical team performed CPR. Within minutes, the care team restored his heartbeat, however, it took more than four hours for Grant’s vitals to be stable enough to be flown via a Teddy Bear Transport helicopter to Cook Children’s Medical Center – Fort Worth.

It started that morning of Sept. 2, 2024, Labor Day weekend, when Grant was at football practice at Walnut Grove High School and he felt something wasn’t right. There were multiple times when he felt like he was going to pass out. He told an athletic trainer who was concerned and called his mother, Tiffany. 

Tiffany called her mother (Grant’s grandmother) who picked him up from practice and Tiffany gave her directions to Cook Children’s Emergency Department – Prosper. Grant felt like he was going to pass out and throw up during the car ride, but they made it. He passed out shortly after arriving and sitting in a wheelchair. 

Soon, Tiffany’s mother called her screaming and crying, telling Tiffany that Grant was coding. Tiffany, who was at work, grabbed her purse and keys as fast as she could, and a coworker drove her to the medical center.

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Grant Ketzle’s life was saved thanks to the quick actions of his family and the team at Cook Children’s Emergency Department - Prosper when he had a cardiac arrest.

“I just remember walking into the room where Grant was and the code clock said 26:29, which is an awfully long time to be coding,” Tiffany said. “He looked very pale, he did not look alive.”

Julio Castillo, M.D., Medical Director of Cook Children’s Emergency Department Prosper, debriefed with her and told her that when Grant arrived, his heart had stopped completely and he was in respiratory failure.

“What I just kept thinking is, No. 1, my child's not going to die today. This is not happening. And No. 2, I've been in his position as a nurse practitioner where I'm trying to tell a parent very terrible information,” Tiffany said. “And I just remember thinking he had such a grace about him and the things he had to tell me were awful, awful things. But he said it in such a kind and caring way.”

Grant had experienced blood clots in his lungs, strokes and acute respiratory distress syndrome (ARDS) which prevents the lungs from exchanging oxygen and carbon dioxide effectively. He was diagnosed with an incidental heart rhythm condition called Wolff-Parkinson-White Syndrome, which is an abnormal extra electrical pathway in his heart that he was born with.

Tiffany was not surprised to see so many people in Grant’s room, but what moved her was the compassion she received from the team members.

“That's what struck me the most about the ER is every single person in that room, you could tell they cared about my son. They were trying to do everything they could to keep him alive,” Tiffany said. “They were all very, very compassionate. From the nurses to all the doctors to the flight crew, every single person, including the security guard.”

Dr. Castillo said this was truly a team effort.

"This was a testament to the incredible skill and dedication of the team. From the moment Grant arrived, the response was swift and decisive,” Dr. Castillo said. “Every member of our team who was at the emergency department that day made a difference in this child’s life, whether they were clinical or non-clinical. To see this young man recover and return to his life is a profound reminder of the power of human resilience and the life-saving work we get to be a part of."

Tiffany shared a post about Grant’s experience on Facebook to share what they had gone through and to help raise awareness of the Cook Children’s Medical Center and Emergency Department in Prosper.

“I was very grateful for the care that we received there. Everyone there was top notch. We definitely wanted to get the word out that this resource of Cook Children’s is here,” Tiffany said. “If this had happened to my son two years ago, he would not be here. If this campus didn’t exist, he wouldn’t be here.”

“We're just very grateful that this campus is directly tied into Fort Worth. So within a 20-minute helicopter ride, you can get every resource that you need,” Tiffany said.

Recovery at Cook Children’s Medical Center – Fort Worth

When Grant arrived at the Pediatric Intensive Care Unit (PICU) of Fort Worth, Tiffany commended the communication and care from all the staff members. She said she truly felt like they were all one unit and was grateful for the involvement in his care.

“The first day was probably the worst day of our lives and as a parent, your worst fear is that your child is going to die,” Tiffany said. “It was such a horrible time in our lives... but somehow the staff just make it a little better, just to give some hope or grace. We got that every single day there.”

One of the great things about Cook Children’s is having easy access to a high level of care and specialists, Tiffany said. Within the first few hours of Grant arriving at Fort Worth, he was seen by many specialists, including gastroenterology, cardiology and pulmonology. Eventually, they also had appointments with hematology/oncology, nephrology and neurology. They were grateful that the specialties are also available in Prosper.

“They were able to coordinate a lot of the testing,” Tiffany said. “For example, he has an MRI coming up for his brain, he's got an ultrasound coming up and prior to this, we would have to go to Fort Worth to do those things. Well, now they can do those things here in Prosper.”

In the PICU, Grant was paralyzed because his respiratory condition was poor and he had a breathing tube placed. When Grant started to wake up after a day and a half, he made a heart shape with his two hands and pointed at the nurses. Even though he was unconscious while they spoke to him, he recognized their voices when he woke up.

As one nurse offered to wash his hair, Tiffany was impressed that she had all the tools and comfort items to wash his hair while he was in the ICU. Mom noticed that looking at his vitals, he became more relaxed as his hair was washed.

“It was wonderful to see people care for your child like you feel like they would care for their own,” Tiffany said. “That’s truly what it felt like.”

Grant was released from the medical center in Fort Worth on Sept. 11, and to the family’s surprise, Grant had recovered well enough to make it to homecoming at his school. Grant said this medical journey has brought him closer to his faith and that he hopes to use his story to encourage others to never give up.

“It was crazy to think how God works because I progressed so much in 10 days and on the final day I felt so much joy when I heard the words that we could go home,” Grant said. “What makes this place so special and unique is how kind and caring the staff are. They were amazing and they knew what to do. I trusted in God and all of them.”

Second Heart Incident

In late October, Grant went to the Cook Children’s Emergency Department - Prosper a second time when his heart caused him discomfort when he woke up in the middle of the night. He felt like his heartbeat was abnormal again.

The family rushed to the emergency department and his care team discovered that his heart was in a rare and dangerous arrhythmia called preexcited atrial fibrillation, which is associated with his Wolff-Parkinson-White syndrome. Through a telehealth visit at the emergency department, a Cook Children’s cardiologist in Fort Worth was able to identify his rare type of arrhythmia and the team at the emergency department in Prosper shocked his heart back into a normal rhythm.

He was flown to Cook Children’s Medical Center – Fort Worth where electrophysiology cardiologist Rohit Madani, M.D. cared for him. Dr. Madani performed an electrophysiology study in which he ablated the abnormal electrical pathway in his heart with a specialized catheter that burns heart tissue. Grant has recovered well from this procedure and Dr. Madani’s hope is that this will be a long-term cure for Grant’s arrhythmia.

“Grant at this point has the same risk of a heart event happening in the future as anybody else,” Tiffany said. “We’re very grateful.”

Friday night lights are beaming bright in high school football stadiums all across the country. Players are suited up, taped up and ready to rumble in an inherently unpredictable game where anything can happen. A turnover that shifts the momentum. A missed tackle that gives up a touchdown. A Hail Mary that wins the game. In football, only one thing is for sure — the risk of injury to players.

Among all high school sports, football ranks No. 1 in injury rates, according to a study published in the Orthopaedic Journal of Sports Medicine. It’s no surprise given the nature of the game, says Dan Guzman, M.D., an emergency medicine physician at Cook Children’s Medical Center – Fort Worth.

“It's a violent sport, and we know players are trained to go out and get that ball and hit hard,” Dr. Guzman said. “So we're going to, unfortunately, have injuries as a result of that aggressive play.”

In some cases, the results are tragic.

In 2023, the National Center for Catastrophic Sports Injuries reported 16 football-related deaths in its Annual Survey of Football Injury Research. Five deaths were at the college level, seven in high school, two in middle school and two in youth league. Three deaths were directly related to football and a result of a traumatic brain injury. Ten fatalities were classified as exertional/medical fatalities, which includes sudden cardiac arrest and heatstroke, that occured during football-related activity. 

In August, National Public Radio (NPR) reported that at least seven high school and middle school football players died during that month from head injuries or suspected heatstroke.

Tackling Trauma

Dr. Guzman has seen his fair share of football-related injuries in Cook Children’s Emergency Department. Most players visit the ER for orthopedic injuries of upper or lower extremities. Dr. Guzman suggests recent efforts to protect the head and neck from traumatic injury are leading to an increase in shoulder and arm injuries. Although these injuries can be serious and lead to loss of playing time, the trade-off is necessary to decrease the risk of traumatic brain injury or concussion, and to protect more critical areas of the body. 

“Coaches are teaching kids to not use their head and neck to initiate contact and, instead, use their shoulder, so I think we've seen a slight increase in the number of shoulder and clavicle injuries and shoulder separations,” Dr. Guzman said.

Not all injuries warrant a trip to the ER, but can have just as significant out of activity implications as their more serious counterparts. Bruises, sprains and strains are some of the most frequent injuries seen in football, according to Jeffrey Bass, MS, ATC, LAT, OPE-C, a licensed and board certified athletic trainer at Cook Children’s Orthopedics and Sports Medicine Walsh Ranch. Bass is also a football medical observer in the Big 12 Conference and a regular on the sidelines at high school football games, where he’s often referred to as “Doc” while he works to protect young athletes from injury.

“It’s a term of endearment based on the fact that the athletic trainer’s work can parallel that of a physician and because they can fill many roles, especially in rural areas,” he said. “The good news is I’ve never been confused with any of our local doctors, and I’ve never been asked to operate on anyone or deliver a baby.”

With 46 years of experience in the industry, Bass knows what makes a good football program, and a focus on player safety is at the top of his list.

“We know that about 95% of participants involved in competitive athletics are going to have a time loss injury,” Bass said. “It’s not a matter of if, it’s just when.”

With the risk of injury in competitive athletics so high, especially in a full-contact sport like football, it’s important that parents know that their child’s football program is ready and equipped to respond to an injury, be it minor or severe. We asked our experts to tell us what’s most important when it comes to player safety so parents can worry less and focus more on cheering their athlete into the endzone. 

What are the most important safety elements of a football program?

Be Prepared
Texas Senate Bill 82 outlines safety regulations for public school extracurricular activities. It mandates safety training for all coaches or athletic event sponsors, along with an emergency drill incorporating this training. It also requires that student athletes be provided training in recognizing symptoms of catastrophic injuries, such as head and neck injuries, concussion, heatstroke, and more. 

The University Interscholastic League (UIL) advises that schools have a detailed emergency action plan to respond to player and spectator medical emergencies during sporting events. Having a plan is the single most important element of a safe football program, according to Bass.

“It’s about having a plan in place, knowing that the likelihood of injury is going to be well above 50% to at least one player,” Bass said. “Do I have the necessary equipment? Do we have splints? Does someone have a phone to call 911? Do we have an AED? Who will make sure gates are unlocked for the ambulance? Do I have the processes in place to deal with an emergency? If we don't have EMS on site, how is that going to change our approach to the need of care and transport? If I'm trying to do it on the fly when everybody's excited, that is not the ideal time to be discussing these things.”

Prioritize Professionals
“Whether it's basketball, football, baseball or any other sport, parents need to know, not just assume, that in the event medical care is needed, there is somebody there that's qualified to care for their child,” Bass said. “We realize there are differences, obviously, between the larger public schools with more established programs and smaller or private school programs, but it’s still full-contact tackle football, and it doesn't make any difference what level that it's played at. You still need to know who is there to care for your child if they are injured.”

In addition to physicians, board certified athletic trainers like Bass often serve as a team’s chief medical professional both on the sideline and in the locker room. Athletic trainers are allied health professionals who specialize in injury prevention, assessment, diagnosis, care and rehabilitation for athletes.

But not all schools have the resources to have a physician or athletic trainer on the sideline for every game. In this case, someone trained in basic CPR should be present, Dr. Guzman says.

“That's the most lifesaving part of this entire conversation,” Dr. Guzman said. “If a player goes down who's unresponsive for whatever reason, then someone can start and initiate CPR within seconds.”

As a Project ADAM partner, Cook Children’s is helping more that 530 schools in North Texas become “Heart Safe” by training school staff and coaches on CPR, how to use an automated external defibrillator (AED) and how to create an emergency plan.

What can parents do to help protect their athletes?

Stay Informed
Ask questions and communicate openly with coaching staff about their protocols in the event of an injury. With a concussion, for example, understand how your player will be evaluated on the sideline. Who and what will determine if they are or are not ready to go back into the game? Going back too soon, Dr. Guzman says, can lead to a traumatic brain injury.

“It’s really important to have that open door communication with the school and coaching staff, " Dr. Guzman said. “Make sure that all those things are in place to keep our kids safe. Don't just think that it's being taken care of. The state of Texas does a pretty good job of making sure that there are lots of protocols in place to keep kids safe, whether it's in the school or at these events, but I think we still need to be a part of that conversation as parents.”

Stay Alert
Kids don’t always speak up when they are hurt for fear of being benched or considered weak. Committed players will often try to tough it out, and that’s not always best for their health. Playing with an injury can lead to a more serious complication that ultimately increases an athlete's time away from the game.

“Parents have to watch for those subtle changes in their children,” Dr. Guzman said. “Whether they're walking a little differently or they're not picking up their backpack the same way.”

Bass says part of his role as an athletic trainer is to educate players about what their body is telling them, and to help them understand the process for getting them through that injury and back in the game.

“I tell them it’s how we deal with injury that ultimately determines the character of what kind of player we’re going to be,” Bass said. “So if we have something that is swollen, that is uncomfortable and just doesn't look the way it should, that's something we need to have evaluated.”

When an injury does occur, the John and Tracy Sellers Sports Complex at Cook Children’s Orthopedics and Sports Medicine Walsh Ranch, helps young athletes get back in the game with training and rehabilitation services. The Sellers Sports Complex also offers injury prevention programs and sport and position-specific training led by certified athletic trainers.

For more on this and health and safety tips for young athletes, click on the links below.

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Buffalo Bills defensive back Damar Hamlin suffered cardiac arrest after a hit during Monday evening’s game. The Bills said in a statement that he was given CPR on the field and his heartbeat was restored. On Tuesday, the Bills said Hamlin was in critical condition.

This incident stunned the sports world and community at large, and reiterates the importance of being prepared for a cardiac emergency, especially in sports and school settings, with CPR and an AED.

More than 530 schools in North Texas have partnered with Project ADAM at Cook Children’s to become a “Heart Safe” school. The program trains school staff members on CPR, how to use an automated external defibrillator (AED), and helps create an emergency plan. It also provides resources and support to become a Heart Safe school, which is renewed every year through training and requirements. Project ADAM is a free resource to schools and the community.

The likelihood of sudden cardiac arrest in children and young athletes is known to be enhanced by athletic participation. On average, a seemingly healthy young person suffers a sudden cardiac arrest every three days in the U.S. and it's the leading cause of death in exercising young athletes.

Athletic personnel need to recognize the threat to young athletes and properly prepare for sudden cardiac arrest. Every school or organization that sponsors athletic activities should have an AED, trained coaches, and written Emergency Action Plan.

Cardiac emergency preparedness training empowers people to use the AED device. Texas requires all schools to have an AED, but often people don’t know where it is located, how to use it in an emergency or rely solely on the school nurse to use the device.

Danielle Moyé, M.D., pediatric cardiologist and physician director for Project ADAM at Cook Children’s, encourages schools, parents and the community to see the large impact an AED and CPR can make on a person’s life if utilized effectively. She shared answers for a few common questions.

What causes cardiac arrest?

Cardiac arrest can be caused by different factors. In an exercise setting, cardiac arrest occurs secondary to an arrhythmia which prevents adequate circulation and perfusion of blood and oxygen to the brain and body.

Why is it important to quickly respond to cardiac arrest? How does it affect the person’s outcome?

Timing is of utmost importance when it comes to cardiac arrest. The rhythm that one is in during cardiac arrest is not a perfusing (pump) rhythm. This means that there is not adequate oxygen and blood flow to the brain and body. Restoring sinus rhythm is critical to prevent irreversible organ damage.

When do you use an AED vs administering CPR?

CPR should be administered as soon as a person is found down without a pulse. While awaiting an AED, appropriate CPR can result in continued blood flow and perfusion that the heart is not doing on its own.

Once an AED is available, pads should be placed on an individual’s chest and once turned on, CPR may be paused briefly while the AED is assessing the underlying rhythm. If the person has a shockable rhythm, the AED will recommend delivery of a shock which can restore sinus rhythm. This is a lifesaving device that the world should know about and everyone should familiarize themselves with.

What should parents and caregivers be aware of if their child participates in sports and other physical extracurricular activities?

As mentioned above, parents and caregivers need to be aware of sudden cardiac arrest. They should encourage the schools and sporting facilities to be aware of the risk, have respect for this risk, and arm themselves with knowledge on good CPR, the locations of AEDs, and have an emergency action plan in place should one need it.

What do you see as a cardiologist that you wish more people knew about?

I unfortunately, have seen many episodes of cardiac arrest associated with exertion and at rest. The patients that have the best outcome are those who had a prompt intervention with an AED. I wish every school and every facility had an AED in place and a team dedicated to responding to these types of emergencies.

Sign and symptoms of pediatric heart disease

Sudden cardiac arrest (SCA) is when the heart suddenly and unexpectedly stops beating. SCA often occurs in active people with no history of heart conditions. In children, common causes are genetic, congenital or related to a sudden blow to the chest. If treated quickly, using an automated external defibrillator (AED), it is possible to restart the heart and increase the chances of survival.

Pediatric heart disease has warning signs and symptoms that can go unnoticed. It is important to recognize the following:

• Fainting or near-fainting during or after exercise, emotion or surprise
• Dizziness or lightheadedness
• Extreme fatigue associated with exercise
• Extreme shortness of breath associated with exercise
• Discomfort, pain or pressure in chest during or after exercise
• Skipping or racing heartbeats
• High blood pressure
• Congenital heart abnormality
• Family history of sudden death prior to age 50 or known heart abnormalities

Not all episodes of sudden cardiac arrest are preventable because many of the kids do not have symptoms until they have the episode. For this reason, secondary prevention strategies are important.

About Project ADAM

Project ADAM, which is nonprofit and nationwide, aims to educate school systems, nurses, coaches, trainers, parents and others about pediatric sudden cardiac death and to establish emergency programs to help provide a timely and lifesaving response as emergency medical services are on their way to an incident.

Project ADAM was started in 1999 after a 17-year-old Wisconsin student named Adam Lemel collapsed and died while playing basketball. His parents helped start the Project ADAM program at the Children’s Hospital of Wisconsin in his memory. Cook Children’s is one of 35 hospitals and program sites providing free cardiac resources, including training and AED devices.

RELATED: How to Become a Heart Safe School

Videos:

• Chapter 1: The Adam in Project ADAM
• Chapter 2: Understanding Sudden Cardiac Arrest
• Chapter 3: Being Prepared in a Cardiac Emergency
• Chapter 4: Implementing Project ADAM in Your School
• AED Drill
• Learn How to Save a Life using an AED and Hands Only CPR!

Heat illness during sports practice or competition is among the leading causes of death in the U.S. for high school athletes, according to the Centers for Disease Control and Prevention (CDC). Scorching summer sun and high temperatures put athletes at increased risk for heat illness, no matter their fitness level. 

Coaches and directors of marching bands are currently conducting practices, rehearsals and scrimmages ahead of football season. This summer, North Texas experienced lengthy stretches of triple-digit temperatures and drought. Rainy days have tampered down the heat, but the humidity is still high.

Students’ primary preparation begins with hydration – not just during and after practice. Drinking water and clear liquids must begin hours, even a day, before the exercise and exertion, said Jason Terk, M.D. of Cook Children’s Pediatrics Keller Parkway.

“If you're not dealing with a full tank, you are not going to be able to catch up or keep up,” Dr. Terk said. “Those leading the practices must also build in enough breaks for rest, shade and hydration.”

Keeping pace with science and research, the University Interscholastic League (UIL) sets guidelines around heat stress and athletic participation for high schools. Their recommendations follow research from the American Academy of Pediatrics Committee on Sports Medicine. UIL now recommends water availability for athletes in unlimited quantities. Cold water is best. Additionally, practice schedules should include 10-minute water breaks for every 20-30 minutes of exercise in the heat.

Dr. Terk is a self-proclaimed marching band nerd and is an unofficial chaperone for Keller High School’s marching band.

Guidelines Make Sense

“In 15 years of doing this, the last nine of them at Keller High School, I have no reported heat-related emergencies,” said Ryan Heath, director of the marching band.

There are two parts to Heath’s preparation for marching season, the music-only rehearsals indoors and the music-plus-marching outside.

“Our district has great guidelines related to temperatures and that dictates what our hours are,” Heath said. “We work to schedule the outdoor part in early morning or in the evening before sundown.”  

Keller Independent School District bases decisions on the National Weather Service’s Wet Bulb Globe Temperature Forecast. Its measurements can help manage workload in direct sunlight and capture temperature, humidity, wind speed, sun angle, and cloud cover (solar radiation). Many of us are more familiar with the “heat index” that only measures temperature and humidity, and does so in the shade.  

Heath starts the discussion with his students in the spring, about summer training for the fall marching band season. When rehearsals get underway, he expects students to have done enough summer activity so they can complete a one-mile run in 10 minutes. Heath says the measurement ensures band students have the cardiovascular endurance required, to play an instrument successfully and march simultaneously. He came up with it after consulting medical professionals and other  experts.

“We don’t have a certain training regimen,” Heath said. “But this is an athletic activity as much as sports and my expectation of participants is they maintain good physical health and stay hydrated.”

For safety precautions, he requires students to have a hat, sunglasses, a gallon of water, and sunscreen when they report for outdoor marching rehearsals. Without those, they cannot participate. He also says, during the first weeks of marching practice many parents show up with extra pop-up tents, ice packs and more water to help monitor students’ response to the heat. Many of the parents are doctors, nurses, nurse practitioners and others with professional expertise.   

Ease Into Practice  

“I played high school football and we practiced for three hours with one water break,” said Daniel Guzman, M.D., pediatric emergency medicine physician with Cook Children’s Medical Center. “I’m happy to see that we have advanced from the archaic ‘it will toughen you up’ to water breaks are important for players’ safety.”

Dr. Guzman’s youth sports career included summer practices in South Texas. He knows now just how dangerous it was and how preventable heat emergencies are.

“Exertional heat illness is one of the leading causes of death each year. Parents need to be aware and informed about their children’s practice schedules and the team’s policy on modifications of practice depending on the level of heat that day,” Dr. Guzman said. “At what temperatures do we modify our practice schedule?  It is within a parents’ right to know what these policies are and what are children being taught about rest and hydration to keep them safe.”

Dr. Guzman says coaches and band directors can help student athletes by acclimatizing to heat during the first seven to 14 days of practice. He says athletes can become more heat tolerant, but are never out of danger. Coaches should be careful and watch closely, while athletes need to self-restrict activity if they begin feeling badly – the sooner the better – to avoid emergencies.

“It’s important to be careful when pushing these young athletes to their limit and be mindful that most kids won’t say they feel bad or need to stop,” Dr. Guzman said.

Early Warnings

What are the earliest signs of heat illness? Dr. Guzman says it usually begins with muscle cramps, lightheadedness, headache, abdominal cramps and nausea. If you ignore these early signs, your condition could become emergent quickly. If you are too sweaty and looking pale, Dr. Guzman says that means it is time to get in the shade and drink something with electrolytes, like a chilled sports drink, to replace salts. It’s really important to treat the symptoms quickly, especially if the athlete is confused.

The color of urine is a good monitor for sufficient hydration. Dr. Guzman says it should be clear and not dark. If urine begins to look brown, red or tea-colored, there could be serious issues underway, like the medical condition called rhabdomyolysis (rhabdo). Rhabdo occurs when injured muscle tissue breaks down rapidly and releases proteins and electrolytes into the bloodstream. In large amounts, the substances can damage kidneys and other organs, cause rapid heart rate and even death.  

“The process makes the blood sluggish. Everything just aches and patients often say it’s too painful to move, they have achiness everywhere, flu-like discomfort,” Dr. Guzman said. “Kids can complain of feeling sluggish and weak. They should skip practice if this occurs and seek medical attention.”

Athletes that have dark-colored urine with or without any other symptoms should consider it a significant cause for concern. Blood tests can measure the level of substances released into the blood stream to diagnose rhabdo. One measurement important to Dr. Guzman is creatine kinase (CK). Normal ranges can vary among patient populations. Generally, he wants to see it under 300-350 micrograms per liter (mg/L). In the emergency department, he has seen patients whose CK is 1,000-2,000 mg/L range and he recalls one athlete with over 10,000 mg/L.

“The treatment is to continue IV hydration two times the normal amount until the patient feels better and the creatine kinase begins to decrease to normal levels,” Dr. Guzman said “Big muscular kids are the ones that concern us the most. Working out vigorously can break down all that muscle and create a dangerous situation.”

Avoiding heat illness among sport and marching-band athletes is a group effort among coaches, band directors, parents and kids. Respecting any outdoor activity for the possibilities and concerns related to heat stress is vital to the safety of student participants. Be cool this summer – literally!

Early Signs of Heat Stress

• Muscle cramps
• Lightheadedness
• Headache
• Abdominal cramps
• Nausea

Reminders for Athletes and Parents

• Monitor your body’s need for water or cooling breaks.
• Avoid worrying about being the ‘weak link.’
• It is okay to say, “I can't go anymore.”

RELATED: The Facts About Fainting in Children (checkupnewsroom.com)

A recent Seton Hall Sports Poll shows 25% of Americans say they will hold or attend a party for the big game. According to Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children's, it is important to avoid large gatherings, even if you’re vaccinated.

“The COVID-19 vaccine is not a green light to get together with people,” Dr. Whitworth said. “If you’ve had the immunization, you can still get an asymptomatic infection and transmit it to others.”

Cook Children’s Medical Center is finally seeing lower numbers of COVID-19 patients after record hospitalizations and positive test numbers in December and January. The percentage of COVID-19 tests administered by Cook Children’s that are coming back positive is under 10%, which is a great improvement.

Dr. Whitworth says more good news is on the horizon. Vaccine rates are going up, and community spread of the disease is declining.

“The more people do their part, the sooner everyone can have large gatherings and celebrate with loved ones,” she said.

COVID-19 can spread from people who are symptomatic or asymptomatic by secretions coming from the nose and mouth. As you exhale, talk, yell, etc., those secretions fall within six feet of you. This is why it’s so important to stay six feet apart from others, wash your hands and wear a mask. When people are yelling at the TV or taking a break to eat or drink, there is always a possibility of spreading COVID-19. Dr. Whitworth reminds everyone, “Cloth, paper or N95 masks keep secretions in so you don't share germs with others around you.”

Although we can’t celebrate like years past, there are alternatives for large indoor gatherings, such as hosting a virtual party or starting a group text thread. These options allow us to enjoy the action with other fans while keeping distance and remaining safe.

As more COVID-19 vaccinations become available, health officials urge everyone to take the same precautions whether fully vaccinated or not. Dr. Whitworth says if everyone gathering is vaccinated, it’s safer, however, the vaccine is only about 95% effective. There’s still a chance someone could get sick.

While some may argue having a gathering in their home is safer than going out in public, Dr. Whitworth says any gathering comes with risks.

“A public place could have an influx of people with no masks and closed doors, and that is a high-risk environment,” she said.

The best way to protect yourself is to celebrate with those you live with.

It is also important to understand COVID-19 testing does not predict the future. If everyone gets tested before a gathering, the risk is lower because you can exclude those who test positive. However, you can test negative one day and transmit the virus the next day. While taking a COVID-19 test could lower the risk, it’s not the best indicator for a gathering.

Dr. Whitworth urges everyone to remain hopeful and to remember that we are getting closer to celebrations like Super Bowl parties, holidays, and birthday celebrations.

“As I've heard one of our scientists say, ‘The months ahead look a lot better than the weeks ahead and vaccine rates are going up everywhere,’” Dr. Whitworth said.

For more information on safer ways to enjoy the Super Bowl, visit the CDC’s website.

"Should my child play football?"

"Should my child play football?"

You may be asking yourself this question with all the recent news about the dangers of chronic traumatic encephalopathy or CTE. A study in the most recent Journal of the American Medical Association (JAMA) found that 110 of 111 NFL players whose brains were studied after their deaths showed they had CTE. CTE is a disease that gets worse over time, affects the brain and is linked to frequent head trauma. CTE is not related to just concussive hits, but repetitive sub-concussive trauma as well. Symptoms of CTE can present as trouble with mental tasks, changes in mood and or behavior.

CTE findings were mainly present in the athletes from the professional level however they were present in both high school and college athletes as well. The study had some limits in that there were some potential biases in choosing the participants from the professional level. As the families of these professional athletes may have notice symptoms while the athlete was still alive, motivating them to donate the athlete’s brain to the study. The study also does not represent the whole group of athletes exposed to football at the college or professional levels.

Now you ask yourself, does this carry over to our middle school and high school football players? Well sadly at this time we still don’t have all the answers and more studies need to be done, but this helpful information going forward.

The Centers for Disease Control and Prevention (CDC) estimates 1.6 million to 3.8 million concussions each year.

So should your child be playing football or any contact sport for that matter?

While the war on concussions is alive and well, the scariest part is that our youth are the ones most susceptible. But what do we do with our youth in the meantime? As parents, you are the ones that ultimately decide what activity your child plays.

I am not recommending that you pull your children out of football or that football shouldn’t exist. As someone that helps treat children with post-concussive symptoms, I urge you to at least educate yourself on the sport your child is asking to play or you are asking your child to play. Here are five questions you should be asking…

1. What is a concussion and how do they happen?

A concussion is an injury to the brain that comes from a hit, a fall or an injury that shakes/ jars the head. Concussions are not only football injuries. They can happen in any sport or in daily life.

2. What can I do to be proactive?!

• Put the safety of your child ahead of winning.
• Make sure the coach is teaching the correct fundamentals.
• Proper tackling form can diminish the likelihood your child will hit their head.
• Helmets are not weapons.
• Despite claims, no helmet has been proven to prevent concussions.

3. What does a concussion look like?

Concussions are injuries to the brain and they are not injuries that you should play through.

Concussions can present in many different ways. The most important thing to watch for is if your child is not acting like his or her normal self. Children may also present or complain of:

• Vision changes - such as sensitivity to light and intolerance to reading.
• Dizziness/ Vertigo.
• Memory loss.
• Loss of consciousness (Fainting).
• Vomiting.
• Changes in mood.
• Lowered attention span.
• Changes in hearing and balance.

4. When should we seek help?

• If there is any sign of concussion you should seek immediate medical attention.
• Any suspicion of a concussion should be treated as a concussion until proven otherwise.
• Find a sports medicine physician that specializes in concussion management to ensure that signs and symptoms are not missed.

5. Who else can help treat the symptoms of concussions?

Concussions may require an overall specialized, team approach:

• Physician to make sure there's nothing more serious going on and to manage the care of the patient.
• Speech and Language pathologist – can help with memory, organization skills and higher level language skills.
• Audiologist - to help with hearing and balance.
• Occupational Therapist- can help if patients have trouble using their hands, writing in school or visual/ spacial management.
• Physical Therapist- can help balance, dizziness and safely return to sport.
• Ophthalmologist- can help with visual problems.

Click to learn more about Cook Children’s ImPACT program.

Other Resources:

• Impact Concussion Management
• What every parent needs to know about concussions
• Helmets Don't Prevent Concussions
• SPORTS resources
• Cheerleader injuries

Our Experts:

Ryan Blankenship, PT, MPT, SCS, is a SPORTS physical therapist at Cook Children’s. Cook Children’s SPORTS Rehab is a leader in the community in sports injury. Additional information and helpful tips can be found on the Cook Children’s SPORTS Rehab website. Cook Children’s SPORTS Rehab is a leader in the community in sports injury prevention.

Ricardo Guirola, M.D., specializes in Rheumatology and Sports Medicine. Dr. Guirola takes care of athletes and being part of their active and directed therapy. As part of his education, Dr. Guirola obtained a Master's of Education. He uses those skills to teach families, students, residents, nurses and other physicians. Outside of his medical practice, Dr. Guirola spends times with family, runs and plays soccer and tennis.

Contributing Author

Alan Littenberg, PT, DPT, is a sports physical therapist at Cook Children’s SPORTS Rehab. At Cook Children’s, our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete’s bones, muscles, body and mind to get your child back on the field as safely and fast as possible

While it’s a fun time of year that many student-athletes look forward to, it's also time to freshen up on our knowledge about concussions so that we don’t put our kids at risk for severe long-term symptoms.

Mismanaged concussions can lead to severe headaches or a prolonged feeling of “fogginess” which can harm our athletes’ ability to learn. And it’s not just high school football players we need to be concerned about. Any athlete can suffer a concussion, including young children. 

So what should parents know? 

A recent study in Pediatrics looked at how long it took for athletes to recover following on a concussion depending upon rather they returned to play or were immediatly removed from the game. Those who went back in to play were nearly 9x as likely to suffer symptoms for more than 21 days. They also had worse scores on neurologic testing and had more severe symptoms than those that were removed.

Not removing an athlete from play is not the only mistake that parents and sports teams can make in regards to concussion management.

Here are 8 ways that parents and sports teams mismanage concussions that could be putting kids at risk:

1)They don’t recognize that a concussion has happened. If you notice a hard hit or hit to the head and see any of the following: headache, confusion, memory loss, nausea or vomiting or excessive fatigue, you have to assume it was a concussion until proven otherwise. If you notice any of those symptoms during an athletic event, even without an observed injury, you should still be very concerned. You don’t have to lose consciousness for it to be a concussion.

2)They trust the athlete to report their symptoms. Highly motivated student athletes know better than to report all of their symptoms because they know that it will get them removed from play. If you notice a hit and see the athlete acting different in any way, you must consider that a concussion despite the fact that they may say that they are “fine.”

3)They insist on a trip to the ER after a concussion. Most concussions can be handled by the trainer in conjunction with a doctor who has some advanced knowledge of concussion management. If the child is conscious and alert enough to talk with you, it can probably wait until the next day as long symptoms aren’t worsening or the athlete’s alertness isn’t decreasing. All that said, if you are worried about the athlete’s symptoms, go to the ER.

4)They insist on head imaging (CT or MRI) after a concussion. Head imaging is usually not necessary after a concussion assuming that symptoms are steadily improving over time. Remember that a head CT does involve radiation so minimizing its use is important.

5)They let the athlete return to play in the same game. As the study above mentions, this can be devastating to the child’s recovery. Prolonged and severe symptoms may be the result, leading to impairment for school work and a longer time to return to the sport.

6)They wake the child up overnight to check them after a concussion. This old teaching is one that still hangs on in the parent and trainer community despite a lack of evidence that it helps in any way. In fact, because rest is commonly what a concussed athlete needs, it could theoretically recovery worse. Would I walk in a few times at night and check on my son if he had a concussion? Sure, but I wouldn’t wake him up to give him a mental status exam.

7)They allow the student to participate in school activities too soon. After concussions, it’s not uncommon for students to need a slow return back to full activities, including school work. I don’t like this time period to be too long, but a couple days of half schoolwork might be necessary. You should work with a doctor who is able to fine-tune the play for your child.

8)They allow the athlete back into the sport too soon. An athlete that has had symptoms of concussion should not return to exercise until they are completely symptom free. If their main symptom is headache, they should be headache free before returning to light exercise, moderate exercise, sport specific practice and finally games. If symptoms return at any of those steps, they must step back to the previous level of activity until symptoms are gone. Again, working with a trainer and doctor who understand return to play protocols is critical to keeping your child safe.

Watching your student-athlete closely after a concussion, removing them from play the minute you notice symptoms and being cautious with their return to play will protect them from prolonged symptoms. It is critical that we remember that they are students first and that not protecting them after a concussion can result in prolonged impairment from school work.

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Dr. Guirola is one of the select group of Cook Children’s doctors who have undergone and completed rigorous training to earn ImPACT credentials. Used by the world’s leading sports authorities, ImPACT is the most widely recognized science-based concussion and evaluation program available today. Cook Children’s has 26 credentialed doctors in nine locations to evaluate a child’s progress on returning to the playing field.

“There’s no evidence that helmets alter concussion risk for young football players,” said Ricardo Guirola, M.D., M.Ed., who specializes in sports medicine. “Helmets do play a protective role in decreasing the risk of fractures, intracranial injuries and oral injuries.”

The recalled helmets were manufactured by Xenith and the U.S. Consumer Product Safety Commission reports that the shells of the helmets can crack, posing a risk of head injuries. Xenith has released a statement saying they have corrected the issue on all helmets manufactured since March 2016. The serial number is printed on a white sticker inside the top of the helmet. For a list of the serial numbers included, visit www.xenith.com/recall.

Along with helmets, Dr. Guirola says young athletes shouldn’t depend on helmet attachments with claims of protecting from head injuries such as bumpers, pads and sensors.

“At this time, there have been no well-controlled studies show that helmets or third-party attachments prevent or reduce the severity of concussions,” Dr. Guirola said.

Awareness regarding the potential negative effects of concussions has increased dramatically in recent years, said Carla Hearl Morton, Ph.D., a pediatric neuropsychologist and also a member of the ImPACT program.

“As we learn more about concussions, guidelines for how best to treat athletes continue to evolve,” Morton said. “Most athletic trainers and coaches have completed several hours of education regarding how to manage a concussion immediately after it occurs. Regardless of any recommendations they may provide, it is a good idea to notify your child’s primary care physician so that his or her doctor can document the concussion in your child’s medical record, provide guidance in the acute phase of recovery, and better coordinate care if symptoms persist.”

To learn more about Cook Children’s ImPACT program, click here.

About the source

Ricardo Guirola, M.D., specializes in Rheumatology and Sports Medicine. Dr. Guirola takes care of athletes and being part of their active and directed therapy. As part of his education, Dr. Guirola obtained a Master's of Education. He uses those skills to teach families, students, residents, nurses and other physicians. Outside of his medical practice, Dr. Guirola spends times with family, runs and plays soccer and tennis.

If you have paid attention to football over the last several years you know that there have been many rule changes geared toward preventing concussions.

Most of these rule changes have been spurred on by a huge law suit that was brought against the NFL by a large group of former players, in which the NFL will wind up having to pay out more than 1 billion dollars. The bottom line and what is portrayed in the movie is that there was research that brought into question the harmful effects of repetitive head trauma related to football. The NFL rather than looking into this and aiding this research in an effort to find out more, put its efforts into discrediting the research and trying to cover their own interests.

The research they were trying to discredit dealt with the autopsies done on the brains of former NFL players that displayed a condition called Chronic Traumatic Encephalopathy or CTE. CTE is a progressive degenerative disease found in people who have suffered repetitive brain trauma, including sub-concussive hits to the head that do not cause immediate symptoms.

Individuals with CTE may show early symptoms of dementia, such as memory loss, aggression, confusion, and depression. Just this past week Ken Stabler former Super Bowl winning quarter back for the Oakland Raiders who played 15 years in the NFL and who died in July was found to have stage 3 CTE.

While there is much more research that needs to be done to fully understand the potential long term effect of concussions and repetitive head trauma the current evidence can’t be ignored. One of the scariest things about concussions is how much we don’t know.

While the NFL is portrayed in a pretty bad light in the movie, in their defense I don’t think they reacted much differently to concussions than the majority of the population does. For the longest time I think a lot of people (myself included) had the attitude of “Oh it’s just a concussion.”

Working with concussion patients in clinic I have heard parents say, “I played football and got a few concussions I didn’t realize that it was a big deal.”

There are many athletes who might get a concussion, recover well and never have any other problems, but there are also patients who have an extremely difficult time recovering. We see patients take months to recover and report constant headaches, dizziness, blurred vision, difficulty concentrating in school, and mood swings.

We have seen patients whose parents report a complete change in their personality where they are much more angry and aggressive than they were before the injury. The scary thing is we don’t know how a person is going to react after a concussion, or how many concussions are too many, or if the repetitive sub-concussive trauma that they sustain is enough to cause problems later in life.

I played football when I was younger. I’m not coming out against playing football, but when I played you couldn’t start playing tackle until your eighth grade year which means 13-14 years old. We have to remember that elementary age through high school kids still have brains that are developing and we need to protect them.

The longer they play full contact football the more hits and more traumas they are exposed to, so I think we need to pay close attention to when we let our kids start playing tackle football. We also need to keep a close eye on how our kids recover if they do sustain a concussion. The longer and more difficult a patient’s recovery is the first time they have an injury, the more likely they will have a long, difficult recovery if they sustained another concussion.

Finally, how many concussions are too many? The answer is we don’t know for sure. What we do know is that concussions are mild traumatic brain injuries. We also know that CTE is a condition found in people who have suffered repetitive brain trauma. So how many concussions constitute “repetitive trauma?” That is a question we cannot answer for sure, but one that I think parents should think long and hard about before letting their kids back on the field.

SPORTS resources:

• The Cook Children's SPORTS program
• Football injury prevention
• What every parent should know about concussions
• There's no such thing as 'just' having your bell rung
• Top 10 questions parents have about sports injuries
• Injury Prevention Guide
• Strength training in children/adolescents
• Young athlete's injury prevention guide
• Rise of overuse injuries in school-age athletes
• The basics of sports injury prevention for kids
• Preventing children's sports injuries
• Pain that won't go away

“My daughter plays select soccer and can’t afford to take any time off for her injury without the risk of losing her starting position on the team.”

Statements like this are commonplace in my world as a sports physical therapist. And while I genuinely believe that parents and coaches have their minds in the right place when it comes to wanting their child to be the best, the idea that this means you must specialize in your sport early in life is not supported.

Early sport specialization is defined as choosing to play only one sport, often without any breaks during the calendar year, while the body is still changing and growing.

As we are in the thick of another year of the NCAA college football national championship and bowl games, let’s revisit last year’s undisputed national champions as an example of one sport vs. multiple sport athletes. In early 2015, a social media post went viral detailing Urban Meyer’s recruiting record during his time as head football coach at Ohio State. Of his total of 47 recruits, 42 were multisport athletes in high school. Only 5 of his recruits played football alone.

Did you know?:

• Three-time Super Bowl champion, NFL Hall of Famer and Dallas Cowboys Ring of Honor inductee Troy Aikman played shortstop and pitched on his high school baseball team. He was drafted by the New York Mets out of high school and came close to choosing baseball over attending the University of Oklahoma, and later UCLA, to play football.
• Two-time women’s soccer Olympic gold medalist and 2012 FIFA World Player of the Year Abby Wambach credits her success as a soccer player to playing basketball in her youth.
• Eight-time NBA All Star and two-time NBA MVP Steve Nash did not start playing basketball until he was 12 or 13 and instead thanks his soccer background for his success in basketball.
• Six-time MLB All-Star Joe Mauer of the Minnesota Twins played football, basketball, and baseball in high school and was named USA Today High School Player of the Year in multiple sports.

An athlete like Tiger Woods, who started playing golf before the age of 2, is an extremely rare occurrence. It is by no means the norm and should not be expected.

In theory, specializing makes sense. After all, practice makes perfect, right? Wrong! In reality, research has shown the following:

Early specialization leads to overuse injuries.

More and more orthopedic experts are speaking out to shine light on the world of pediatric sports injuries. They have become increasingly alarmed by the skyrocketing rates of injuries in kids and some go so far as to describe it as an epidemic. Each year, roughly 3.5 million children, 14 years of age and younger seek medical treatment for sports injuries.

Of these, at least half can be attributed to overuse injuries. Repetitive activity leads to increased stresses on a growing child’s bones and muscles and can result in injuries such as Little League elbow, Little League shoulder, shin splints, Sever’s disease, Osgood-Schlatter disease, runner’s knee, jumper’s knee, or even stress fractures in areas like the back (spondylolysis or spondylolisthesis), hips, and feet.

So what’s the first line of prevention? Rest. Children should have at least two months off each year to recover from their specific sport. And if we’re talking about baseball, it’s recommended for those athletes to have three to four months of absolutely no throwing or overhead sports.

Early specialization interferes with healthy growth and development.

Playing a competitive sport is stressful, and just as the body must adapt to the changes and demands physically, handling the stresses around winning, losing, practice schedules, traveling, etc… in addition to regular schoolwork can be emotionally draining as well. Children may also struggle with identity and view themselves as solely an athlete. Playing a wide range of sports promotes diverse relationships and allows for a wide variety of experiences.

Early specialization increases the risk of burnout.

Playing only one sport, especially at a competitive or select level, can lead to burnout as a result of stress and physical and emotional demands. A history of injuries can also increase that anxiety. If a sport stops being fun or a child feels pressured to succeed, it can certainly lead to a desire to quit.

Early specialization reduces the chance that children will maintain an active lifestyle as an adult.

In 2013, researchers from The Ohio State University released a study that found that children who specialized in one sport early in life were more likely to be inactive as adults. Committing to a certain sport at too young of an age can lead to early burnout, quitting, and being reluctant to then rejoin physical activities as an adult. A history of injuries also contributes to an aversion towards exercise and a preference for a sedentary lifestyle.

Early specialization doesn’t guarantee future athletic success.

Consider these statistics from the NCAA regarding athletes during the 2013-2014 school year.

                              Estimated Probability of Playing in College

                           Estimated Probability of Playing Professionally

When you look at the numbers, the odds of playing a sport in college and especially professionally just aren’t in your favor.

So what does this mean for our kids?

• No, we shouldn’t put them in a bubble and shield them from sports. Athletic activity is extremely important.
• Children should learn the fundamentals of various sports and enjoy the experience.
• Sports should be fun at every age.
• Sports should create positive habits for later in life.
• Sports shouldn’t cause repetitive injury.

And if your child happens to be one of the lucky few who go on to play in college or even professionally, a history of playing multiple sports is clearly of great benefit.

About the author

Melissa Bro, PT, DPT, SCS, is a physical therapist for the Cook Children's SPORTS Rehab program. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind. As a part of Cook Children's integrated pediatric health care system, our patients have access to a multitude of pediatric specialty areas with board certified doctors, as well as laboratory services, nutritional consultations and sports medicine counseling.

Dr. Rogers, a Cook Children’s pediatrician, was in the stands with her family on Saturday, watching TCU’s incredible triple overtime 47-41 victory against Oregon in the Alamo Bowl in San Antonio.

During the dramatic second-half comeback, Dr. Rogers knew right away that her celebration while the Frogs were on offense drew the attention of ESPN’s national broadcast because her phone began blowing up with text messages.

But then, she went viral.

The website sbnation.com posted a GIF of Dr. Rogers celebrating and her daughter Dianna, 20 and a TCU sophomore, calming her mom down. After all, you don’t cheer while your team’s offense is on the field, right?

“It’s hard for fans to be quiet when your team is making a 2^nd half comeback, thanks in part, to Gary Patterson’s change of shirt,” is how the website described Dr. Rogers’ celebration. “This TCU lady is one of those fans, and her fellow TCU fans quickly reminded her that **whispers** you gotta stay quiet when your offense is on the field.”

So how does this "TCU lady" feel about going viral?

“A little freaked out, but it’s also pretty funny,” Dr. Rogers said. “Especially since I’m not on any of those things where people watch those videos like Facebook or Twitter. It kind of weirded me out a little because we are there at a football game and then the next thing you know it’s all over the Twitter world. But that’s the way it is now. I’m OK. It makes me laugh.”

Checkup Daily articles featuring Dr. Rogers:

• Is 13 too young?
• Asthma and your child
• Should you immunize
• Does my child need antibiotics?

About the source

Dr. Audrey Rogers was born in Odessa, Texas and attended school at Highland Park High School in Dallas. Texas. She received her undergraduate degree from Emory University in Atlanta, Ga., her medical degree at Southwestern Medical School in Dallas, and completed her pediatrics training at Children's Hospital of Oklahoma.

Her special interests are behavioral pediatrics and adolescent medicine. She became board certified in 1989. Dr. Rogers has been active in the Fort Worth community, serving as a board member for the Child Study Center and Hill School.

Last night, NBC 5 Investigates released an enlightening report looking at the rates of concussions in North Texas districts. This report showed a much higher rate with more than 2,500 concussions reported in just 41 districts.

There are still a lot of misconceptions about concussions, what they are and what they might mean to your student athlete.

Here are 5 concussion MYTHS:

1. It was just a “mild” concussion.

Concussions are brain injuries, period.

One might classify a concussion as mild if symptoms were brief and not severe. However, you cannot predict whose symptoms will be severe based on the way the child was injured or even the symptoms right after the injury.

Even seemingly minor trauma can cause headaches and other symptoms for weeks.

2. If the child/athlete didn’t lose consciousness, it wasn’t a concussion.

Symptoms of concussion vary from child to child but passing out or blacking out are not required to make the diagnosis. Basically if a child has a fall or other injury that results in any neurologic symptoms, they can be diagnosed with a concussion.

Some examples of concussion symptoms are headache, nausea/vomiting, vision changes or problems with concentration and memory. Some of these symptoms may take time to develop, so it’s possible to diagnose a concussion a few days after the injury.

3. Concussions are only a problem for football players.

Almost all sports can cause concussions, including the cheerleaders on the sideline of the football games. Some other sports that are known to have higher incidents are soccer, baseball and softball. Other common causes are kids riding bikes and falling off playground equipment.

4. All concussions need either an MRI or CT of their head.

Most concussions can be diagnosed based on telling your doctor the story of the injury and the related symptoms along with a physical exam. Imaging is not necessary because a CT or MRI will most likely be normal even in the midst of a severe concussion.

Also remember that a CT of the head does not come without risk. While we should perform them when necessary, we should make sure we are not using them in situations where they will not provide useful information.

5. Don’t let your child sleep after a concussion.

Treatment of concussions is evolving. If you suspect your child has sustained a concussion, you should immediately seek medical attention and advice from a doctor about how you should treat your child’s symptoms.

There have been some changes in the treatment of concussions. First, we no longer require that you keep someone with a concussion awake for a set period of time. In fact, after their evaluation, the doctor may recommend that you allow them to sleep in order to help their brain heal. Your doctor might also prescribe some time away from TVs and other screens, school or homework or other activities that might cause their brain to work harder.

Concussions are much more common than we previously thought. I believe that the UIL will make changes to better track the risk of concussions for our high school athletes, which will hopefully lead to better ways of evaluating and treating concussions. In the mean time, don’t buy these common concussion myths.

Richard Roberts, M.D., a neurosurgeon at Cook Children’s, wonders what it’s worth for your child to play sports with a reputation for head trauma.

“I think the fact that when the NFL players sued the league initially and won, the judge said the settlement (more than $700 million) wasn’t big enough,” Dr. Roberts said. “That says a lot about this growing issue more so than anything else.”

The issue discussed in the NFL cases has been CTE (chronic traumatic encephalopathy), a progressive, degenerative brain disease that has been found in some athletes with repetitive brain trauma.

Research is currently being done to study just how playing contact sports such as football mainly, but also soccer, can cause damage to an athlete’s head. But is it worth it for parents to wait for the results of this work.

“Amateur sports are different than professional sports because no one is feeding their family with the activity that they are doing,” Dr. Roberts said. We need to look beyond the short term and really understand what could happen in the long term. That potential for long term problems should be the primary thought, not the secondary thought.

“What is the actual incidence? We don’t know. But if it was your kid, how much would you be willing to risk? Even if it was 1 in 10, would you roll the dice on your own kid?”

Dr. Roberts has previously worked at Children’s Hospital in Philadelphia and Charity Hospital in New Orleans. While he saw concussions at the other hospitals, he’s never seen parents argue with him about concussions as he has seen at Cook Children’s.

“Part of what I’ve seen which is different here than other places is that I do get push back from parents who I think underestimate the severity of some of these injuries,” Dr. Roberts said. “Some of it is that they want their kids to play and I think some of it is the short term nature of some concussions.”

Children get concussions and they do well relatively quick, so opposed to having a broken arm which is in a cast or needing surgery and having stitches for three weeks, kids hurt their heads, they are knocked unconscious for five minutes, but then feel essentially better soon after. This apparent sign of improvement makes it difficult for some parents to grasp that their child may have a fairly significant brain injury.

“The more we understand concussions and the more we see people who have hurt their heads for various reasons, soldiers, professional athletes, anyone who has suffered a head injury, I think that we are seeing that in adulthood they are starting to have more cognitive issues,” Dr. Roberts said. “Now the science is not perfect yet. We can’t say to a football player you had three concussions and that’s why you have dementia. We can’t say to the soldier you were exposed to be a bomb blast and that’s why you have dementia because it could be multifactorial. It could be that you have the right genes to make you this way later on. But the percentage seems higher in people who have had traumatic brain injuries.”

Dr. Roberts says parents should be concerned after head injury one. He knows you have to let kids live their lives and be kids, but the brain wasn’t made to get beat up like happens sometimes in sports.

It’s not known for sure that after one concussion, people are more likely to get more, but Dr. Roberts’ suspicion is that it is likely the case.

And when does he have a serious heart-to-heart with the parents and the athlete?

“After two. We discuss no longer participating in the activities which could cause further injury because the likelihood of you having a head injury in your lifetime is still pretty high,” Dr. Robert said. “You are going to hit your head on a tree branch or you are going to fall off your bicycle or someone is going to run into you. You are going to be stepping out of the car and slip or walking across ice and fall down. My opinion after behavior has shown us that you are going to get injuries in a particular sport, you should probably not be playing in that sport because you are not able to protect your head.”

Dr. Roberts has seen strong reactions from both the parents and the kids after being told he or she should quit playing their respective sport. And it’s not just football as most people expect. It’s with the gymnast who has fallen off the bars and knocked herself out or the soccer player who has headed the ball and gotten knocked unconscious.

But football still remains king in Texas – in popularity and in concussions.

So what can be done about it?

Dr. Roberts is not sure there’s a good answer to that question. Building better equipment helps, but then armoring players probably makes them feel invincible and they hit harder. If you take away the facemasks or hard shell football helmets, he expects you will return to the old days – less concussions, but more skull fractures and in the process, immediate deaths on the playing field.

For now, Dr. Roberts wants parents to monitor their kids closely and to take the recommendations from their doctor closely. If they say it’s time to stop – stop!

“All the steps that sports are taking to make it safer are positive,” he said. “I think that everybody involved has to think less about return to play and more about long term health.”

About the source

Richard Roberts, M.D., is a neurosurgeon at Cook Children's. When a child with a neurological disorder requires surgery, the experts at Cook Children's Medical Center offer comprehensive care and state-of-the-art technology. With the help of such state-of-the-art equipment as the revolutionary intraoperative MRI (iMRI), our neurosurgeons are able to determine effectiveness of surgical procedures for cranial and spinal nerve disorders and tailor the treatment to each child's unique needs.

After a child sustains a concussion, he or she should be removed from the game or practice in order to allow the brain to rest. While the importance of rest following a concussion has been scientifically validated, the definition of "rest" has not been well-established. As such, an individualized approach to concussion management is preferred. While limiting physical activity is often the first area considered when a child is instructed to rest, limiting stress in other areas of life can be equally important. In addition to physical rest, cognitive and emotional rest is also important following a concussion.

Although an extreme approach to cognitive rest is sometimes recommended, studies suggest that a more moderate approach results in better long-term outcomes. In fact, scientific evidence documenting the benefits of cognitive rest is limited. Nevertheless, limiting cognitive exertion can decrease the frequency or intensity of other symptoms, such as headache.

School is the most cognitively demanding activity for most student athletes, and their baseline level of academic functioning should be considered when creating a treatment plan. Students with more severe symptoms may benefit from staying home from school for 1 to 2 days.

However, because symptoms typically resolve within a few days, formal homebound education services are generally unnecessary because the amount of instruction provided is minimal (e.g., typically only about 4 hours per week). Furthermore, homebound school services are typically reserved for students expected to miss school for an entire month.

Immediately returning to school may be a better option for some students with mild symptoms as well as students who are likely to become severely distressed if they miss a day of school. In addition, when children are told to maintain complete cognitive rest (e.g., sit quietly in a dark room with no electronics), they may become overly focused on their symptoms and consequences of rest (e.g., having to make up multiple school assignments later).

It is also important to understand the role of electronics and technology in the lives of children, especially adolescents. While using a computer or texting on a telephone may trigger headaches, completely prohibiting a teenager from engaging in these activities can result in social isolation and contribute to emotional distress. Depending upon the assignment, prohibiting all use of electronics can result in a student being unable to complete homework requiring use of a computer.

When compared to other areas, less attention is typically given to importance of emotional rest. Particularly for teenagers, social and emotional situations can be a big concern. Limiting a child's exposure to volatile emotional situations (e.g., pressure from friends and coaches to return to play, arguments between parents) is important. In addition, peers and teachers often have a variety of reactions to a child's concussion.

For example, while most people will likely respond with understanding and support. Others, however, may discount the significance of the child’s symptoms and doubt whether the symptoms are "real" because the child does not look "sick."

When the validity of symptoms is questioned, a child will sometimes unconsciously exhibit persisting or worsening difficulties. An athlete may also feel pressure from peers, teachers, or parents to return to play before they are ready, which can lead to emotional distress as well as the appearance of persisting or worsening of cognitive symptoms.

A concussion often results in increased fatigue, particularly in the first few hours after the injury. Indeed, some scientific evidence shows that physical rest during the first 24 to 48 hours may result in an overall faster recovery. In addition, because other studies have demonstrated that a concussion sustained within a week of a prior concussion can result a longer duration of symptoms, avoiding high-risk activities (e.g., returning to play) in the days following a concussion may be best.

However, studies have also shown that extreme physical rest for more than 3 days can worsen symptoms and lead to deconditioning. Most children and adolescents who sustain a concussion will stop experiencing severe symptoms within hours to days and will completely recover within a few days to a couple of weeks.

Regardless of when a student returns to school, it is important that the school nurse and all teachers be informed that the student has sustained a concussion. Following a concussion, students may exhibit inattention, distractibility, slow thinking, and confusion as well headaches, vision difficulties, and fatigue.

Some temporary accommodations can include preferential seating in the classroom (e.g., at the front of the room and away from distractions), testing in a separate room, extra time to complete tests and assignments, shortened assignments, copies of teacher notes prior to lectures, note-taking services, rest breaks during the school day, and permission to eat lunch in a quiet environment.

Considering the typically rapid recovery following a concussion, a formal accommodations plan at school is usually unnecessary because, by the time a plan has been finalized, the student is no longer symptomatic.

If, however, a child is slower to recover, a more thorough medical evaluation may be necessary to further investigate and treat physical dysfunction (e.g., headaches, dizziness). In addition, a neuropsychological evaluation can be helpful in evaluating the specific areas of cognitive difficulty and severity of the deficits as well as provide guidance regarding the need for a more formal academic plan.

About the author

Carla Hearl Morton, Ph.D., is a pediatric neuropsychologist at Cook Children's. She is a licensed psychologist with expertise in how learning and behavior are connected to the development of a child's brain structures and systems. At Cook Children's, neuropsychologists work closely with a team of neurologists andneurosurgeons to provide the best treatments and interventions that meet the individual needs of each child.

But summer doesn’t guarantee complete relief for kids with asthma.

“For most children, asthma tends to be better during the summer. This is mainly because there are less circulating viral infections in the community, which tends to be a big trigger for asthma flares or attacks,” Karen Schultz, M.D., a pulmonologist at Cook Children’s said. “During this time of the year, the biggest triggers are allergies and ozone days with poor air quality. In general, it is recommended that everyone avoids too much activity during orange or red ozone days, but this is particularly important for individuals with asthma or other respiratory conditions.”

Dr. Schultz said it appears that grass and elm pollen are in the medium range in Fort Worth, Texas, this time of year and that may be affecting the allergies of children with asthma. She thinks it’s a good idea for parents to download a weather app on their phone to keep up with the outside conditions.

As the school year gets closer, many kids will be starting activities such as band and/or athletics. Dr. Schultz advices parents and children with asthma to listen closely to their asthma symptoms such as coughing.

“It’s important for people to know asthma can happen during the summer,” Dr. Schultz said. “It’s best for children with asthma to practice or work out earlier in the day if possible. As school starts, more children will be outside with PE and recess. Many kids stay inside during the summer if they do not have structured activities. So they may not be used to the outside conditions. Also, we will start seeing more viral infections not long after school starts, so good hand washing is very important.”

About the source

Karen Schultz, M.D., is a pediatric pulmonologist at Cook Children's. To schedule an appointment with her call 682-885-6299. The Cook Children's Pulmonary team diagnoses and treats children with lung diseases. Our team includes board certified pediatric pulmonologists, clinical nurse specialists, registered nurses, respiratory therapists, Child Life specialists, clinical dieticians and social workers. The professional opinion of each team member, including parents, is considered in developing a plan of care for your child. We place a high value on continuity of care with your primary pulmonologist.

Ball sports and games have many benefits for kids besides being a lot of fun. Playing ball helps kids develop skills:

Increased coordination with both hands

How?

o Stand in one place and dribble a basketball.

o Run while dribbling a ball.

o Playing/bumping a volleyball.

Increased hand eye coordination

How?

o Playing catch.

o Batting practice.

o Playing mini golf.

o Playing a racquet sport like tennis or ping pong.

Improved balance

How?

o Kicking a ball while standing in place.

o Kicking a ball while running.

o Jumping and reaching to catch a throw.

There are great ball options for kids of all ages and abilities. 

For kids 3 and under

Once babies can sit on their own, they can begin to roll a medium sized ball. As they grow, they will begin to use two hands to attempt to catch by pulling a ball closet to their body. Kicking is something that we should start to see with toddlers. At first your little one will walk into a ball to move it forward. As your child matures they will begin to lift one leg to kick. This requires balance and is a good challenge for toddlers and preschoolers. As their balance improves they will be able to the kick the ball harder and farther and in a straight line.

For grade school kids

At this age, kids are ready to be challenged with balls of different shapes and sizes like soccer balls, footballs, baseballs and tennis balls. These balls can be thrown and caught, but also can be used in more complex ways as part of a game. A great way to get this age group active is to create a game that they can play with friends.

For the preteen and teenagers

If your child is not yet involved in a team sport, it is important to continue to encourage them to be active with their friends, including games that include ball skills.

Sports are beneficial whether played on formal teams or as part of pick-up game with friends. Sports not only challenge your child physically, but encourage them to work on things like taking turns and being a good sport. Activities like soccer, baseball, and basketball require children to coordinate their own movements with the movements of other children in order to be successful. Teamwork and compromise are great skills for all kids to work on and will benefit them in many areas of their life.

So whether it is on their own, with siblings and friends, or as part of a team, encourage your kids to be active this summer and get involved with ball games. Remember that all kids should be getting at least one hour of physical activity a day and they will need lots of water when playing outside in the Texas summers. 

About the author

Kate Mcgee, PT, DPT, is a physical therapist at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield.

He’s not hurt and had a presumably bright future in the NFL.

Why did he retire?

In light of the recent focus on repetitive trauma, concussion and brain injury, he decided that it was in his best interest to stop playing football.

Consider it this way: After years of playing football, starting a very young age, succeeding in high school and later at the University of Wisconsin, he reached the pinnacle of his sport and decided it was better to walk away than to keep playing. Granted, he’s only one player and many, many more will continue to make the decision to go back to training camp in July.

Most football players will never reach that point where they’ll have to decide if the NFL is right for them. I played junior high football, but didn’t move on to high school. I like to tell myself that I was making sure I was protected from injury for tennis season (truth was, I was probably a little scared of being small and getting hit by bigger high school kids. Sorry for lying, Coach West).

If you look at the research,  it seems like cumulative trauma is the issue. The older and bigger you get and the longer you play, the number and the force of the traumas increase. The rules are changing in an attempt to make the sport safer. But, I’m sure many of you read this and worry about your young football players.

My sons haven’t asked to play football yet. At 5 and 3, I think the level of risk for concussion is higher when I pick them up and throw them as high as I can in the air barely grabbing them before they crash into the ground. But living in the middle of Texas, football countr,y and having an older son built like a perfect tight end and having little brother with a canon for an arm, I am sure that is a conversation we will have some day.

I wonder if someday we’ll look back on the days when football was played and think, “I can’t believe that they used to do that to themselves.” Or, will the sport look so different that we will barely recognize it?

What about you? Do you have concerns about your sons playing football?

Lately, football has put a lot into perspective for me. Take a look at the two starting quarterback for the Super Bowl between New England and Seattle.

New England’s Tom Brady seems to be the prototypical signal caller, standing at 6 feet, 4 inches tall.

On the other hand, Seattle Russell Wilson for the Seattle Seahawks is listed at 5’11.” New England wide receiver, Julian Edelman, who was the star of the Patriots’ victory over Baltimore is listed at 5’10,” which is the average U.S man’s height

Much like the children, we see at Cook Children’s, athletes come in all shapes and sizes.

Probably half of the children I treat are brought by families due to concerns about height. The reality of life is that people come in all heights, and height offers an opportunity to make assumptions and judgments about a person which can sometimes be hurtful.

Cincinnati Bengals Head Coach, Marvin Lewis, created a social media firestorm when he said this about the undersized quarterback for the Cleveland Browns and Heisman Trophy winner at Texas A&M, Johnny Manziel.

“You gotta go defend the offense. You don’t defend the player, particularly a midget.”

Lewis quickly apologized for his words as others including organizations like Little People of American explained to him how derogatory and offensive the term was especially to those with serious medical conditions causing their short stature.

The movie, “Rudy,” is a perfect example. It’s one of the most inspiring stories about a shorter man with a passion for football who overcame the odds. At 5’6”, Rudy Ruettiger wasn’t a typical defensive lineman for Notre Dame, but his hard work and dedication paid off with a chance to play.

My opinion is that it’s important to have the right perspective about height. A good attitude and acceptance of one’s height is important and a person shouldn’t make judgments about another solely on height.

Sometimes it’s something more than just genetics or the child being a “late bloomer,” it can be an endocrine disease and the child will need treatment for a condition such as hypothyroidism or growth hormone deficiency.

At times, we the child may have trouble coping with his or her size and may even need counseling.

In my area of expertise, it is a challenge to determine whether a child’s height is normal or not. There are times when height and growth are abnormal, and further investigation is needed:

Genetics: Shorter parents often times have shorter children. These kids continue to achieve milestones such as puberty or growth spurts at a normal rate, but they generally stay around the same height as their parents.

If a child is terribly uncomfortable with his or her height, we may talk to the family about counseling. If the child doesn’t reach puberty at the normal age, the discussion may include puberty hormone treatment. But, this needs to be decided with your endocrinologist or pediatrician.

Constitutional growth delay: These are often times what’s considered “late bloomers.” Children with condition are small for their age, but continue to grow at a normal rate. They usually reach puberty later than other children and experience delay in sexual maturity. They usually catch up with their classmates, but it sometimes takes them longer.

Endocrine conditions: We treat these children for hypothyroidism or growth hormone deficiency. These children require treatment from an endocrinologist and may need medication for growth.

Turner syndrome: This is a common genetic condition occurring in 1 in every 2,500 girls born. It is caused by missing all or a portion of one of the X chromosomes. The condition varies in severity but has physical and psycho-educational impacts.

Care of girls with Turner syndrome is an integral part of the practice of the pediatric endocrine group at Cook Children’s. The majority of girls affected will have short stature and early failure of the ovaries. Growth hormone treatment is prescribed and monitored by pediatric endocrinologists to treat short stature. The task of monitoring puberty and timing of estrogen replacement is equally important to insure overall health.

In the coming weeks, I’ll give more facts on children’s growth and talk when a parent should be concerned about their child’s growth.

Strength:  As these athletes push themselves to achieve the lifting goals set by coaches, is their form being supervised by someone trained to observe any breakdowns?  Complex lifts such as cleans, snatch, push-jerks, etc. put enormous strain on the athlete’s muscles, especially when they are younger and still developing, but if their form is poor it also makes them susceptible to back, shoulder, knee and neck injuries. Often the athlete lacks the core strength and stability to provide a solid foundation so that the body can move correctly. Core strengthening should be an integrated part of every strengthening program. Unfortunately, many of our athletes are never taught to control their core in basic sitting and standing postures, but yet we expect that they will somehow find their core while in the weight room or on the field. If you think core strengthening is all about abs, then you are missing the bigger picture.

Conditioning/ nutrition/ hydration: Cardiovascular conditioning is often an area that coaches hit pretty hard in the offseason, and most athletes have been working on some kind of conditioning program. However, the nutrition and hydration components of this area are often over-looked. Understanding how to fuel your body for peak performance is just as important as knowing how to perform the activity. Working with a nutrition/dietitian specialist can give your athlete the tools needed to unlock their full potential.

Flexibility: This is one of the most overlooked areas of a good training program for a football player getting ready for middle or high school ball. There is nothing glorious about stretching. There is also nothing glorious about missing a majority of the season while sitting on the bench due to a pulled hamstring. Flexibility training is about preparing the body to perform.  Dynamic stretching (moving stretches) prepares the body for immediate performance and should be used before any type of physical activity. Static stretching (prolonged holds) help prepare the body for tomorrow’s workout and promotes having the muscle length needed to achieve the greatest power. Use of a foam roller can also help improve flexibility by preparing the muscles for stretching.

Neuromuscular control: Why is it that the pros make it look so easy?  The ability to cut-back, stop-start, and change directions centers on the way an athlete’s brain can control the body. A physical therapist or trained professional can use any number of functional movement assessments to see how the body is moving and recommend corrective exercises and/or cues to improve these patterns. Learning the best patterns means the athlete can generate more power, more quickly, and in more directions. The best movement patterns also keep the body in the best alignment, and less likely to become injured.

Overtraining: The AAOS also recommends avoiding the pressure that is now exerted on many young athletes to over-train. Listen to your body and decrease training time and intensity if pain or discomfort develops.

See a physician if you begin having pain. This will reduce the risk of injury and help avoid “burn-out.”

Related links:

• Football injury prevention
• SPORTS resources
• Does your child play one sport?
• 9 ways to prevent injuries in young athletes
• Cheerleader injuries
• Top 10 questions parents have about sports injuries
• Young athlete's injury prevention guide
• Strength training in children/adolescents (5-15 years)
• Rise of overuse injuries in school-age athletes
• The basics of sports injury prevention for kids
• When growing pains are not growing pains
• Preventing children's sports injuries

About the author:

John Stanley, a physical therapist and SPORTS Rehab Clinical Coordinator at Cook Children's. The Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS) program offers care to children and adolescents with orthopedic or sports-related injuries.