National Alliance for Youth Sports – SportingKid Magazine
Fall 2007
An estimated 135,000 youngsters between the ages of 5-18 visit hospital emergency rooms each year due to concussions - and that's just the tip of the iceberg. Countless others suffer concussions that aren't recognized by volunteer coaches and parents and continue playing, opening the door to even more serious problems.
By Greg Bach
Millions of young athletes participating in organized sports programs across the country skin their knees, sprain their ankles and strain their muscles, while thousands of others suffer much more serious concussions, many of which - alarmingly - go unidentified by volunteer coaches and parents. As youngsters nationwide fasten on football helmets and strap on soccer shin guards - to step on fields for two of fall's most popular and contact-laden youth sports - the alarm on concussions is being sounded by not only medical experts but everyone from researchers to professionals in the sports industry.
"The 10- to 18-year-old range is really that window when a child's brain is most vulnerable to injury," says Dr. Kevin Guskiewicz, a certified athletic trainer and professor and director of the Sports Medicine Research Laboratory at the University of North Carolina.
While the high-speed collisions in the NFL - the ones that raise fans out of their seats in excitement on Sunday afternoons - are well documented for the concussions they produce and the careers they chop short, young heads bumping together on community soccer fields or smashing into one another on local football fields are beginning to draw much more attention, too. While the bodies aren't as big and the force of the impacts aren't nearly as great as what is seen in the professional and collegiate ranks, jostling a child's still-developing brain is still major cause for concern.
"Parents and coaches need to be aware that children are at risk," says Dr. Julie Gilchrist, a medical epidemiologist with the Centers for Disease Control and Prevention' (CDC) Injury Center. "You can't tell kids to shake it off, to play through the pain or that they'll be fine. Those mantras we heard growing up are not appropriate. Concussions need to be taken seriously and parents and coaches need to know what to do."
The numbers are startling: The CDC estimates that approximately 135,000 youngsters between the ages of 5-18 visit hospital emergency rooms for brain injuries every year.
"It seems like a lot, but this is only the tip of the iceberg," Gilchrist says. "What's more concerning is that there are many children who don't receive any type of medical care anywhere. They may have a headache for a few days but they don't know they have suffered a concussion."
Gilchrist was one of the lead authors on the study analyzing head injuries in sports and recreational activities from 2001 to 2005. The results were published last month in the CDC's Morbidity and Mortality Weekly Report. The study also reported that 5 percent of all sports-related injuries for youngsters in the 5 to 18 age bracket that require emergency room visits involve the brain.
The American College of Sports Medicine reports that approximately 85 percent of all concussions are never diagnosed, and according to the Ontario Brain Injury Association, approximately one third of all children will have suffered a concussion by the time they finish high school. Furthermore, once a child suffers a concussion he is four to six times more likely to sustain another one.
"The real number of concussions that occur may not have increased much in the past 10 years, it's just that we're learning how to recognize many of the ones that were missed in the past," says Dennis Piper, second vice-chair of the Headgear Subcommittee for the American Society for Testing and Materials, an international standards development organization.
PLAYING THROUGH THE PAINA child doesn't have to be knocked out to suffer a concussion, and the vast majority of concussions do not include a loss of consciousness. Therein lies a big part of the problem, as kids scramble to their feet to get ready for the next play when they should be escorted to the sidelines and observed for the remainder of the game.
The most typical concussion symptoms include a feeling of having been dinged, amnesia about the injury event, nausea, headache, dizziness and sensitivity to light or sound.
"These symptoms occur surprisingly often in youth sports, but most players play through the injuries because they've been taught to be strong and resist pain," Piper says.
That is particularly true in sports like football and hockey, where coaches preach toughness and bouncing back up after taking, or delivering, a hit.
"Football is a very macho sport," says Dr. Barry Boden, of the Orthopaedic Center in Rockville, Mary. "Athletes are taught to play through pain. But concussions need to be taken seriously. The single most important piece of advice that I can give is to never let an athlete play football if he has any neurological symptoms (amnesia, dizziness, headache, irritability and personality change) whatsoever."
The American Academy of Neurology classifies concussions into three different types. Grade one is the most common, and accounts for approximately 90 percent of all concussions suffered. The athlete is only momentarily confused and does not lose consciousness, though he may have difficulty remembering the event for up to 30 minutes after the injury.
"Kids are more apt to experience dizziness, nausea and sensitivity to light," says Guskiewicz. "These are the red flags. When an adult takes a blow to the head and isn't thinking clearly it's more easily identified because they can communicate back that they're having concentration problems. With kids it's a little more challenging to determine if the youngster is just being silly or if he's really injured."
Grade one concussions, oftentimes referred to as "dings," pose all sorts of potential problems for youngsters, primarily because they're difficult for coaches and parents to recognize. Consequently, many kids - without them or their coaches being aware that a concussion has been suffered - continue right on playing.
"When a child breaks his arm he knows it's broke and he knows when it's healed," says Dave Rossi, the chief marketing officer for Schutt Sports. "It's not as easy to detect with a brain injury. If the child is not fully recovered, and his brain's chemical function is not back to normal and he sustains a second injury, then that is where the risk goes up dramatically."
Known as Second Impact Syndrome (SIS), youngsters suffer permanent brain damage or die after a head injury occurs while the brain cells are still recovering from a previous head injury. Although rare - approximately four to six youngsters die due to SIS each year - it is devastating. It is believed that it occurs almost exclusively in athletes under 18-years-old.
Grade two concussions are typically associated with a loss of consciousness for less than five minutes, followed by difficulty remembering events lasting anywhere from 15 minutes to 24 hours.
A grade three concussion - the most severe - results in a loss of consciousness for more than five minutes and includes more than 24 hours of post-injury amnesia. Grade two and three concussions are the most easily recognizable, due to the loss of consciousness, and require immediate medical attention.
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