Head Injuries and the High School Athlete

 The news is full of information (and misinformation) regarding concussions and head injuries in athletes.  Given the hysteria surrounding Frontline’s “League of Denial” and the possibility of CTE (Chronic Traumatic Encephalopathy) among long retired pro football players many parents are concerned about letting their child or adolescent play not only football but any sport that can heighten their chances of their suffering a traumatic head injury.

 While traumatic head injuries can be devastating and all that can be done to protect the only brain you have is critical, it is important to dissociate fact from conjecture. Regarding CTE it does not take much imagination to envision that a situation in which 300 pound players beat each other up with the goal of knocking opposing players out of the game may have some type of deleterious effects. The mind set in pro football for many years of having “your bell rung” meant you sit out for a play or two and then return to the game was certainly bad advice.  This does not mean that anyone who played high level football will suffer devastating brain pathology in their later years.  There are many other factors that differentiate NFL players of past generation from the “normal population” including steroid use, drug and alcohol use, bad nutritional and other habits, etc.  While further research is clearly warranted the conclusion that concussions are the proximal cause of later CTE is far from established.

So what does all this mean to a parent who is contemplating allowing their child to play in a contact sport such as tackle football?  Given the differential size of the head and brain in a child versus an adolescent and adult as well as more limited space between the tissues surrounding the brain in children, avoidance of any type of blow to the head that could lead to a concussion should be avoided. While there is no absolute general consensus allowing a child to play any contact sport, such as tackle football, before the age of 14 is generally not recommended by many medical experts. As noted in a recent headline in “the Atlantic” “America’s Most Dangerous Football Is in the Pee-Wee Leagues, Not the NFL.”  Some clinicians discourage parents from allowing their children to play tackle football before the age of 18, although empirical data on such an age threshold is not available.

Nevertheless, when you as a parent make the decision to allow your child of any age to play in any type of contact sport make sure that their protective equipment is fitted and maintained properly in order to provide expected protection.  Helmets have a limited lifespan of effective protection and must be handled with care.  A helmet should never be used if any significant impact with a hard surface has occurred whether or not evident damage is visible.  Helmets protect by absorbing impact via breakage of the internal and external protective material.  Any helmet breakdown, even normal wear and tear reduces the protection factor.  Helmets should be replaced at a minimum of every 2 to 3 years to ensure maximum protection.

It is also important that the young athlete realize the importance of following the safety rules and rules of their sport.  Make sure that you encourage and reward the practice of good sportsmanship and playing in a clean manner to your child.

Due to the possibility of a severe condition referred to as “Second Impact Syndrome” it is critically important that your child does not return to play with a known or suspected concussion until they have been evaluated and given permission by an appropriate health care professional.  Most high school trainers and coaches now have some information regarding the danger of concussion although not all do and the information they have may be outdated.  Make sure the athletic program for your child has an appropriate head injury and concussion management program in place before allowing your child to participate.

Other tips to keeping your child athlete ‘brain safe’ include:

  • Ensure that you (providing a good role model) and your child always wear a properly fitted and maintained helmet:
  • while riding a bike, motorcycle, snowmobile, scooter or all-terrain vehicle;
  • when playing any contact sport such as football, hockey, lacrosse, or boxing;
  • when using in-line skates or riding a skateboard;
  • batting and running bases in baseball or softball;
  • riding a horse; or
  • skiing, sledding, or snowboarding

In summary, we all want our children to grow up healthy. While many parents desire the benefits of having their children participate in athletics, such as expanded social networks, improved self-esteem, and maximal physical health, the decision to allow your child to experience the positives of athletic participation while minimizing to risk of long-term devastating consequences should be everyone’s concern.

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