It is late August in Texas and a steamy 100 degrees in the shade. It can only mean one thing: football! I recently found myself overdosing on Olympic field hockey, volleyball and water polo. Who knew they could be so violent? One thing is for sure, the 30-45 million children and adolescents who participate in non-scholastic organized sports are starting to practice and play. It is estimated that in the United States 300,000 people suffer sports-related brain injuries each year. Athletics are good, but who is educating the well-intentioned moms, dads and volunteers on the prevention and management of concussions?
A few weeks ago I was present at a "Meet the Coaches" night for my 8-year-old grandson, who is in his second year of tackle football. That's right, I'm the neurologist who said his son would never play football. So of course he played in middle school and high school. Now I have a grandson who started playing tackle football at age 7. What can I say? We live in Texas.
I inquired as to the level of training the "parent coaches" received about injury and concussion prevention. The answer? Zero. A few minutes later I was asked to examine another 8-year-old who had been hit in the head by a rock launched at his helmet-less head. Picture it: More than 100 small boys running around the field and poking at each other. I am about to blow the whistle and get back to the facts, but first watch this very brief YouTube video of two 8-year-olds "practicing."
Concussions in Children and Adolescents
Despite that errant rock, concussions in children and adolescents over 10 years of age are more likely to occur in organized sports than other activities. It is sometimes amazing that our children survive their early childhood. A nosedive off the changing table or mountain climbing on the kitchen cabinets result in numerous falls, each thunk sounding like it shaved off a few more IQ points. But youth sports is a situation where we can actually intervene to prevent an injury. Consider that most of these sports injuries occur in non-scholastic youth leagues and it is clear that the numbers of injuries are underreported. Couple that with the fact that the staff is not trained to recognize a concussion, and that the player or parent fears the athlete will lose their position on the team, and you can see how the problem grows. A 2004 study noted that fewer than 50 percent of student athletes reported their concussion symptoms.
Children and adolescents are at a greater risk to suffer a concussion than collegiate or professional athletes. Theories for this difference include the fact that their brains are still developing, that their small body size may be able to absorb some of the forces, or that their brain is more sensitive to the chemicals that are released at the time of head injury. We do know for sure, though, that they are at risk.
Who Is Watching the Store?
The National Athletic Trainers' Association reports that only 42 percent of high schools have a certified athletic trainer. That's at the high school level, and I suspect predominantly in larger urban communities. That means that moms, dads, volunteers and other well-intentioned people with little or no training in concussion and injury prevention staff most youth athletic leagues. We call them "Coach," and in Texas the kids say "Yes Sir, No Sir." However, all of these great people may not know any more than you do about head injuries. It is time to educate everyone and protect our children.
Coaches and Parents, Listen Up!
We have made great progress in the last few decades. We all know about hydration and the kids all go through a conditioning program. More good news: The most recent statistics reveal that 38 states and the District of Columbia have passed "Concussion Laws" for public school students. This is a great start and protects more than 7 million high school student athletes, but we still have more than 30 million children in youth leagues. Whistle! Huddle up: This is what we should do:
• No one coaches any youth sport without concussion education. Take it personally. It's your responsibility.
• If your child plays a contact sport, read the links below and be as knowledgeable as the coach. You are your child's personal trainer. You know them better than anyone else and will have a better idea if they don't make it back to their baseline.
• You find sponsors for your T-shirts, uniforms and banners. Ask a local hospital or doctor to sponsor a "Concussion Awareness Program" for your league using the materials listed below.
• Download the Center for Disease Control's Heads Up program. Print out the sections for coaches, athletes and parents. No one plays until they have read it. You are going to have stay on top of this one, since a study reported that the data was helpful but only 50 percent of coaches felt the material changed their opinions about concussions. We have work to do. Take two laps.
• Go to the American Academy of Neurology Website and download their Concussion Guidelines. If you are a coach, laminate the sideline card and give it to all your assistants. Give all the parents the Return to Play Criteria and follow them.
• No athlete, repeat, no athlete returns to play the same day they suffer any symptoms of a concussion. Remember, children and adolescents will take longer to recover than adults, so avoid the temptation to let the athlete play earlier than is prudent. Follow the six-step Return to Play Guidelines in the CDC and AAN downloads. No cheating! Follow all six steps.
Coaches and parent: He may be the team's star running back, and the playoffs may be next week, but we want him to be someone's doctor someday and not one of my brain-injured patients. Listen up!
Correction: A previous version of this blog cited the National Association of Athletic Trainers. The organization is the National Athletic Trainers' Association.
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