What Youth Athletes Think About Concussions

Cailin Davis, 16, Emily Hunter, 17, Katie Mueda, 16, Brie Boothby, 17.

According to a new study by Safe Kids Worldwide, youth and teen athletes commonly ignore concussions and sports injuries because they feel pressure to play through pain. Elizabeth Murray and Sheinelle Jones from the TODAY Show shared a story last week about Brie Boothby. During a high-school field-hockey game in September 2013, near her Virginia hometown, Boothby was struck in the side of her head with an opponent's stick and blacked out. 

"The only thought in my mind was getting back in the game," she told Jones. And despite her injury, the field-hockey player kept playing. "I thought I had to be tough. I thought I had to go back in because we were losing and I needed to support my team."

That night, the 17-year-old felt nauseous, and began losing her memory. A trip to the doctor revealed devastating news: Boothby had sustained a serious concussion that left her with permanent brain injuries. 

It took Boothby 10 months of physical therapy just to be able to stand up without falling over. Since then, Boothby said that her school work suffered, and she's been diagnosed with ADHD. "MY GPA dropped so much that I'm really anxious about college," she said. "I'm not sure if I'm gonna get into what I've worked for my entire life."

Boothby's story is one of more than 1 million young athletes who are brought to the emergency room every year. And a new study by national research group Safe Kids Worldwide may help explain why one child is taken to the emergency room for a sports injury every 25 seconds. The study's results show that young athletes are engaged in a dangerous culture comprised of ignoring sports injuries, and feeling pressure to play even when they're hurt. 

The study, which surveyed 3,000 athletes, coaches and parents, found that:

• 42 percent of kids said that they have downplayed or hidden injuries so that they could keep playing.
• 53 percent of coaches said they've felt pressure to put injured players back in the game.
• Almost 1/3 of kids surveyed said it's "normal" to play rough in a game, to "send a message" to the other team.

While this problem in youth sports has been well-publicized, this new research found that many young athletes are still putting themselves at unnecessary risk. 

"The awareness we have about injuries and the risk to our children is not matching the behavior that we're seeing on the field," said Kate Carr, president of Safe Kids Worldwide.

Doctors can't say if Boothby made her injury worse by continuing to play, but there are very serious risks for athletes who continue playing with a head injury.

"If kids return to play too soon after a concussion or a head injury, they're at risk for second impact syndrome, which is a really serious brain injury," said Dr. Tracy Zaslow, a sports medicine physician at Children's Hospital Los Angeles.

All 50 states now require young athletes to be pulled from play if a concussion is suspected, and many have restricted contact in youth sports practices. Sports associations say they're training coaches to resist pressure to play injured athletes, and the High School Coaching Association is pushing for new laws that would require medical personnel at all youth sports games. 

Boothby said that until young athletes really understand the message, they'll continue to play. Even though it's now not what she recommends. "I think when in doubt, sit it out," Boothby said. "And yes, it might stink sitting under the lights on the bleacher. It's better to be safe than sorry. I mean, what is one game compared to your entire lifetime?"

For more information about the warning signs of concussions in youth sports, visit the CDC's website.

Recognizing Concussions

USA Today recently brought up the topic, “how do families with concussion concerns pick sports?” Although there is much talk in the news about youth football injuries, many other sports pose injury concerns for parents and athletes. According to Safe Kids Worldwide, soccer players have the same percentage of injuries that are concussions as football players. Soccer player Tori Bellucci told her concussion story earlier this year as part of the White House’s summit on concussions and youth sports. The summit shined a spotlight on the nation’s interest in finding new ways to identify, treat and prevent serious head injuries in youth athletes.

After a successful high school soccer career at Huntington High School, Bellucci was offered a full scholarship to play soccer at Towson, but the physical and emotional effects of multiple concussions made her realize the risks of continuing to competitively play the sport she loves. Tori elected not to play soccer in college after she suffered her fifth concussion.

“It changes the way you think and feel,” Bellucci, 18, said. “I was just like really sad, really kind of desperate type of feeling. I couldn’t do anything because of my head, so I would just be in my room with the shades drawn. I was like, ‘I don’t want to live like this anymore.’”

Unfortunately, the effects of initially unrecognized and repeated concussions meant Bellucci’s dream of playing soccer in college ended, but she continues to work hard to recover and remains active in sports by teaching young children how to play soccer. At the summit, President Obama referenced Bellucci’s experience as an example to other young athletes and parents about the commitment ahead of us to change perceptions and improve outcomes.

Safe Kids reports that every three minutes in the U.S., a child is seen in the emergency department for a concussion, yet 54 percent of athletes admit they have played injured. The CDC has great resources for parents and athletes for preventing, recognizing and treating sports injuries.

Signs of a concussion that coaches, athletic trainers and parents may notice:

·         Appears dazed or stunned

·         Is confused about assignment or position

·         Forgets an instruction

·         Is unsure of game, score, or opponent

·         Moves clumsily

·         Answers questions slowly

·         Loses consciousness (even briefly)

·         Shows mood, behavior, or personality changes

·         Can’t recall events prior to hit or fall

·         Can’t recall events after hit or fall

Symptoms that athletes may report:

·         Headache or “pressure” in head

·         Nausea or vomiting

·         Balance problems or dizziness

·         Double or blurry vision

·         Sensitivity to light

·         Sensitivity to noise

·         Feeling sluggish, hazy, foggy, or groggy

·         Concentration or memory problems

·         Confusion

·         Does not “feel right” or is “feeling down”

For an easy reference, visit the Childress Institute for Pediatric Trauma's easy concussion overview and click the graphic to download and print. For more information and stories from athletes, parents, coaches and athletic trainers, please visit:

• CDC's concussion reference
• CDC's Heads Up program for athletes
  
• CDC's concussion story from a basketball player
  
• A parent's story about concussion in youth athletes
  
• Matthew Gfeller Foundation
  
• Safe Kids' youth sports culture infographic
  
• Safe Kids' sports safety infographic
  
• Safe Kids' Ten Tips for Parents
• USA Today's story on concussions and youth athletes

How You Can Keep Kids Safe by Dr. Eichelberger

I have been a pediatric surgeon for over 35 years and have dedicated my life to saving the lives of injured children. Even though my surgical work is focused on saving kids once they are injured, I realized early on what an impact prevention and safety could make in the staggering number of injured children we saw each year. 

After years of treating these kids, I felt compelled to act and founded the National SAFE KIDS Campaign with Herta Feeley in 1987, which became Safe Kids Worldwide in 2005. Through research and data gathering, we learned over the years that kids of different age groups are primarily injured in certain ways that can be tracked, assessed and impacted with increased prevention tactics. Toddlers and young children have a higher occurrence of injuries from falls, while adolescents have higher incidence of injuries in motor vehicles because they're drivers now. We have to be careful in making sure that we're talking about the right group before we go thinking about prevention because sometimes prevention is not as relevant. 

I think that the approach to injury really focuses in on our communities because people ask themselves, “What can I do?” Believe it or not, there’s a lot you can do.  My lifelong quest to prevent childhood injuries has led to increased research, improved safety measures and significant change in awareness of child safety issues. You can find many valuable tips and life-saving advice at SafeKids.org, and other great prevention and safety websites. 

My daughter has three kids, and earlier this year I spent four days chasing them around, and I can tell you it’s a real challenge to keep kids safe. They are quick and inquisitive, all the things that you want kids to be. The problem is they put themselves in harms’ way and it’s our job to protect them from getting hurt, while allowing them to have fun. It’s a fine line between too much and too little.  

While visiting my daughter, I saw a man riding a bicycle who was approximately 220 pounds, and sitting in front of him on the handlebar was a 4-year-old that couldn’t have been more than 40 pounds. They’re riding this bicycle in a well-populated city in the United States. I asked my son-in-law, “Who is that? That is crazy because if they fall that child’s going to get crushed, and he shouldn’t be riding on the handlebars.” He responded, “Well, that’s our local pediatrician.” I was astonished. This person should not only be more informed than anyone else, but he should be sharing safety messages with all his patients and their parents while setting a good example to anyone that sees him in public.

There are a lot of people that are uninformed about ways to protect kids. Many people don’t see how they are responsible for the effects of an injury. That’s where the community steps in and assumes some responsibility through updated laws and state guidelines for care. Without these initiatives, such as simple helmet laws for children, we end up with millions of dollars in additional healthcare expenses and children that will never make an impact in our society.

As a surgeon, a parent and a grandparent, there are so many things we can do to make sure our kids live in a safer world. We’ve made tremendous progress in prevention over the last 25-30 years, but we still have children suffering needlessly from severe injuries. There are still 10,000 children dying every year from injuries and almost 200,000 children that are hospitalized each year because of injuries. There is plenty of room for improvement in all areas. Our society can make a bigger impact for saving injured kids.

In my experience treating injured children, most parents ask, “Why did this have to happen to my child?” and, “What could I have done to prevent this from happening?” These tough questions don’t have answers that comfort us, but the secret to saving many children is to ask some of these hard questions before the injuries occur.

- Martin R. Eichelberger, M.D., Professor of Surgery and of Pediatrics, George Washington University Children’s National Medical Center, Washington D.C.