When I was kid, I remember my dad scolding my brother and me when one of us decided to hold the other one upside-down. In that position, he reasoned, we could fall on our head. As a cognitive psychologist, my dad was always thinking about the brain. Despite his concern with all things cerebral, my dad outlawed only one sport: football.
That was decades ago. We now are far more aware of the dangers of head injuries in sports than we were then. As a parent of two athletic children, I, too, have explicitly outlawed only one sport: football. But I worry a little every time one of my kids steps onto a soccer field or basketball court. All injuries upset me, but I can accept the possibility of a torn ligament or even a broken bone. Like my dad, I have a lot of trouble with the idea of a head injury.
To some extent, I will have to live with that fear, as with many other fears related to the welfare of my children. Although safety is a primary concern for parents, putting it as a top priority always is not only impractical, but ironically, has its own dangers, many of them involving mental health. So although I don’t have any grand ambitions for my children in sports, I will also not tell them to stop playing. Sports have many social, psychological and health-related benefits, no matter how skilled (or not) your child is at them. (Of course, my kids are above average—and I know yours are, too.)
So what should parents do to protect their children, given the new data on the dangers of concussions in youth sports? I asked Patric Stanton, a neuroscientist at New York Medical College in Valhalla that question. Stanton studies what happens to the brain after an impact, so it’s safe to say he’s pretty spooked. He’s seen, firsthand, the anatomical signs of chronic traumatic encephalopathy (CTE), a severe neurodegenerative disorder, in a 17-year-old. (Yep, that kid played football.) As a result, I would consider his advice conservative—but let me go out on a limb and also say he knows what he’s talking about.
If you are the type of parent who is willing to give up everything, or most things, for you child’s sport, you may reject some of the advice below. Stanton’s tips are geared toward parents who have some room for the opinion that sports should be played primarily for fun, learning, friendship and exercise.
1. Know the symptoms of a concussion. If your child feels very sleepy or dizzy, has blurred or compromised vision, or feels sick to her stomach, you should take her to the emergency room. According to the Mayo Clinic, signs and symptoms of a concussion may also include:
• Headache or a feeling of pressure in the head
• Temporary loss of consciousness
• Confusion or feeling as if in a fog
• Amnesia surrounding the traumatic event
• Ringing in the ears
• Slurred speech
• Delayed response to questions
• Appearing dazed
To take out most of the guesswork, grab your phone and download the app Concussion Recognition and Response (CRR). Its checklist of signs and symptoms will help you know whether to take your child out of a game and whether she needs medical attention. It also provides questions to ask your child after the injury. As a rule of thumb, Stanton says, if a child is hit on the head, if she has any symptoms at all, err on the side of caution and take her to the doctor. If you and the child’s doctor have any concerns, consult a neurologist. If your child has been knocked out, then proceed immediately to the nearest emergency room for a Magnetic Resonance Image (MRI).
2. If your child does get a concussion, be extremely conservative about letting him return to play. First, a neurologist needs to clear the child for physical activity. (The doctor may base his or her recommendation on how long the symptoms lasted and how long the child has been symptom free.) Then, Stanton says, wait again an equivalent time-period, so that you have waited twice the recommended time. This safety buffer can be critical. If the brain has not recovered fully, any further impact to the head could be devastating. “A second impact within a window of vulnerability is tremendously more damaging than the first one,” Stanton says. Unfortunately, no one is sure what that window might be. It depends on the severity of injury and the individual child’s brain, but research continues to suggest that it could be far longer than previously believed. In many cases, a child should sit out for the remainder of the season.
The main treatment for a concussion is rest. The idea is to give the brain time to heal itself. During that interval, a child should do everything possible not to impede recovery. In addition to avoiding physical activity, he should be told that under no circumstances should he drink alcohol or use any drugs; his brain is extremely vulnerable to the effects of such chemicals.
When a child does return to a sport, he should do so gradually, in stages. The CRR app includes a return to play guide, which details the steps to follow. These start with brief, light aerobic exercise, proceed to moderate activity and then to more intense workouts and weight lifting. After that, the youth can participate in practice and finally, games. Between each step, the child must rest for 24 hours and be on the lookout for symptoms.
3. Before your child starts the season, consider getting your child a concussion baseline test; ask pediatrician for a prescription, or, some sporting leagues offer such testing to participants. The results will provide information about what a child’s cognitive function is normally, an important benchmark against which a neurologist can evaluate the results of similar tests conducted after an injury. A neurologist is likely to recommend multiple cognitive tests at different time points post-injury.
4. Before play begins, find out what procedures the athletic organization overseeing your child’s sport has for handling concussions. Ask about its protocols for getting kids off the field and evaluated, and the rules for clearing a kid to play. Who is assessing a child who gets hit in the head during a practice or game? You could start with the coach or could turn to an official higher up in the organization. Make sure the coach and league have thought about this, and have established rules. If there is any chance of a head injury, that kid should sit until she can be evaluated. If sensible procedures do not exist, consider finding a different league or organizing parents to push for change.
5. Talk to your kids. Teach your kids about concussions and instruct them to tell you right away if they hit their head. Often a child does not want to talk about being injured, and some kids might even lie to you and say they are fine because they want to play. (Adult athletes earning $6 million per year will do the same thing, Stanton points out.) If your child tells you about any type of impact to the head, use the app to determine the next steps or follow Stanton’s rules of thumb in tip 1.
6. Pay attention to practices. These can actually be more dangerous than games. After all, a kid might practice a drill, such as heading the ball, many times that she does maybe once in a game, if at all. Practice, after all, involves repetition. What is more, parents tend not to attend practices, making it important that a coach know what to look for—and that you teach your child to report anything that happens to her head.
7. Consider setting limits. If your kid plays soccer, you might ban or discourage heading the ball, particularly in practice. Although most concussions in soccer seem to involve the head hitting the ground or another player, many scientists believe that repeated impacts to the head that cause no immediate symptoms nonetheless damage the brain over time. In one study published last year adult players who headed the ball a lot—885-1,550 times a year—for years showed brain changes similar to those seen after concussions; those who headed the ball at the highest levels performed worse on memory tests. For the most susceptible brains, such repetitive head trauma could even lead to CTE, which can take decades to develop (see “Does Heading the Soccer Ball Cause Brain Damage?”).
The bottom line? “I don’t think heading the ball is a good idea,” Stanton says. “There is no right way to head the ball that can entirely eliminate the risk of cumulative impact.” Other experts suggest banning heading for all kids under age 14 and recommend that younger players practice heading with a beach ball instead of a soccer ball. You might also consider having a young soccer player wear protective headgear, which some studies show can reduce the rate of head injuries from either headers or unintentional contact during a soccer game.
While we are on the topic of controversial restrictions, investigate the risks of tackle football. “I’d do everything in my power to prevent a child from playing football,” Stanton says. Given that football practices offer many opportunities for head injury, at least consider making sure your child’s practices conform to the latest safety rules (listen to “Limit Youth Football Practice Hits for Brain Health”).
Whatever sport your kid plays, it will be safer (and probably more fun) if practiced in moderation. After all, the more time on a court or field, the greater the risk of injury. At really high levels of play, children can also just burn out.
8. Have a good attitude. Sure, your kid plays to win. All good athletes do. But winning should not be your top priority when you sign up your child to play. If your child is the star of the team but has to come out because he bashed his head against another player’s, then so be it. “There is no substitute for an informed set of parents whose number one goal is the health and wellbeing of a child,” Stanton says.
As parents, many of us are annoying worry warts. (Okay I’ll speak for myself.) But I gave up on bubble wrap a while back; it is simply not possible to prevent all bad things from happening to my precious progeny. The good news, Stanton says, is that kids are resilient. Even a child’s brain, despite being relatively vulnerable to injury, typically heals more quickly than an adult’s. So if a flying basketball ricochets off your child’s cranium, he or she is likely to recover and function fine. That said, not all people’s brains are equally impervious to the kind of cascading damage that occurs in CTE. “Some people will be susceptible and others resistant; we have no idea how to identify who is at risk,” says Stanton. So I’m opting to play it safe.
For more information, see the Scientific American in-depth report: