Probably along with many of you, our household cheered when the United States won the Women’s World Cup championship last month. Amidst the excitement for the win, however, one moment in the tournament stands out for me- the head to head collision between Germany’s Alexandra Popp and USA’s Morgan Brian in the semifinal round. As the celebration for the championship winds down, the controversy surrounding the call to allow both players back on the field after the collision persists. Regardless of whether that was the correct call, I think it’s important to recognize that when it comes to concussion risk, coaches and clinicians should take a more conservative approach for youth athletes.
A similarity between professional and youth sports is that, for both populations of athletes, it is nearly impossible to tell whether an individual has sustained a concussion from how severe an impact looks. Concussions are caused by a combination of linear and rotational forces, and as the casual television or sideline observer, we can't accurately perceive the severity of impact.
The current recommendations for FIFA (soccer’s international governing body) and for youth athletes are that if the on-site medical professionals suspect that a collision might cause injury, that individual should be evaluated immediately. FIFA’s latest recommendations allow referees to stop a match for three minutes, allowing a team doctor to examine an injured player for signs of concussion. Following the evaluation, the doctor, and not the player, decides whether the player can remain in the game. For high school or youth athletes, the U.S. Centers for Disease Control and Prevention (CDC) recommends the “Heads Up” 4-step Action Plan for high school or youth athletes suspected of having a concussion:
- Remove the participant from play and keep him or her out the remainder of the day.
- Ensure that the participant is evaluated by an appropriate healthcare professional.
- Inform the participant’s parents or guardians about the possible concussion and give them information about concussions. Make sure they know that the athlete should be seen by a healthcare professional experienced in evaluating concussions.
- Keep the participant out of play until an appropriate healthcare professional says the participant is symptom-free and gives the OK to return to play.
So why can a professional athlete return to the field, while a youth athlete is recommended to stay on the sidelines for the remainder of the game? In professional sports, the players accept a certain level of risk; it is their job to play that sport. For youth sports, there is or should be a different level of acceptable risk. Additionally, in professional sports, trained health care professionals are available to perform sideline assessments. Youth sporting events do not always have sideline personnel available to perform such assessments, which gives even more reason to impose a more conservative approach; if an injury is suspected, the player should be removed from play until they can be assessed by a qualified health care professional.
Sports are a great experience for kids and teens, and there is always a certain level of risk involved. But the important distinction is that kids are not just small adults, and what we’ve learned about concussion risk for adults and at the professional level cannot always be translated directly to children. That’s why CHOP recommends a more conservative approach for our youth athletes, one that takes into account the unique needs of children and teens when it comes to concussion and other injuries.
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