A Parent’s Guide to Youth Football Concussions

By: Erin O'Tool, MD

Believe it or not, the summer is ending, and the high school football season has officially kicked off. You are probably aware that contact sports carry a higher risk of concussions, whether playing for fun, in school, or at the professional level. Concussions, also called traumatic brain injuries (TBIs), have become more mainstream as we learn that prevention and early intervention are key components of keeping players safe. As the parent of a high school athlete, do you know the protocols, symptoms, and prevention methods for youth football concussions?

At Midwest Orthopedic Specialty Hospital, our concussion experts have established best practices for traumatic brain injuries, including awareness, education, post-concussion care, and testing. The Concussion Care Network at MOSH has created this guide to help parents, coaches, and school administrators learn about concussions and how to maximize the recovery of the injured player.

Football and Traumatic Brain Injuries

Our delicate brains are suspended in cerebrospinal fluid and protected by the skull. Any activity that causes our brain to impact the inside of the skull can cause a concussion. A blow to the head, neck, or jaw, a violent shaking of the body, or a sudden jolt can all cause TBIs.

All concussions are significant, even if your child doesn’t lose consciousness. Concussions left untreated can cause long-term problems like Second Impact Syndrome, Post-Concussion Syndrome, and Chronic Traumatic Encephalopathy.

• Second Impact Syndrome (SIS) is a serious condition that results from a second TBI before fully recovering from the first head injury. Although rare, the chance for repetitive head injuries increases in students who return to the game too quickly.
• Post-Concussion Syndrome (PCS) happens when recovery from a concussion takes an extra-long time. Most concussions resolve after a week or two, but people with post-concussion syndrome have symptoms that can last for months or longer. Post-concussion syndrome usually goes away on its own, but the symptoms can become permanent on rare occasions.
• Chronic Traumatic Encephalopathy (CTE) is a fatal brain condition resulting from repetitive injuries. The disease is progressive, and although there are symptoms like dementia, aggression, depression, and anxiety, diagnosis only occurs during the examination of the brain during autopsy. While researching CTE, neurologist Dr. Ann McKee found that 110 out of 111 deceased former National Football League players’ brains had CTE, a 99% occurrence rate. Contact sports can increase the risk of future CTE in young athletes.

A study of almost 2,000 high schools over six years found that males between 14 and 18 had more youth football concussions than any other high school sport. TBIs don’t just happen on game day, either; 48.2% of concussions occur during practice.

While high school football has the highest rates of concussions among male students, girls’ soccer is the number one cause of concussions for female students. Other youth sports also have a higher rate of concussions, including ice hockey, cheerleading, volleyball, field hockey, track and field, and swimming.

The good news is that you can help protect high school athletes from concussions and long-term effects by following these six guidelines.

1. Practice Concussion Prevention

The best way to lower the risk of a sport-related concussion is to practice concussion prevention methods, like TBI education, compliance with policies and laws, and keeping the sport safe. Concussion education and awareness programs help players, coaches, and parents understand the danger inherent in sports so they can make informed decisions. Most schools, athletic programs, and states stipulate that parents and guardians provide permission for their student athletes to participate in contact sports. For example, Wisconsin has a state law that requires “…all youth athletic organizations to educate coaches, athletes and parents or guardians on the risks of concussions and head injuries and prohibits participation in a youth activity until the athlete and parent or guardian has returned a signed agreement sheet indicating they have reviewed the concussion and head injury informational materials.”

Focusing on safety can also reduce the risk of TBIs. Safe practices include:

• Wearing the right protective gear, like well-fitting helmets.
• Practicing the proper technique for player contact.
• Checking to make sure equipment is in good condition.
• Staying up to date on concussion guidelines.

2. Get Pre-Season Baseline Testing

During pre-season training, athletes prepare their minds and bodies for game day. It’s also the perfect time to establish a health reference point. Qualified medical professionals will perform baseline testing, which evaluates an athlete’s physical and cognitive abilities before brain damage occurs. Health care professionals use these assessments to compare an athlete’s condition after a head injury to determine if they have a concussion, the severity of the damage, and the best treatment plan for that individual.

3. Recognize Signs and Symptoms of a Concussion

Spotting a possible TBI is vital in any youth football concussion protocol. Sometimes, it’s easy to determine if a person has just experienced a mild traumatic brain injury because they might briefly lose consciousness or have no recollection of what just happened to them. Other times, they might appear fine and show concussion symptoms hours to days later or have little to no symptoms at all.

It’s always best to call your doctor within two to three days of sustaining a head injury. Be sure to seek emergency medical attention if the athlete experiences headaches that worsen, seizures, unusual behavior problems, feeling very tired or can’t be awakened, repeated vomiting, slurred speech, significant irritability, inability to recognize people or places, increasing confusion, weakness or numbness in arms or legs, or is less responsive than usual.

Other symptoms of traumatic brain injury in children and adults include:

Physical Symptoms of a Concussion:

• Headache
• Nausea/vomiting
• Dizziness
• Balance problems
• Fatigue
• Sensitivity to light/noise
• Numbness

Emotional Symptoms of a Concussion:

• Irritability
• Sadness
• More emotional
• Nervousness

Cognitive Symptoms of a Concussion:

• Feeling mentally foggy
• Feeling slowed down
• Difficulty remembering
• Difficulty concentrating

Sleep-Related Symptoms of a Concussion:

• Drowsiness
• Sleeping more or less than usual
• Trouble falling asleep

4. Remove the Athlete from Play

If a player is suspected of having a concussion, whether symptomatic or not, they must be removed from play. Many schools, organizations, and states have rules or laws that require the injured student to be benched until they are deemed healthy enough to resume the sport. Wisconsin’s Concussion and Head Injury Statute 118.293 and the National Federation of High Schools Association’s “Suggested Guidelines For Management Of Concussion In Sports” are two examples of sport-related policies.

The coaches or school must inform the parents or guardians of the injured athlete about the incident, injury, and any symptoms the child may be experiencing. It is recommended that the injured player see a doctor to determine whether the player has a concussion and, if so, the treatment plan they should follow. Pre-season baseline testing will provide valuable information on the severity of the TBI.

In the United States, most laws and policies state that the injured player be removed from all sport-related activities for at least 24 hours and will require clearance from a medical professional before the athlete participates in the sport again.

5. Treat the Concussion

Post-concussion treatment often begins at home and combines a doctor’s instructions, monitoring the player’s symptoms and relative rest. Usually, relative rest is a combination of physical and mental down time so the player can heal, which includes:

• No mentally taxing activities like video games or homework.
• No sports, exertion, or strenuous physical activities.
• Ensure the athlete sleeps well, stays hydrated, and eats healthy food.
• Reduce or eliminate screen time.
• Do not participate in sports, gym class, or other recreational activities.
• Avoid loud noises, bright lights, and a lot of head movements.
• If an activity makes symptoms worse, stop. Do not “push through.”
• Completing the recommended physical therapy program.

6. Follow the Return to Play Protocols

The safest way to ensure maximum recovery and avoid Second Impact Syndrome is through a graduated increase in physical activity known as “return to play” protocol. These protocols are for the safety of the player and liability purposes. Studies have shown that having one concussion puts a person at a higher risk for a second concussion, so it is essential that the player is fully recovered before resuming normal activities. According to the American Academy of Pediatrics, the following criteria need to be met before the injured player can begin the return to play protocols:

• The athlete is displaying no concussion symptoms.
• The athlete is not on medication for concussion.
• The athlete is at the same academic level as they were pre-injury.
• The athlete has medical clearance to begin return to play protocols.

The Concussion Care Network at MOSH uses ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) software as one assessment tool to help healthcare providers determine an athlete’s ability to return to play after suffering a concussion. Other tests may include imaging, neurological, and balance evaluations.

Once a physician gives the okay, you can follow the return to play protocols as outlined in the “Head’s Up” program by the Center for Disease Control (CDC):

• Step 1: The Athlete Returns to Normal Activities. Normal, restful activities include going to school and doing light chores at home. Physical activities are limited.
• Step 2: The Athlete Returns to Light Aerobic Activity. The goal is to slowly increase the player’s heart rate in a safe environment. Light exercise can include stationary bikes or treadmills for five to ten minutes. The athlete may also take short walks on level ground but can’t lift weights or carry heavy objects.
• Step 3: The Athlete Can Begin Moderate Activity. Moderate physical activity means exercises such as short jogs and light weightlifting.
• Step 4: The Athlete Can Begin High-Intensity Activities But No Contact Activities. Examples include sprinting, completing stationary biking or jogging routines, restarting a pre-concussion weight-lifting routine, and non-contact sports drills.
• Step 5: The Athlete Can Participate In Practices. At this stage, athletes can return to their sport for practices and full-contact drills in a controlled environment.
• Step 6: The Athlete Can Return to Play. The athlete is considered fully recovered and can resume all pre-concussion activities.

Concussion research has led to a better understanding of mild traumatic brain injuries and how to treat and prevent them. Most concussions resolve independently after a few rest days, but concussion care is still needed. If you think your child has a concussion, follow concussion protocols and see a physician. You can also request an appointment with our Concussion Care Network, or call MOSH directly at 414-817-5800.

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