Center for Injury Research and Prevention

Managing Risks in Youth Sports

January 21, 2016

With the release of the movie "Concussion," I recently had an opportunity to sit down for an interview with WHYY's "Radio Times" about chronic traumatic encephalopathy (CTE), concussions, and youth sports. CTE is a neurodegenerative disease of the brain that tends to be discussed in the context of athletes such as football players but has also been identified in variety of other populations, including individuals in the military. It tends to manifest in later life as depressive symptoms and a range of undesirable, including violent, behaviors. Currently, it can only be identified upon autopsy, or after death.

One question I often receive is whether kids who play collision/contact sports are at risk for developing CTE. We don’t know if CTE is a result of one big blow versus a series of sub-concussive events, and we don’t know if playing contact/collision sports as a youth leads to CTE as an adult. Even for those that played contact sports at a high level – collegiate football or rugby or the NFL – some but not all seem to demonstrate the symptoms of CTE. We don’t know what predisposes a person to developing this debilitating disease.  These questions cannot be answered with the data that we have now. We absolutely need funding and resources to do the types of longitudinal studies that would be required to answer these questions.

In the face of these unanswered questions, however, what can parents do?

Parents are always managing risk for their children, whether it’s walking across the street, teaching them to drive, or participating in contact sports. There are many documented benefits of sport participation-- reduction of obesity and chronic disease, as well as the development of teamwork, leadership, and resilience skills, just to name a few.

The key is balancing the risks and rewards of any activity. If fear of the risks leads parents to remove children from sports all together, then we as researchers and clinicians have provided a disservice to families. What we need to do is focus on making sports safer.

If a child is interested in a contact sport, consider these tips for families:

  • Be an advocate for your child. Make sure your child is participating in a league with a coach that is trained to recognize signs of concussion and in a league that has a stated protocol to deal with a concussion. Remember the CDC slogan, “when in doubt, sit them out.” Approximately 50% of concussions go unreported, so we need improved detection on the front line-- from coaches, trainers, and even officials. Leagues that used Pop Warner rules and the USA Football's Heads Up program - which includes coaching education and tackling education drills that limits player-to-player contact in practices - showed a reduction in injuries including concussions. 
  • Look for a coach who respects the return to learn/play process. Current concussion treatment includes cognitive and physical rest on a timeline that is individualized and gradual. It may take longer for one child to recover (e.g, for symptoms to subside completely) than it does for another child, and the coach should be prepared for these differences.
  • Advocate for changes in rules to promote safety while maintaining a focus on key skills for that sport. For instance, flag football helps children to develop skills, such as speed and agility, while minimizing risk of head injury. In ice hockey, changing the age at which body checking is allowed has been a positive change for injury as well. 

Remember, about 50% of concussions result from activities off the field (e.g., motor vehicle crashes). We haven’t banned those activities, but we have tried to make them safer with technology like child restraints and seat belts. We need to do the same thing for sports.

Click here to learn more about CHOP’s Concussion Care for Kids: Minds Matter program.