Playing It Safe: What Parents Should Know About Concussions in Youth Sports

Editor’s note: This article was sponsored by Seattle Children’s Hospital.

Too often, concussions go unnoticed for young sports players.

But identifying a brain injury early — and stepping off the field — is critical, says Dr. Sara Chrisman, a pediatrician and concussion researcher at Seattle Children’s Hospital.

“We think a lot about knee injuries that take you out of the game, but brain injuries take you out of your life,” Chrisman says.

Roughly 2 million children and teenagers have experienced a concussion, or a mild traumatic brain injury. Returning to physical activity too soon after a concussion can increase one’s risk for further injuries and result in prolonged recovery. That’s why it’s so important to take concussion seriously, seek care and allow time for the brain to recover.

What causes concussion?

Concussions occur when a bump or jolt to the head or body disrupts the brain’s normal functioning. People with concussions may experience headache, dizziness and problems with memory, sleep, balance and mood.

About 70 percent of emergency department visits for sports and recreation-related traumatic brain injuries (including concussion) come from children ages 17 and younger, according to the Centers for Disease Control and Prevention (CDC), and nearly half these are due to contact sports such as football, basketball and soccer. Recreational activities like cycling and off-road vehicle riding (ATVs) also contribute to these statistics.

In sports, concussions are due to collisions, most commonly with other athletes, but also with equipment or the ground. Sports with the greatest concussion risk are those in which crashing into another player is expected — like football and hockey. But many complex factors influence how risky an activity might be, including playing style and other variables. For example, how high does a cheerleader fly in the air and what material are they practicing on?

Seeking care and treating the injury

If someone experiences a strong blow to the head and isn’t feeling well, it’s important to leave the field and assess the injury, Chrisman says. Someone with a concussion may struggle to react appropriately to complex events on the field, which puts them at risk for additional injuries. Balance can be impacted, too.

The decision whether to seek medical care following a head injury depends on the presence and severity of symptoms, which can include headache, vomiting or a change in mental status. Symptoms that are severe or persist could be a sign of a more severe head injury.

“When we as medical providers are on the side of the field, we’re not trying to diagnose to concussion, but to make sure the athlete doesn’t have a more severe injury like a head bleed. If someone isn’t responding normally, that’s the most concerning,” she says. “As a parent, you know your kid and there’s no wrong time to go to the ER if you’re worried.”

How to recover from a concussion

As researchers learn more about this common brain injury, the science on how to treat concussions is evolving. Medical wisdom once held that the best way to heal a concussion was to seal oneself away from sensory input in a dark room or so called “cocoon therapy,” but that approach has shifted.

Youth sports with the highest rates of concussion:

1. Boys’ tackle football
2. Girls’ soccer
3. Boys’ lacrosse
4. Boys’ ice hockey
5. Boys’ wrestling
6. Girls’ lacrosse
7. Girls’ field hockey
8. Girls’ basketball
9. Boys’ soccer
10. Girls’ softball

“We now understand that the way you heal from a brain injury is by getting back to the things you did before,” Chrisman says. “If you have a stroke and you can’t walk and you lie in bed for a year, you’re not going to magically be able to walk. The brain heals by doing.”

In the first few days after a concussion, it makes sense to sleep, rest, hydrate and ensure appropriate nutrition. Your child will likely need a break from school for at least the first one to two days following the injury. However, after that time, it’s important to add a little bit more every day, using a rehabilitative approach. Start with walking, stretching, reading, and then add in from there. Taking too much of a break from school can make it harder to get back.

In Chrisman’s own practice, she often hears from parents who wonder about screen use following a concussion. People who avoid screens in the first few days following a concussion do recover from symptoms faster, research has found. That’s largely thought to be because they gave their brain time to rest — without the demand of cognitive focus that can come from screens. However after the first week or so, using screens is less a matter of risk and more about pacing. As Chrisman says, “Later on in recovery, screens aren’t dangerous; they’re tiring.”

Researchers are still trying to fully understand the short- and long-term effects of a second head injury before the first has healed, she says. It’s wise to avoid activities that could reinjure the brain for at least a week or two while someone may experience slower processing time and poorer coordination. During that time, though, low-risk physical and mental activity can help the brain return to normal.

Deciding when to return to a sport can be complicated and influenced by individual factors, which means parents should consult with their medical provider for specific guidance. The CDC offers a step-by-step guide to returning to play following a concussion, a sequence that steadily ramps up activity levels and function before ultimately participating in games.

Generally speaking, though, the earliest a child should return to play following a concussion is a week — and that’s for cases in which the child is feeling nearly 100 percent the day following the injury, Chrisman says. Most kids with a concussion take a couple of weeks to let their brain heal before they return to play.

During the recovery period, it’s important to work with the school to develop a plan, too. While some kids will be fine, others might have trouble concentrating following a concussion. They might require some forgiveness in assignments, or the opportunity to take exams in a quiet place.

If struggles with concentration and focus linger, it’s not always a sign that the initial concussion is to blame, she cautions. Sometimes, the injury reveals a challenge with focus or learning that the child was already experiencing but became worse with the concussion. “If they were barely keeping their head above water before the injury, they may have sunk to a place they can’t get out of. Sometimes having a concussion is how issues like attention deficit disorder are identified,” she says.

The issue of long-term complications, and how many injuries are too many is also complex and individual. It’s hard to compare a child who falls down the stairs at age 2, and was fine the next day, to a youth football player who has experienced repeated concussions.

“With one concussion, you will heal completely with no permanent damage,” she says. “If you have a kid who is having multiple concussions, you might need further evaluations and conversations about what constitutes acceptable risk as a family.”

Balancing safety risks and rewards

Those conversations can be tough — with many distinct variables. If a child stops playing a higher risk sport, will they substitute it with another lower-contact sport or stop playing altogether? What will be the mental health impact of giving up a sport they love? What about the impact to their physical health? A child who loves football probably isn’t going to pick up tennis.

“Everything in life is a risk/benefit balance,” she says. “You have to find what works for your family.”

Still, there are some steps that could help reduce the concussion risks for all players. Increasingly, there’s a movement to emphasize preventing concussions in young athletes and changing the culture of sports. For example, in the United States, heading in soccer is not permitted for athletes 10 and younger. After that, it’s slowly introduced over a period of a few years as kids develop a better sense for more complex parts of the game, and for judging how their body moves in space. Similarly, bodychecking in ice hockey isn’t allowed for younger players.

“I’m a huge proponent of working with athletic organizations to make sports safer,” Chrisman says. “We need to meet families where they are.”

In future research, she is planning to study the role of brief huddles before a game to reaffirm safety protocols for young players, a project that she and her colleague Dr. Kroshus are leading in partnership with U.S. Soccer. That assurance, combined with more training from referees, coaches and parents, could bring concussion awareness to the forefront. Parents, too, can be selective about sports organizations, reviewing their safety focus before signing up and talking to leadership about ways they can be a leader in terms of safety.

“You should also talk to your kid before the season,” she advises, “If your child knows you want them to report if they think they might be injured, they’re more likely to let someone know.”