Kids and concussion: What every parent, coach, and health-care professional should know

Concussions are more than "just a bump" — they're brain injuries that can seriously impact a child's life. In this episode, Dr. Shelina Babul, concussion expert and creator of the Concussion Awareness Training Tool (CATT), joins us to break down why concussions matter, especially in children and youth. We explore common misconceptions, early symptoms, and how CATT is changing concussion care across Canada and beyond. 

Whether you're a parent, coach, teacher, or teen, you'll learn how to recognize and respond to concussions early — key to safer recoveries and better outcomes. Tune in and learn how we can all protect kids' brains.

Learn more about topics discussed in this episode:

Concussion Awareness Training Tool (CATT) website

Concussion Awareness Training Tool for youth: Impact on concussion knowledge, beliefs, and reporting intentions, Health Education & Behavior

Concussion Harmonization Project webpage

Follow-up visits after a concussion in the pediatric population: An integrative review, NeuroRehabilitation

All episodes written and produced by the Research Communications team at BC Children's Hospital Research Institute.

Theme music: "Life Is Beautiful" by Anastasia Kir

Transcript

Kristen Hovet (00:00)
My name is Kristen Hovet and I'm a research communications specialist for BC Children's Hospital Research Institute. Joining me today is Dr. Shelina Babul, a concussion and traumatic brain injury expert whose work has been instrumental in standardizing concussion care around the world. Dr. Babul developed the Concussion Awareness Training Tool, a free e-learning tool that provides concussion information to anyone who needs it. The Concussion Awareness Training Tool or CATT is so impactful to concussion care that it is recognized as part of the Canada-wide Concussion Harmonization Project.

Shelina Babul (00:39)
Hi, my name is Dr. Shelina Babul. I'm the director of the BC Injury Research and Prevention Unit, a clinical professor in the Department of Pediatrics at UBC, and the director for the Canadian Hospital's Injury Reporting and Prevention Program at BC Children's Hospital, and an investigator with the BC Children's Hospital Research Institute and the Centre for Brain Health at UBC.

Kristen Hovet (01:00)
To ensure we're all on the same page and to cover the basics, what exactly is a concussion and why are children and youth especially vulnerable to these?

Shelina Babul (01:11)
In most simplistic terms, a concussion is the rapid movement, acceleration, deceleration, and rotation of the brain inside the skull. So when there's an impact to the head or the body resulting in essentially a whiplash type motion of the head, you get the shaking and the jarring of the brain, which results in disruptions of the neurons or the wire connectivity of the brain. And when there's a shearing and tearing of this interconnectivity of neurons, that's when you get resulting symptoms that individuals feel. So if I can give you an example of an earthquake, when there's an earthquake, there's fractures in the roads and cars cannot proceed until the roads have been repaired. Similarly in the brain, you've got over a trillion interconnectivity of neurons or wiring. And when there's the disruption of this wiring or breakage of the wiring, information can't flow as it normally would and then that information gets backlogged and that results in the symptoms that the individual feels.

Kristen Hovet (02:17)
Thank you for that. And I also read in one of the research articles that your team sent that it is considered a traumatic brain injury. Is that correct?

Shelina Babul (02:26)
Correct. There was always a misnomer that a concussion wasn't a big deal. You just had your bell rung, tough it out, play through it. And that's not the case. A concussion is a minor traumatic brain injury. I would argue that it's not really minor for those who are having persistent symptoms that are leading to long-term consequences of mental health or persisting headaches or other cognitive or behavioural symptoms that are persisting. So it is a brain injury that needs to be recognized immediately and managed accordingly. Your question on why children and youth are more vulnerable is because their brains are still developing. Their brains continue to grow until they're about 18 years or so. And it takes a longer time to recover from a concussion because of the neurological immaturity of the brain because it hasn't fully developed. Children and youth have thinner cortical skull bones. The skull around the brain is thinner and it's continuing to grow as they get older, as well as having a weak neck musculature. Typically, as we get older, we have a more firm musculoskeletal system from the neck and shoulders that helps absorb some of the impact. But when children and youth are younger, you kind of get that bobblehead effect resulting in more movement of the brain inside the skull.

Kristen Hovet (03:46)
You developed the Concussion Awareness Training Tool, or CATT for short, which has become a trusted resource around the world. What inspired you to develop it and how has it grown since 2013?

Shelina Babul (04:00)
Yeah, so around 2010, 2011, I started getting more and more calls in my office at BC Children's from families saying, who do I go? You know, the doctor said he or she has had their bell rung and my child is throwing up or the teacher doesn't believe that they can't study for a test. They think they're trying to get out of writing their tests or what do I do? How do I manage my child's concussion? Am I doing the right thing? So we really recognize there is a disconnect in what evidence-based information people knew. We conducted an environmental scan, an international environmental scan, to say, does anything exist that's evidence-based to inform individuals on how to recognize, diagnose, treat, and manage concussions? And there wasn't. There was a few that were out there, and there was a cost attached. But our government said to us, look, if we want British Columbians to know about concussions, we don't want to charge them. We want to build a resource where they can get evidence-based credible information at the tip of their fingers essentially. And then the second requirement was if we build it, we shouldn't just build it to a British Columbia context because how we recognize, treat, and manage concussions in BC should be no different than how they do it across the globe. So let's build something with an international context. Then what we did is we conducted focus groups because, depending on who you are, what you need to know is very different. So we conducted focus groups with physicians, with school teachers, with parents, with players, with high performance athletes, and we said, if we build a resource, what do you want? What resonates for you? How best would you like to learn the information? And we quickly learned that some like to read, some like to watch, and some like to listen. So we incorporated all the feedback we received from these focus groups. And that's when we built the Concussion Awareness Training Tool in 2013.

Kristen Hovet (05:51)
That's amazing. So CATT offers different learning modules and these are tailored to everyone from coaches to healthcare professionals to the youth themselves. Why is it so important to customize concussion education for each audience?

Shelina Babul (06:08)
Depending on who you are, what you need to know is very different. So for example, physicians need to know how to accurately diagnose a concussion with their patients to be knowledgeable on the latest evidence-based clinical care in terms of what to do in that diagnosis, how to accurately diagnosis, and what provision of resources should they give their patients. School teachers need to know, for example, how to recognize persisting symptoms in a student who has suffered a concussion and what they should do to help support their students. Athletes and youth, high school youth, need to know how to recognize should they feel that they potentially have received an impact that could potentially cause a concussion, they need to know how to recognize it and what to do about it. So depending on who you are, what you need to know is very different. And that's why we built, currently we have about eight modules for the various audiences to really inform that specific audience on how to prevent, recognize, and manage concussions.

Kristen Hovet (07:11)
Your recent research shows that many children and youth don't get a follow-up visit after a concussion diagnosis. Why is this happening and what's at stake when these follow-up visits don't take place?

Shelina Babul (07:24)
Yes, this is very important. We know the state of our healthcare system and how hard it is to get a physician visit, a timely physician visit. But it's very important when you are diagnosed with a concussion to book a follow-up visit because we want to ensure that that patient is recovering appropriately. So you want to monitor their recovery. You want to assess them for any persisting symptoms if there are any. And you want to ensure that you are able to safely return them to activities.

If you sustain a concussion and it's not recognized and you continue to participate in your activities, you're three times more likely to sustain a second concussion, potentially more severe and with more symptoms. And now if that second one isn't recognized, you are then nine times more likely to sustain a significant brain injury and possibly in rare instances, even death. And we had, you know, we had a case of that in Canada in 20... I believe it was 2015, the death of Rowan Stringer who was playing high school rugby. So it's really important that you get personalized guidance from your physician, you get accurate educational resources, but you do book a follow-up visit so you can review your symptom management. If you need medication, there can be any adjustments made in education, or if your symptoms are getting worse, you can be referred to a specialist as needed. So it's really important that you do get a follow-up visit and, importantly, to book it right then and there when you're at the physician's office.

Kristen Hovet (08:55)
We often hear about concussions in the context of sports, and definitely for me, that's where I heard about them most. But research shows that around half of all pediatric concussions are not actually sport related. Can you talk about some of the other ways that kids can get concussions and why it's important for parents and caregivers to know about this?

Shelina Babul (09:16)
It's very true. Concussions are not only a sport related injury and over the past decade we've recognized this more and more. You can sustain a concussion from falling off the sidewalk and hitting your head on the ground or falling in the house or a motor vehicle accident. There's various ways where you can get a concussion but if you think about the mechanism of how you get it, it's anything that can result in your head accelerating and decelerating rapidly, and you want to ensure that it's immediately recognized, and you need to know what to do should you be feeling any symptoms of a concussion. But it's important to note it's not only a sport related injury, it can happen in any daily activities that one is involved in.

Kristen Hovet (10:00)
What are some of those first symptoms of a concussion that parents and caregivers should watch for?

Shelina Babul (10:05)
Yeah, so initially, you know, if there's an impact, you want to watch for a headache, nausea, sensitivity to light, sensitivity to noise, feeling confused, not able to sleep or sleeping too much, not able to eat. Those are symptoms of a concussion. But you want to first ensure that there's no red flags. If there's vomiting, if there's a worsening headache, if there's trouble breathing, if there's confusion, if there's loss of consciousness, if there's any kind of bleeding or changes in pupil size or slurred speech, trouble speaking, any of those that appear, you need to go to the emergency immediately. If there are not any red flags, then you kind of want to monitor your symptoms. You know, I like to say that no two concussions are alike. So you want to monitor yourself because signs and symptoms can appear subtly. You know, a lot of times a player is pulled off, say playing soccer, where they have a suspected concussion, they're asked a few questions, they seem fine, they're put back into the field. That's not the right thing to do because signs and symptoms can appear subtly up to 48 hours. So you want to monitor that individual to make sure that there's no onset of subtle symptoms.

Kristen Hovet (11:15)
You've been instrumental in getting concussion education added to the UBC medical school curriculum, which is amazing given I know how hard it is to actually fit more into that curriculum. How is concussion care changing in Canada? And what does better education mean for future health care providers and their patients?

Shelina Babul (11:36)
The approach that we've taken is a dual approach. It's a bottom-up and a top-down approach. So you want to start at the ground level educating individuals. But you want to also start top-down from whether it's policy implementation through governmental organizations or whether you want to inform the medical community. So what better way than to educate medical students who are going to be out in the real-world settings likely diagnosing concussions?

So we wanted to ensure that students at UBC, medical students, are aware of the importance of concussion, know how to accurately diagnose a concussion, and what resources they should be giving their patients. So we incorporated the concussion education in the training to fourth year medical students at UBC. It's really important to change the trajectory that, you know, concussions aren't a big deal. And we have done that over the past decade. It is being taken more seriously, but it is an invisible epidemic. Nobody fully understands what's happening to the brain at the time and why do people respond so differently? You can have an individual who takes a significant head-to-head impact, say, heading the ball in soccer or hitting another person, ⁓ and they are completely fine the next day versus someone who has hit their head, say, on the kitchen cabinet and is out for months from persisting symptoms.

So we don't exactly know why that's the case, why it's so individual and we're still trying to investigate that, but we've come a long way in the last decade to really advance knowledge and understanding of concussions and different modalities. Parents want the magic bottle of pills. What can I give my child so that they can play in the finals next week or the nationals? There's no such thing. The magic bottle of pills are really immediate recognition, slowly monitoring for symptoms within 48 hours, but that doesn't mean go into a dark room. That has changed over the past decade. Before it was go into a dark room and don't come out until you're symptom free. Then that was changed to, don't go into a dark room, but don't do any activity until you're symptom free. And now we know, based on the evidence, that that's not the right thing to do either. Small bouts of exercise, small bouts of activity are actually helpful in your recovery. So don't stop what you're doing for the first couple of days, but really limit it, where you aren't going to get another head impact. You can continue your activities of daily living, but if you feel your symptoms are getting worse, then slow down a little bit. In the Concussion Awareness Training Tool, we've developed return to work, return to activity, return to sport, and return to school guidelines that really show you what you should be doing at every stage of your recovery.

Kristen Hovet (14:25)
That's great. One thing I read on the CATT website as well is that you're continually updating that resource as the research changes, which I think is really important for people to know. This isn't one bit of information that's static. It's changing with the research and as care changes.

Shelina Babul (14:42)
One of the feedbacks that we got is we want an evidence-based resource that's a one-stop shop. If I Google concussions, I'll get over a million hits. How do I know what's credible? How do I know what's evidence-based? But it's also important to note that we don't reinvent the wheel. We collaborate with colleagues across the country who have valuable resources themselves. So where those resources existed, we didn't develop new ones. We've just incorporated it into the Concussion Awareness Training Tool.

Kristen Hovet (15:10)
You recently studied how the Concussion Awareness Training Tool for Youth, abbreviated to CATT Youth, impacts high school students' concussion knowledge and their willingness to report concussions. What did you find, and what are some of the best ways to change behaviour around reporting concussions?

Shelina Babul (15:28)
The most important thing was that youth were not aware of the severity of concussions or the seriousness of concussions. They didn't think it was a big deal. More often than not, they probably wouldn't report it for fear of isolation from friends or from activities. They didn't understand what they needed to do. Should they be feeling a certain way? Developing the CATT for Youth, which specifically focused on high school youth, was really a way to

inform them on what they need to do and the importance of doing it. We want to change the trajectory that I hear so often. It won't happen to me to, if I only knew. And so we thought we'd develop a resource for high school youth in a more engaging, fun way for the students. It also incorporates videos from other high school students who share their experiences when going through a concussion so that they know that they're not the only one feeling this way, and they can learn how these other videos from students, what they did to recover from their concussion.

Kristen Hovet (16:33)
Right, totally. So the first week of June is Safe Kids Week and the theme this year is kids and concussion. What's one thing you want every parent, coach, or young person to know about concussions?

Shelina Babul (16:45)
That it is a brain injury and you need to recognize it immediately so that there's no impact on the quality of life of your child.

Kristen Hovet (16:55)
What excites you most about where your research is headed next?

Shelina Babul (17:00)
You know, as I said, we've come a long way in the last decade and we're learning so much. We've got colleagues doing wonderful work in neuroimaging, looking at blood biomarkers. There's no diagnostic tool for a concussion right now. It's purely based on what the symptoms are of the individual, looking at the history of that individual, doing some balance testing, doing some cognitive testing, and making a diagnosis. Right now, colleagues are looking at whether they can detect a concussion via simple blood test.

So there's work being done in that area as well. So, you know, I think as I said, we've come a long way. We do have a long way to go. But I think we're really making strides and advances and really understanding the intricacies of our brain. Our brain is so fragile and delicate and it's the only organ that you can't transplant. It's your information highway for living, for walking, for talking, for eating, for hearing. So we really need to heed the warning and take the necessary preventative measures, where available, to avoid a concussion from happening. But should a concussion happen, recognize it immediately and know what you need to do. I think I just really want to highlight and stress the need to take concussions seriously, recognize that it's a brain injury. 75%, 80 % of concussions will resolve uneventfully if there's appropriate recognition and management immediately.

You have about 30 % of the individuals who take a longer time for recovering and they need more specialized care. So make sure that you tell your health care provider if your symptoms are getting worse so that you can get that specialized care immediately and not prolong it before you're way down the road and there's nothing you can do. So I'd like to say that that, you know, take it seriously. If you do so, then you will recover uneventfully, but know what you need to do to recover.

Kristen Hovet (18:56)
And a question that we're asking all of our guests is how does your research help children live their best lives?

Shelina Babul (19:03)
Your brain is your information highway and it's the only organ you can't transplant. It's about three pounds. It's encased by a skull of the thickness of three pennies. So you really want to take it seriously and we don't want children to have their quality of lives impacted. If I can give you one example, we've seen a whole slew of individuals whose quality of life was impacted from not wearing a helmet or not doing the right thing. I mentioned the death of Rowan Stringer, who wasn't aware of what she needed to do and to stop playing the sport of rugby and telling someone. We want children and youth not to be heroes to their parents, not to be heroes to their coaches or to their teammates, but really know what they need to do so that they can live their best lives and their quality of life is not impacted.