It’s a question more and more parents are asking these days: “Should I let my kid play football?” Or maybe it’s soccer, lacrosse, ice hockey, or some other contact sport. Their concern with these activities can be summed up in one word: concussions.
For most kids, playing sports is fun, social, and challenging. Sports are also an excellent way to teach teamwork, competitiveness, and responsibility, while helping kids grow stronger and stay fit. But at the same time, a growing body of research has focused on the dangers of concussions and head injuries in youth sports, and the conversation has escalated over the past few years. Lawsuits by former pro-football players with lingering health problems and Will Smith’s 2015 movie Concussion have brought the topic of sports-related head injuries into the spotlight.
In some ways, this extra attention is great for young athletes. And yet, in other ways it’s holding them back, as some parents wonder whether contact sports are safe in any capacity.
When Can Kids Start Playing After a Concussion?
Discussion about the risk of sports-related brain injury leads to heightened awareness. Many families and coaches now better understand the signs and symptoms of concussions. They’re seeking care when necessary, taking precautions, and following the proper return-to-play guidelines (a set of criteria detailing when someone can return to the field after a concussion)—all positive developments.
Concerns over athletes returning to play too quickly have led legislators in almost all states to pass laws stating that no player may return to play the same day of getting a concussion and that the athlete must be cleared by an appropriate health care professional before she is allowed to return to play in games or practices. The laws typically also mandate that players, parents, and coaches receive education on the dangers of concussions and recognizing their signs and symptoms.
The return-to-play protocol is significant for athletes of all ages and competitive levels because the long-term effects of concussions in children can be considerable. The American Academy of Pediatrics recommends a six-step program, allowing approximately 24 hours for each step. If any symptoms return during this process, it’s a sign of incomplete recovery and the young athlete should wait an additional 24 hours before attempting that step again. Generally speaking, symptoms should improve within a week to 10 days, but a doctor should re-evaluate athletes with persistent symptoms.
“There’s a rare condition called ‘second’ impact in which a second concussion occurs before a first concussion has properly healed,” according to Jay Selman, M.D., chief of neurosurgery and consultant to the Traumatic Bain Injury Unit at Blythedale Children’s Hospital in Valhalla. “This causes rapid and severe brain swelling and a vast majority of these cases end in death.”
The first step in the AAP’s protocol is for the child to rest—physically, as well as cognitively. “Relative cognitive rest involves minimizing potential cognitive stressors, such as schoolwork, but this also includes video games,” Dr. Selman says. “Modified school assignments shouldn’t result in your child playing Xbox all afternoon.”
After that, the steps call for the child to slowly and methodically return to activities.
This is an example of a what a typical return-to-play plan looks like:
- The athlete must observe complete physical and cognitive rest while symptoms are present.
- Once the athlete has stopped showing any symptoms, he or she can progress to light aerobic activity.
- Provided symptoms don’t return, activity may increase to sport-specific exercises without head impact.
- The athlete may advance to more complex, non-contact drills.
- The athlete may advance to full-contact practice.
- The athlete may advance to normal game play.
New Policies to Reduce the Risk of Concussions
Another result of the public discussion about concussions is that Pop Warner, the country’s largest youth football organization, announced in May that it will ban kickoffs in games starting this fall, the latest attempt to reduce the risk of head blows that can lead to concussions.
The elimination of kickoffs will apply to the three youngest Pop Warner divisions, which include players ages 5-10. It will possibly expand to older kids in the near future, once the results of the change have been reviewed. Instead of kickoffs, the ball will be placed at the 35-yard-line at the beginning of each half and after each score. Pop Warner will also reduce the amount of contact time in practice in all age groups, to 25 percent from 33 percent.
Because the number of children who sustain concussions is on the rise, youth recreation programs and many school districts are responding with stricter policies to ensure safer play. For example last winter, the Westchester County Concussion Task Force unveiled a list of best practices for concussion management for high school and youth sports. The 10-point plan focuses on improving collaboration between school officials when treating head injuries. It also stresses the importance of parent education about concussions and how to identify symptoms. The task force’s goal is to get schools caught up on the latest, rapidly evolving science of head injury protocol and concussion treatment.
Many advocacy groups encourage parents to have their children evaluated before the playing season begins to establish a baseline measure of brain function. One such test, called the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), evaluates memory, motor speed, and reaction time. Athletes take the test at the start of the season and periodically thereafter, and again if they’re injured.
Some Parents are Still Paralyzed by Fear
The recent attention to the dangers of concussions has led some parents to say they are now paralyzed with fear and are choosing to keep their kids out of sports entirely. Lisa, a mother of two in Scarsdale, is relieved that neither of her boys has asked to play football. “I would be fine with flag football but I would be entirely opposed to tackle football,” she says. “Although, my 13-year-old son, who, like many boys his age, has suffered from one concussion already from soccer. So now I’m rethinking soccer as well. I’m starting to question the safety of any sport at this point.”
There is a middle ground that some experts are advocating. Instead of kids avoiding sports entirely, these advocates believe in setting a minimum age for when kids should be allowed to start playing contact sports. Bennet Omalu, M.D., a forensic pathologist and leading expert in the growing field of concussion research, wrote an op-ed piece last year for The New York Times saying that children should be prevented from playing football and other high-impact contact sports before the age of 18.
“Our children are minors who have not reached the age of consent,” Dr. Omalu wrote. “It is our moral duty as a society to protect the most vulnerable of us. The human brain becomes fully developed at about 18 to 25 years old. We should at least wait for our children to grow up, be provided with the information and education on the risk of play, and let them make their own decisions. No adult, not a parent or a coach, should be allowed to make this potentially life-altering decision for a child.”
Other experts in the field propose that tackle football, heading in soccer, and full-body checking in ice hockey not start until kids are 14, largely because their brains and bodies are still developing and are therefore more vulnerable to serious injury.
“Nothing magic happens when an athlete turns 14,” Dr. Selman says. “There are big 14-year-olds who develop earlier and then there are 14-year-olds who look like they are 10. But by the time teens are juniors or seniors in high school, the difference in size between the athletes isn’t quite as dramatic.”
When to Quit Playing Contact Sports
There is no set number of concussions that determine when a young person should give up playing contact sports. The circumstances that surround each individual injury, such as how the injury occurred and the duration of symptoms, are very important and must be factored in when assessing an athlete’s risk for—and potential long-term consequences from—experiencing additional and potentially more serious concussions. The decision to quit certain sports is a decision best reached after a complete evaluation by your child’s primary care provider and consultation with a physician or neuropsychologist who specializes in treating sports concussions.
It’s not an easy decision to make. Ultimately, it is up to parents to make informed choices based on their individual circumstances about whether to let children play contact sports. And above all, it is critical for parents and coaches to arm themselves with proper concussion knowledge, the right equipment, good training, an understanding of the symptoms of a concussion, and a healthy attitude about sports should they let their kids participate.
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