Head's Up

The recent spotlight on National Football League concussions puts the focus on child sports safety

By Dwain Hebda

Safety and awareness are key to prevent concussions.

Safety and awareness are key to prevent concussions.


Justin Hawkins has a lot on his mind when it comes to concussions. As director of coaching for Arkansas United Soccer Club in Little Rock, Hawkins is responsible for implementing coaches’ education that includes how to respond appropriately when a player is injured. Increasingly, that means looking for signs of traumatic head injury.

 “This has definitely been a very hot topic in soccer over the last year and a half, ” Hawkins said. “We have certain mandates on the ways we can train in practice all the way to the referees association and how they handle things like this in games.”

 Arkansas United’s safety measures—which include educational components and concussion protocols that parents, coaches and referees are made to learn and abide by—are a sign of the times in youth sports. Thanks to alarming headlines from the pro ranks, specifically football, sports-related concussions have gained more attention on the soccer pitch, basketball court and other fields of play.

  “A lot of our kids play multiple sports, so if we’re keeping one sport safe we need to keep all sports safe,” Hawkins said.

 While no sport is completely free of potential injury, concussions included, Hawkins said youth soccer is growing in part due to the perception of a lower threat of head injuries, particularly by parents nervous about football. And while that may be accurate anecdotally, national figures paint a murkier picture.

 In late 2009, NFL Commissioner Roger Goodell was hauled before Congress to answer to former players’ health issues, and by year’s end, the league had admitted concussions may lead to other problems later in life. Over the next three seasons, the nation’s largest youth football organization, Pop Warner, reported a nearly 10 percent drop in participation, according to a 2013 investigative piece by ESPN. As additional stories about high school teams struggling to fill rosters began to pop up all over the nation, some speculated the unthinkable was happening in football-mad America.

 However, The Washington Post reported last year that rumors of the death of tackle football may have been greatly exaggerated. It cited the annual survey by the Sports & Fitness Industry Association which found organized tackle football participation stayed relatively constant, down a mere 4 percent between 2009 and 2013. What’s more, the survey reported youth sports participation in general was down, further suggesting that while football was catching most of the flack, other supposedly non-contact sports were having issues of their own.

 Such ongoing debate has driven positive changes in youth sports, notes Dr. James Nesmith, medical director of the Arkansas Children’s Hospital Concussion Clinic.

 “There are certainly studies that have shown an increase in emergency room visits for kids with concussions,” Nesmith said. “That increase has been parallel with the increase in public knowledge; more people are recognizing it and more people are taking kids in to get checked out.

 “It’s also due to legislation. All states now have youth concussion laws that say pretty much the same thing in that they mandate that someone who is suspected of having a concussion must be evaluated by a health care provider before they return to play.”

 On the other hand, Nesmith said people who view youth sports as the sole culprit when it comes to kids and concussions aren’t seeing the whole picture.

 “Concussions don’t just happen in sports; they can occur in any recreational activity,” he said. “Certainly any activity that carries with it a significant risk of fall or hitting something, you’re going to have that possibility."

 Dr. Brent Masel of Galveston, Texas, national medical director of the Brain Injury Association of America, said parents need to take a balanced, common-sense approach when evaluating risk.

 “(Concussions happen with) stuff that you and I did when we were children: Falling off the swing, playing with your friends,” he said. “The overwhelming majority of concussions in children are playing-around kinds of sports, not organized sports. But, I wouldn’t let my kids play football. You can’t put your kid in a bubble, but you don’t go out of your way looking for it. Certainly, there are other organized sports where you get the camaraderie and the teamwork and the goal-driven stuff just as easily as opposed to banging your head.”

 Masel added that much of what the medical community knows about concussions during childhood is still evolving and that the thinking surrounding treatment has taken a dramatic about-face in the last couple of years.

 “We’re just starting to figure this out; we used to think you put the kid in a dark room and no exposure to anything and give them absolute rest. It turns out that was really a bad idea because the kids go nuts,” he said.

 “Certainly if they’ve had a concussion it’s not a good idea to just get up and go back to school that day and certainly not to go back and play football. Take a day or two off, not necessarily in a dark room and with no exposure to anything, just hang around the house.”

 Also contrary to previous thought, parents should strive to get kids back to school as soon as possible, as most can be cleared to return to class even before they are cleared to return to the field. Then, Masel said, students should be reintegrated until they begin to demonstrate symptoms, then back off and repeat. It’s a strategy that requires a deft touch.

 “It’s a completely individualized kind of thing and it takes a very involved, educated parent, it takes understanding teachers and understanding coaches.”


 Youth Concussions:  What To Look For
With the majority of concussions, the person does not lose consciousness and youth may lack the verbal or cognitive skills to tell you what’s happening. Any time a child or youth suffers a fall or collision that includes hitting their head on another person, game equipment or the ground, pay particular attention to the following:

• Headache or “pressure” in head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light
• Sensitivity to noise
• Feeling sluggish, hazy, foggy or groggy
• Concentration or memory problems
• Confusion
• Just not “feeling right” or is “feeling down”

• Appears dazed or stunned
• Is confused about assignment or position
• Forgets an instruction
• Is unsure of game, score or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness (even briefly)
• Shows mood, behavior or personality changes
• Can’t recall events prior to hit or fall
• Can’t recall events after hit or fall

An athlete should receive immediate medical attention if after a bump, blow or jolt to the head or body if she or he exhibits any of the following danger signs:

• One pupil larger than the other
• Is drowsy or cannot be awakened
• A headache that gets worse
• Weakness, numbness or decreased coordination
• Repeated vomiting or nausea
• Slurred speech
• Convulsions or seizures
• Cannot recognize people or places
• Becomes increasingly confused, restless or agitated
• Has unusual behavior
• Loses consciousness; even a brief loss of consciousness should be taken seriously

Source: US Youth Soccer “Heads Up” Program & Centers for Disease Control