Ep #10: Bumps to the Head and Other Brain Health Stuff with Dr. Thomas Tervort

Has your child ever bumped their head and you have wondered what do you need to be worried about, what should you be watching for, what’s normal, what do we need to do? Today I’m having a conversation with Thomas Tervort who is the Clinical Director of Neural Effects which is a concussion treatment in Provo, Utah. He is a doctor of nursing practice. And previous to running the concussion clinic, worked with The Neural Surgery Group participating in surgery and treating surgical patients related to the central nervous system.

We talked about normal growth and process of development of the brain. We talked about what happens when things go wrong. And we talked about signs and things you should notice if there is a problem. Dr. Tervort also happens to be a dad of six children. And so we got to talk a little bit about what that looks like in his house and someone who works with brains every day, what he practices at home with his own children so that was a fun conversation to have. Join me for that conversation right after this.

Welcome to the Raising Healthy Kid Brains podcast where moms and teachers come to learn all about kids’ brains, how they work, how they learn, how they grow and simple tips and tricks for raising the most resilient, kind, smart, compassionate kids we can. All while having lots of grace and compassion for ourselves because you know what? We all really need and deserve that too. I am your host, Amy Nielson. Let’s get ready to start the show.

Amy: Alright, I’m going to welcome Dr. Thomas Tervort to the show, thank you for coming and being with us today. Thomas: Well, thank you for having me, I appreciate you letting me take this opportunity to do this.

Amy: Yeah, I am so excited to talk with you. Stephanie on our team talked to me about you and said that you were talking to her about the normal growth and process of brain development in children. I thought maybe you could talk to us a little bit about that, how children’s brains actually grow and develop, what’s going on in there.

Thomas: Of course, you bet. And just to give you a little bit of an idea of where I’m getting this information from. I have done a little bit of background. I work specifically with children, particularly with concussion. So any time that there is an injury to the brain, something like that I get parents to bring their kids in here. I don’t just treat kids, I treat adults and across the lifespan. But I go over the specifics of what’s going on with the brain and what things we need to be looking out for and what do we need to be treating. What things are okay as we proceed and what things need extra attention?

And part of explaining that to parents and giving counsel and guidance on what to do for a concussion requires me to know a little bit about what normal function is like.

Amy: Absolutely, yes.

Thomas: And so to get into answering that question for you a little bit, normal function of the brain and development as we grow, there’s a lot happening particularly when people are small. Little kids are doing a lot of change and development in their brain. Our brains are very much plastic. And that’s a term that several years ago I had to really figure out what does that really mean? Because I’ve heard the term plastic a lot in the medical community but I mostly heard it referred to when talking about plastic surgery. We’ve all heard that term before.

And usually, with plastic surgery, we’re thinking about something major changing on an individual. And this is no different, the word plastic is change. Neuroplasticity means that there is change able to be made in the brain. And neuroplasticity is what I work with every day. So understanding neuroplasticity a little bit I think is a huge part of treatment of injuries to the brain and how the brain develops. So neuroplasticity having that ability to change little kids from the very beginning is changing constantly. Their brains are developing.

Those freeways of the brain, those pathways of the brain that we do everything on are being added and added and added into the brain over a period of time, especially in the first few years of life. And then there’s something that happens after, there are so many pathways added in the brain. The brain has formed all these pathways and then it has to start getting rid of ones that it finds unnecessary. So it starts to prune away pathways that are not entirely needed. And so this is a part of normal development in the younger years of children.

And so that pruning and pathway development kind of sets the stage for everything that we do after that point. And everything that affects the brain including injury or what we do with our activities and what pathways are stimulated so that they’re kept versus which pathways are not stimulated and are lost because the brain is a don’t use it lose it kind of a tool. And that’s part of that development process.

Amy: So the ones that we want to keep or keep strong we need to use more often those pathways and then ones that we’re not using we tend to kind of drift off a little bit and then prune those out, is that what you’re kind of what you’re saying?

Thomas: Absolutely, yeah, and that’s a huge part of what our brain is left with. I mean trying to develop those pathways and get the ones that are needed so that we can become good at things and we add to complexity as we grow and change. If we are not using the pathway the brain will naturally prune it in those early years of life. And we want kids to have a good amount of healthy pathways so that they can develop and add and change and those normal development processes, they’re really good. And that pruning process is a good thing too.

We don’t want to have stuff that’s not necessary in there gumming up the works, or taking too much energy and it’s not necessary. But we know that activity and what you guys are doing, playtime and that kind of stuff is incredibly helpful and healthy for the brain, especially in those younger two years of life.

Amy: I love that. Awesome. So good to hear. Okay, so we want to be giving them exposure to new things and then helping kind of add depth maybe to the things that they’ve already been doing and maybe complication making it more and more challenging and that kind of strengthens those pathways as they’re growing?

Thomas: Absolutely. And that’s going to naturally occur. People are going to increase what they’re trying to do and children will explore and add and they’ll know that the result of this activity is going to be this. And so if I try this other thing what’s going to happen? And that’s going to help develop those pathways and increase what the brain can do.

Amy: That’s so good. Okay, I love it. So what happens when things go wrong? Because this is something that you work with every day.

Thomas: Absolutely. No, I like to talk about this stuff a lot. This is where I spend most of my day counseling with parents and talking a little bit about the specifics of what do we do with the brain when we’re concerned that something is not like it should be? And I specifically focus on a lot of concussion or mild traumatic brain injury. That’s a lot of what I treat. So when a kid has a fall in the playground the parents will bring him in just out of concern and want to get some evaluation done and make sure there’s not anything major. Or if there is, what do we do about this or what should we expect?

And managing expectations is a lot of what I do on a daily basis. But there are some things outside of just concussion that can be harmful to the brain as well. And we talk about those with parents and patients all the time as well. I won’t talk about those as much. But talk just a little bit about what happens when your kid has a fall and there is a bump to the head. What should you be doing about that? There are certain things that can happen that are dangerous that we want to make sure we do something about right away.

But most of the time and in most instances it’s pretty – I don’t know what the right word is, mild I guess, what’s happened after somebody’s had a bump to their head. And a little bit of time is what is needed. But when somebody is coming in to see me after having hit their head I want to do an evaluation to make sure that there’s not something going on underneath that’s a bigger deal like a bleed on the brain. And with little kids, it doesn’t happen as often as it does in say adults who have a little bit of change in their brain shape and the size of their brain and things like that.

And so there are some major things to look for. So we’ll do an assessment, an evaluation, if we need to get a scan of the brain or something just to make sure everything’s okay, we can do that. But when somebody comes in and they’re having some behavioral changes or something that is outside of normal for that child’s regular behavior then we need to start diving in to find out, okay, what’s the baseline, where are we? What could potentially be changing here for this child? And is there anything that we need to be doing right to help prevent significant change in the brain that could be life-altering over an entire lifetime?

That’s kind of in the initial moments what I want to look for. Is there anything we need to look for that’s significantly dangerous or life-altering?

Amy: So if a parent is wondering because I’ll get a call from the school if my eight-year-old falls and hits her head on the playground and gets a bump and they’ll let me know that that’s happened. So what kind of things should parents be watching out for if they’re concerned if their child gets a bump on the head?

Thomas: If a child has been dealing with changes in any sort of personality, if they’re not immediately responding like they regularly would, I think those are pretty big obvious signs for anybody that we need to look into this a little bit more. But if they’re complaining of a little bit of some pain from a bump or a little scratch or something like that but they seem to be within their normal function, their normal personality, those kinds of things, it’s more than likely going to be something that will just continue to improve. It’s not something that we need to be overly stressed about.

Kids fall, that’s part of growing up and developing and growing and changing. And so I don’t want to steer it one way or the other that bumps shouldn’t be taken too seriously. But also the opposite side of that, we want to take them seriously if there’s anything that’s concerning. So if ever there’s a question, definitely get it checked out and have somebody take a look at it. But more than likely depending on the age of the child there are going to be some observations that happen.

And as the child gets a little bit older we’re going to ask that there be more engagement, more activity, more things that stimulate the brain to try and help, any pathways that might have been disrupted from the fall. And we can get into the specifics of what happens to the brain when we have a fall but you kind of know what’s going on in these moments. But I don’t want to run away here and just [crosstalk 11:36].

Amy: So is that what would change the behavior of a child? Because you said that was one of the things that we would be concerned about is behavior change and noticing a behavior change. Is that because some of those pathways have been interrupted, that the normal pathways that a child has in their brain?

Thomas: Yeah. So there are behavior changes that are a result of pathway disruption. There are behavior changes that come on as a result of how you respond to what’s happening in the moment. There is a system in all of our bodies called the autonomic nervous system. And this system most people know of it as your fight, flight, freeze, rest and digest system. That system is an important piece to all of us. It’s the piece that helps us to kind of navigate situational changes in our lives. If something is going on around you that is dangerous your brain picks up on that and says, “We’re in danger.”

And the brain sends a signal that sends a response to your entire body to try and make a change that allows you to put yourself in a situation that’s no longer dangerous. So if, for example, you’re being chased by a bear which I don’t know that that’s realistic but if you are, your brain is going to say, “We’re in danger.” And it’s going to send a signal to the body to try and get you in a safe and safe place. When you are feeling that autonomic nervous system kick in there’s a lot of stuff that’s happening. Your blood flow is shifting away from your core to your arms and your legs so that you can run faster, fight hard.

Not that I think you should run from a bear, I actually don’t know what you should do. Are you supposed to play dead or something?

Amy: So we’re not getting advice on what to do with running from bears.

Thomas: No, that’s not it. But when you are in that heightened state of response like you should be in a dangerous situation, that blood flow shifts. Your body is trying to do everything it can to save your life. Your senses become heightened. Your eyes become super sensitive. Your ears become sensitive. And all of that is meant to allow you to find a way out and protect yourself. Do whatever you need to do to live. And in those times we choose how we feel in that moment of response.

And our behaviors and this is very true in children are shaped by how we respond in those moments and how we feel affects how we’re going to address that the next time or that development that happens. And so those neural pathways being disrupted can cause sometimes a fight or flight response to kick in. And that causes us to have a response in a certain way. And then that affects the way that we feel or respond to things in the future, there’s kind of a cascade that happens as a result of injuries to the brain or bumps to the brain.

So in the moment when somebody’s dealing with say a head injury or a bump on the head we want to assess and make sure that they’re doing okay, make sure that they’re not having those fight or flight responses kicking in at random times or repeatedly because those can be a bit of a nuisance to a child.

Amy: That is really interesting. I hadn’t thought of that as being part of the behavior change. So what are some things you would recommend, you had mentioned to me that you have – do you have six children, is that right?

Thomas: I do.

Amy: You’re a dad of six?

Thomas: Yes. I’m not just speaking out of what I hear from patients, I am speaking a little bit from what I see in my daily life with all these kids.

Amy: I bet you do. I bet you do, yes. Well, so tell me as someone who works with children both at home and at work and with brains specifically every day, what are some things that you would recommend to parents for just healthy development of their children’s brains at home?

Thomas: Sure. So there are of course some of the basic things that we’re all going to know a little bit about which is being sure that you’re eating right and making sure that there is plenty of activity, both physical and mental cognitive stimulation. Those things are huge for the development of the brain. We love to encourage that playtime, that activity. Here in our clinic when we see someone with a concussion that’s usually the form of treatment that we’re going to give them is stimulation, try and activate the brain.

For the first 24/48 hours, you want to try and take it easy a little bit, there’s some inflammation. Things like that, that are happening but settle that down and then get into activity. The brain needs that stimulation in order to function the very best way that it can. I am a huge fan of encouraging activity. For little kids, it’s hard to bring them in here and say, “We’re going to do some therapies.” And then we do structured therapy because some of that structure is not exactly working with their mindset or how kids play and that kind of thing.

And so we do a lot more of what does your child like to do? Are they really into hide and seek, is there tag? I mean do they like to play these different kinds of games? Because we’ll bring them in and have our therapist play with them in that way to try and just get them, the brain stimulated, showing the parents, “Alright, this is the good kind of activity that you should be doing.” The home and duties thing, and that’s good for a brain that has been injured but it’s also really good for a brain that’s developing. That kind of stuff, stimulation, I can’t say that enough, is really good for those pathways of the brain.

Amy: That’s so interesting that we use the same things both for therapy when a brain has been damaged as well as we’re just using healthy brains, encouraging that physical and cognitive activity, I love that, that’s so cool.

Thomas: Yeah absolutely. And then as far as nutrition which I touched on just a little bit, we definitely want kids eating the right balance of foods. And this is something in my own home that I want to make sure is done well because I want my six kids to have the best chance at life that they can have. And I think one of the things that I can provide in addition to a healthy environment from a cognitive standpoint is nutrition, good nutrition. My wife and I are very much fans of, we grow, big garden, we do a lot of processing of our own foods. We bottle tomatoes and stuff like that because we love to have good things at home to eat.

We eat a lot of meals together so that we know where our food is coming from. There is a lot that goes into what we put into our bodies. I’m not super over the top about nutrition, I don’t dedicate certain parts of my life to researching that. But I know, and the research that I have done, I know that taking foods in that are less processed is always going to be good. I encourage parents on a regular basis to eat Mediterranean, have their kids eat Mediterranean-type foods, things that are healthy fats, less sugar, more fresh fruits and vegetables and this is all pretty basic stuff.

I mean most people know this stuff. You should be eating these kinds of foods but here in the United States, we eat a lot of processed foods. We eat a lot of things that have ingredients that aren’t super great for the brain. They don’t really contribute or add anything and they’re usually packed with a lot more sugars. The brain needs glucose, it needs that to function but it can get that from a healthy balanced diet, not just eating sugar foods.

Amy: Are there any specific foods like avocados or something like that that are a food that just stands out to you that you would say this is a food you should have or nothing really like that, just trying to kind of maybe minimize the sugars and the processed foods?

Thomas: More that than specifically giving one type of food. There are lots of foods out there that people will classify as brain foods or smart foods or whatever. And with children, that’s a hard thing to say, “You should be eating an avocado a day or you should be eating things like this specific item.” Because kids also have their own personalities and their own likes and dislikes. And of course, they’re going to want probably more of the sugary things than the not. It’s better to reduce some of that.

And if you’re making it a regular routine in life and at home, it becomes a little bit easier. But it’s more those healthy fats, the omega 3s, the fish oils, things like that are really good for the brain. The brain has a lot of fatty tissue in it and those things are good for it.

Amy: Okay. So kind of, if we were going to wrap this up and just give a couple of simple suggestions for parents, lots of play, doing physical and cognitive stimulation and then just paying attention to what you’re putting into your body and nourishing your brain with food-wise?

Thomas: Absolutely. I think those are key parts. There are some good habits related to sleep, things like that that are important, but sleep is sometimes a complicated process for children as they’re developing and learning how to find those good patterns and parents helping them to figure that out. I’ve been down that road six times, sleep is not always the easiest thing to find a perfect way to get it, then get the kids to fall in that pattern. But patterns of sleep are huge.

There is a process taking place in some of our deepest cycles of sleep that are removing some of those buildups that are good things that we need and use in our brain every day but having too much of them in there, you know, we need to get rid of that waste. So that happens in our good deep cycles of sleep so sleep is also an important factor in good brain development.

Amy: That’s a good one, yes. And working on trying to get those patterns and help them develop those and whatever that looks like with your specific kids and stages I feel like, different stages where they tend to sleep better than others, right?

Thomas: There is truth to that, yes.

Amy: Well, this has been fascinating, thank you so much for coming and sharing this information with us today. And if people want to come and find out more about what you do, how can they find you?

Thomas: So one of the best ways to find us is on our website. Our clinic is called Neural Effects, that’s N-E-U-R-A-L E-F-F-E-C-T-S. There are lots of ways when you hear that to say it. But neuraleffects.com is the best way to find us, get information from us.

Amy: That’s perfect and we will definitely include that in the show notes so that people can just click on that really easily and get over to your site and find out more about you and what you’re doing. Thank you so much for spending this time with us today and helping us learn a little bit more about brain health.

Thomas: Of course, no problem, thank you for having me.

Thank you so much for spending some time with me today and listening to this episode of the Raising Healthy Kid Brains podcast. We are a brand new podcast which means we are harder to find than the perfect LEGO in a big box full of LEGO. And we need your help so that we can reach more moms, and parents, and teachers with this information about their children’s brains. So how can you help? You can follow this podcast wherever you listen to podcasts and leave us a rating and a review. That would mean the absolute world to us.

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