How Worried Should Parents of Athletes Be About Concussions?

Most parents would be incredibly proud if their sons grew up to be like John Urschel. He is both a remarkable athlete and award-winning mathematician pursuing his doctorate at MIT. Unsurprisingly, many moms and dads took notice this summer when Urschel retired from the NFL after three seasons with the Baltimore Ravens.

He announced his retirement shortly after JAMA: The Journal of the American Medical Association published a study that found evidence of chronic traumatic encephalopathy (CTE), a neurodegenerative brain disease occurring in those exposed to repeated head trauma, in 110 of 111 brains of deceased NFL players.

Many parents of football players are now wondering if their child should follow suit, and if they should prevent younger kids from starting to play the game. We asked physicians to weigh in on how parents should factor in the latest study when determining what sports their kids will play.

Keep this study in perspective

The study, while worrying, does not have doctors sounding the alarm and pulling kids off the field. Instead, they are urging caution when it comes to applying the study to youth sports.

“While we need to take the study seriously, we cannot assume that every kid who plays football will get CTE. That’s not true, and we shouldn’t let the pendulum swing too far,” cautions Dr. Nathaniel Jones, a sports medicine specialist and medical director of the Loyola Medicine Concussion Program.

In addition, CTE is not yet completely understood. “There’s some disagreement in the scientific community about what CTE is and what causes it,” says Jones.

Dr. Carrie Jaworski, director of Primary Care Sports Medicine for the NorthShore Orthopaedic Institute, agrees, noting, “The CTE discussion is confusing, and CTE is something we are still researching.”

“Hitting your head multiple times is definitely not a good thing, but we haven’t been able to prove that getting a concussion equals CTE,” says Jaworski.

Also, the study itself has a few issues, including selection bias, given that the families who donated players’ brains for study likely had reason to suspect issues with CTE. Physicians also caution that, while it’s jarring to hear that more than 100 players’ brains showed evidence of CTE, the figure is not all that large considering the large number of players in the NFL over several decades.

“It’s important to know that there are a lot of NFL players who do not have CTE,” says Dr. Rebecca Carl, an attending physician in pediatric sports medicine and concussion specialist at Ann & Robert H. Lurie Children’s Hospital of Chicago.

Physicians also note that playing youth football as a hobby for a few seasons is different from playing professional football for many years. “It is unknown whether any conclusions drawn from this study can be applied to younger populations,” says Dr. Andrew MacDougall, neurologist at Advocate Lutheran General Hospital.

“If I had a son, would I want him to play in the NFL? No. Would I be okay with him playing Pop Warner football as a kid? Yes,” Carl says.

Another factor not accounted for in the study is that every concussion is different, and there may be genetic differences that play a role in recovery. “Some kids recover nicely from concussions, while a small number do not,” explains Jaworski, who notes that there is still much research to be done and data needed in the area of concussions.

“We have to look at each particular case with each particular child and determine how your child’s body responds to a head injury,” she says.

Consider both the risks and the benefits

The physicians agree that there is no such thing as a completely risk-free sport. Injuries, including head injuries, are among the risks associated with playing football and other sports. Concussions can also happen to non-athletes, too. Jones notes that he’s seen concussions happen from everyday activities, like slipping on an icy sidewalk.

“Life is not risk-free,” he says. “While you do put yourself at a higher risk of concussion if playing football than not, it becomes a question of does your kid love it? Are the fitness and other benefits worth it?”

The doctors also emphasize that there are numerous benefits to playing team sports, including football. Those benefits include physical ones, such as exercise, building strength and improving coordination. There are also social-emotional benefits that include increased self-esteem and learning valuable life lessons such as teamwork and how to deal with adversity.

“It is up to the individual athlete and his/her parents to determine whether the potential benefits outweigh the risks,” says MacDougall.

One factor to consider is the athlete’s affinity for the sport. If a sport is something a child really, really loves, the doctors caution against tearing them away from it.

Also, if a child does sustain an injury, it’s still not time to panic.

“Most kids recover from concussions just fine. They return to normal activity, it doesn’t affect their school work and they do well in life. Are there exceptions? Of course. But in general kids recover well,” explains Jones.

Head injuries happen off the football field

It’s not just football players who sustain head injuries.

An estimated 300,000 athletes suffer sports-related concussions in the U.S. each year, according to the University of Pittsburgh Medical Center Brain and Spine Injury Program.

Among high school athletes, female soccer players suffer the most concussions, according to a study released this spring by the American Academy of Orthopaedic Surgeons.

Carl also notes that while hockey and lacrosse have a lot of contact, there aren’t often calls to ban those sports like there when it comes to football.

What can parents do?

1. Know the signs of concussions and encourage kids to report them

It’s important that parents, coaches and athletes all know the signs of concussion. Make sure everyone involved knows how to spot the signs.

Equally important is emphasizing to athletes the importance of reporting any signs or symptoms they may experience. In addition, teammates should be watching out for each other as they are likely to notice when a player seems confused, dizzy, or has frequent headaches.

Parents need to “be smart, be vigilant and be their child’s advocate,” says Jaworksi. The Heads Up program by the Centers for Disease Control offers resources for parents, kids and coaches, as does USA Football’s Heads Up Football program.

2. Do your homework when selecting a sports program for your child

Make sure coaches are adequately trained in player safety. MacDougall emphasizes the importance of finding coaches who “recognize that player safety is the number one priority, and that the outcome of a game or season is secondary.”

Talk with other parents who already have experience with the program, too. Ask them if they’ve seen evidence of kids being allowed or even made to come out of the game after sustaining an injury.

“Look for programs that teach the fundamentals and how to do the skills well. I do worry about little kids, as you need close supervision at younger levels with an emphasis on technique, not the number of tackles you’re getting,” says Jaworski.

“If the coaching seems aggressive or kids are getting hurt often, those are red flags,” she adds.

3. Pay attention to equipment

While wearing a helmet doesn’t necessarily prevent a concussion, helmets can prevent traumatic injury and it is important for athletes to wear them.

“The best helmet is whatever fits the best,” advises Jones.

While helmets are very important, Jones cautions that there are no products out there that have been proven to prevent concussions and he’s not certain that there ever will be.

4. Consider baseline testing

Many, but not all, high schools do some sort of baseline testing of athletes. The results are used as a tool that physicians can use when treating concussions. “It’s better to have it and not need it, but don’t panic if you don’t have it and your child sustains a concussion,” says Jaworski, who notes that NorthShore and other medical providers offer the testing.

5. Don’t overdo it

“The best thing is to do everything in moderation,” says Jaworski. “Some of the best athletes are multi-sport athletes. I encourage parents and athletes to try not to specialize at age 9.”

 

Find more concussion management resources from the Illinois High School Association

 

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Shannan Younger

Shannan Younger is a writer living in the western suburbs of Chicago with her husband and teen daughter. Originally from Ohio, she received her undergraduate and law degrees from the University of Notre Dame. Her essays have been published in several anthologies and her work has been featured on a wide range of websites, from the Erma Bombeck Humor Writers Workshop to the BBC. She also blogs about parenting at Between Us Parents.