Pediatric Annals

Editorial 

The Importance of Proper Concussion Management

Stanford T. Shulman, MD

Abstract

We are finally recognizing the untoward effects of repeated concussions related to contact sports activities, especially football. Several excellent reviews in this special issue of Pediatric Annals provide comprehensive information about the pathophysiology of concussion and provide guidance related to the pediatrician’s role in assessing the effects of concussions, and certifying the safe return to school and sports activities.

Many states recently have mandated that a physician must certify that it is safe for a concussed adolescent to return to school and/or to sports. Consequently, this responsibility often falls to the pediatric community.

Recognition of the potential long-term impact of repeated head trauma and repeated concussions is becoming more and more clear. It has been well-publicized in recent years, that a number of former professional football players have committed suicide after manifesting signs of dementia; upon autopsy examination of the brain they have been found to have had chronic encephalopathy that appears very likely to be related to repetitive head trauma.

Several professional football players, including New York Jets linebacker Bart Scott and now-retired quarterback Kurt Warner (who played for the St. Louis Rams, New York Giants, and Arizona Cardinals), have indicated publically that they do not want their sons to play professional football. One can only speculate what the long-term impact will be upon the future of football as we know it today, at all levels including professional football. Presumably, fewer participants playing football will mean fewer boys and men suffering repeated concussions in the future and hopefully fewer with serious consequences.

Other sports are not immune to the impact of concussion upon cognitive function. Justin Morneau, an All-Star first baseman for the Minnesota Twins — and former hockey player — famously lost a full-year of play for the Twins because of the lingering effects of a concussion incurred on the field of play in what appeared to be a routine play at second base.

This month’s Healthy Baby column on oral health screening and prevention in the pediatric office is timely. The most recent issue of the American Journal of Public Health reports that poor oral hygiene in disadvantaged kids has been linked to lower grade point averages and more days of school missed.1 The study investigators indicate that by incorporating screening and prevention programs into aspects of children’s health care, we can help reverse this trend.

Stamps illustrating this issue include a stylized Argentinian stamp, issued in 2011, to honor the 100th anniversary of the Sociedad Argentina de Pediatria (Argentine Pediatric Society). Founded on Oct. 20, 1911 (two decades before the founding of the American Academy of Pediatrics), this Buenos Aires-based society was celebrated by a Centennial Congress held Sept. 13–16, 2011.

Stamp released in 2011 by Bosnia and Herzegovina to honor Marie Curie and the International Year of Chemistry.

The Society was established to promote the study of the biological aspects of pediatric illness, and later the psychologic and social aspects as well. Predating the establishment of the Society was Archivos Latino Americanos de Pediatria, a journal founded in 1905 by Gregorio Araoz Alfaro, MD of Argentina, and Luis Morquio, MD, of Uruguay. Archives was published for 25 years until 1930, when it was supplanted by journals of the individual Latin American countries. In that year the Archivos Argentinos de Pediatria was established, with Maria Teresa Vallino, MD as the first editor.

The brown stamp was issued to honor Dr. Morquio (1867–1935), considered the father of pediatrics in Uruguay and the greatest personality in South American pediatrics. He had studied in Paris with Jacques-Joseph Grancher, MD, the pediatrician who worked with Louis Pasteur. Morquio is famous…

We are finally recognizing the untoward effects of repeated concussions related to contact sports activities, especially football. Several excellent reviews in this special issue of Pediatric Annals provide comprehensive information about the pathophysiology of concussion and provide guidance related to the pediatrician’s role in assessing the effects of concussions, and certifying the safe return to school and sports activities.

Many states recently have mandated that a physician must certify that it is safe for a concussed adolescent to return to school and/or to sports. Consequently, this responsibility often falls to the pediatric community.

Recognition of the potential long-term impact of repeated head trauma and repeated concussions is becoming more and more clear. It has been well-publicized in recent years, that a number of former professional football players have committed suicide after manifesting signs of dementia; upon autopsy examination of the brain they have been found to have had chronic encephalopathy that appears very likely to be related to repetitive head trauma.

Several professional football players, including New York Jets linebacker Bart Scott and now-retired quarterback Kurt Warner (who played for the St. Louis Rams, New York Giants, and Arizona Cardinals), have indicated publically that they do not want their sons to play professional football. One can only speculate what the long-term impact will be upon the future of football as we know it today, at all levels including professional football. Presumably, fewer participants playing football will mean fewer boys and men suffering repeated concussions in the future and hopefully fewer with serious consequences.

Other sports are not immune to the impact of concussion upon cognitive function. Justin Morneau, an All-Star first baseman for the Minnesota Twins — and former hockey player — famously lost a full-year of play for the Twins because of the lingering effects of a concussion incurred on the field of play in what appeared to be a routine play at second base.

Poor Oral Health in the News

This month’s Healthy Baby column on oral health screening and prevention in the pediatric office is timely. The most recent issue of the American Journal of Public Health reports that poor oral hygiene in disadvantaged kids has been linked to lower grade point averages and more days of school missed.1 The study investigators indicate that by incorporating screening and prevention programs into aspects of children’s health care, we can help reverse this trend.

This Month’s Stamps

Stamps illustrating this issue include a stylized Argentinian stamp, issued in 2011, to honor the 100th anniversary of the Sociedad Argentina de Pediatria (Argentine Pediatric Society). Founded on Oct. 20, 1911 (two decades before the founding of the American Academy of Pediatrics), this Buenos Aires-based society was celebrated by a Centennial Congress held Sept. 13–16, 2011.

Stamp released in 2011 by Bosnia and Herzegovina to honor Marie Curie and the International Year of Chemistry.

Stamp released in 2011 by Bosnia and Herzegovina to honor Marie Curie and the International Year of Chemistry.

The Society was established to promote the study of the biological aspects of pediatric illness, and later the psychologic and social aspects as well. Predating the establishment of the Society was Archivos Latino Americanos de Pediatria, a journal founded in 1905 by Gregorio Araoz Alfaro, MD of Argentina, and Luis Morquio, MD, of Uruguay. Archives was published for 25 years until 1930, when it was supplanted by journals of the individual Latin American countries. In that year the Archivos Argentinos de Pediatria was established, with Maria Teresa Vallino, MD as the first editor.

The brown stamp was issued to honor Dr. Morquio (1867–1935), considered the father of pediatrics in Uruguay and the greatest personality in South American pediatrics. He had studied in Paris with Jacques-Joseph Grancher, MD, the pediatrician who worked with Louis Pasteur. Morquio is famous for describing Morquio syndrome (mucopolysaccharidosis type IV), and he founded the Sociedad Uruguay de Pediatria in 1915.

The other stamp was released in 2011 by Bosnia and Herzegovina to honor Marie Curie and the International Year of Chemistry. This stamp is shown here with an attached label depicting Madame Curie and her Nobel medal on the right. Madame Marie Sklodowska Curie (1867–1934) was born in Warsaw, where her family’s home, now a museum, can still be visited.

Madame Curie was awarded a Nobel Prize for physics in 1903, with Henry Becquerel and her husband, Pierre Curie, for the discovery of radioactivity. She won another in 1911, this time in chemistry for the discovery of the elements radium and polonium (the latter named for her country of birth).

Madame Curie is the only person ever to win Nobel Prizes in two different scientific areas, and was also the first woman to win a Nobel. She died in 1934 of aplastic anemia, very likely related to her cumulative radiation exposure over many years.

Dr. Morquio (1867–1935) is considered the father of pediatrics in Uruguay.All images courtesy of Stanford T. Shulman, MD. Reprinted with permission.

Dr. Morquio (1867–1935) is considered the father of pediatrics in Uruguay. All images courtesy of Stanford T. Shulman, MD. Reprinted with permission.

Argentinian stamp issued in 2011 to honor the 100th anniversary of the Sociedad Argentina de Pediatria (Argentine Pediatric Society).

Argentinian stamp issued in 2011 to honor the 100th anniversary of the Sociedad Argentina de Pediatria (Argentine Pediatric Society).

Reference

  1. Seirawan H, Faust S, Mulligan R. The impact of oral health on the academic performance of disadvantaged children. Am J Public Health. 2012;102(9):1729–1734. doi:10.2105/AJPH.2011.300478 [CrossRef]
Authors

 

Pediatric Annals Editor-in-Chief Stanford T. Shulman, MD, is the Virginia H. Rogers Professor of Pediatric Infectious Diseases at Northwestern University Feinberg School of Medicine; and Chief of the Division of Infectious Disease at the Ann and Robert H. Lurie Children’s Hospital, Chicago, IL. Dr. Shulman is the recipient of the AAP 2011 Award for Lifetime Contribution to Infectious Disease Education.

An avid stamp collector, Dr. Shulman chooses relevant stamps from his personal collection to accompany his column each month.

Reach Dr. Shulman via email: Pediatrics@Healio.com

10.3928/00904481-20120827-01

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