When children come to Dr. Tracy Zaslow at Children’s Hospital Los Angeles to evaluate a head injury, they do so with a heightened sense of anxiety.
The threat of a concussion, and the lifelong health problems it could cause, weighs on the shoulders of her patients and their families.
Driven by new research showing that concussions can have health effects for years, as well as reports of traumatic head injuries suffered by professional football players, “parents and patients take the issue far more seriously,” Zaslow said.
Football injuries get the most attention in the world of youth sports, but other young athletes are also at risk of potentially severe head injuries.
“It’s pretty diverse,” Zaslow said. “We definitely see a lot of football players, but we also have a large number of lacrosse and soccer players. Volleyball is another sport you wouldn’t expect but we see a lot of athletes from. We treat cheerleaders who will bang their head during a performance as well as basketball players who end up with contact.”
As professional sports teams assess concussion rates, pediatricians are calling on parents and coaches to take a closer look at children’s participation in sports that frequently cause contact injuries.
A spotlight on football
According to the Centers for Disease Control and Prevention, a concussion is a type of traumatic brain injury “caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth.”
Much of the concussion research in young people focuses on football, because it is intended to be a contact sport.
Some research suggests that even children who don’t show immediate signs of concussions may experience brain changes after playing the sport. A September study in the journal Radiology Today showed that football players aged 8 to 13 years old with no concussion symptoms still showed some changes similar to traumatic brain injury.
Additionally, a May study commissioned by USA Football and the National Collegiate Athletic Association found that younger players, such as those in middle or elementary school, return to the field more quickly after a concussion than those at the high school level because coaches or other officials don’t take enough time to evaluate the injury.
Research last year from the Journal of Neurotrauma discovered that NFL players who had started playing football before turning 12 had a higher risk of “altered brain development” compared to those who started playing later. While it was not definitive evidence that playing football will result in brain injury, the evidence indicated that early participation in the sport could negatively impact the normal process of how a child’s brain changes over time.
However, the research is still unclear on whether there is a safe age for children to start playing football, Zaslow said.
“The medical answer is we don’t know,” she said. “What we usually recommend is if they elect to play contact football and tackle football is that they learn the proper technique.”
Zaslow referenced a football strategy known as “Heads Up.” The strategy, promoted by the federal Centers for Disease Control and Prevention, encourages young football players to tackle with their arms instead of trying to knock players over with their body or leading with their head.
But Dr. Paul C. Lebby, the medical director of the neuropsychology and neurodevelopment at Valley Children’s Hospital, believes there’s more at issue than just technique. American culture itself is rabidly focused on winning, which can be a detriment to athletes who push themselves too much instead of aiming for more steady improvements, he said.
“Society tends to define success only by winning rather than continuous improvement,” Lebby said. “The win-at-all-costs attitude pressures our kids to keep playing, even after a head injury – but at what price?
“Every time children continue to play soon after a concussion, they risk severe complications. For each successive concussion, children are trading precious brain cells for touchdowns, goals, trophies or glory.”
Children who experience successive concussions are at risk for problems related to cognition, sensory processing, and even mental health issues, such as depression and anxiety, according to the National Institutes of Health. Multiple head injuries can cause chemical and metabolic changes to brain cells, making it more difficult for the brain to function and communicate.
Competition starts early
The fact some children join sports at a young age is another concern for some medical experts. Many schools and private leagues host football for children who are in fifth grade, or as young as 10. At Clovis Unified School District in the Central Valley, for example, fifth and sixth grade students can play on a school team and compete in a weekly game against other schools.
Additionally, Pop Warner, a football league for children ages 5 to 15, has over 100 leagues in California.
Dr. Jennifer Crocker, who sees patients in the Physical Medicine and Rehabilitation group at nearby Valley Children’s Hospital, has seen more young children suffering from sports injuries in recent years, she said.
The upside is that, just as with the patients that Zaslow sees in Los Angeles, there’s a greater awareness of the risks associated with head injuries, Crocker said.
“It’s partly because we’ve got some of these kids playing collision sports at a very young age,” she said. “We have such young children playing tackle football with pads, and we didn’t see that ten years ago.”
The key is for parents, players and coaches to be aware of the signs of a potential concussion and report them during a game, Crocker said. Symptoms of a brain injury include appearing dazed, having clumsy movements and answering questions slowly, according to the CDC.
“It’s important that parents and coaches teach athletes not to ignore an injury to try to remain in the game, because the results can be problematic,” Crocker said.
Children with multiple concussions should be evaluated for ongoing symptoms and could be ordered to sit on the sidelines for a longer duration or permanently if they don’t recover, she added.