As a mother of triplet sons, I have always taken a keen interest in their safety. I suspect that all parents would say, if asked, that they put their kids' safety first — whether it is playing organized sports, at home, or riding their bike in the neighborhood. Many parents — particularly mothers, who have been the guardians of children at play since the dawn of time — not only talk that talk, but walk the walk, and are very protective.
I admit that, when it came to my sons' safety — and the safety of their teammates, I fell — and still fall — at that end of the spectrum, because I feel that, while life always involves some degree of risk, childhood should be a time when it is our responsibility as parents to minimize those risks and make it one of our highest priorities.
I remember when my son, Spencer, was playing junior varsity football. My mother's intuition told me that it wasn't a good idea. He was one of those gifted kids who played 100% on defense and 100% of offense. I was worried about what all those hits to the head [1] and blows to the chest [2] were doing to his brain, and, even though he never suffered a hit that actually knocked him out [3], I was aware that he had suffered three previous concussions [4], one while snowboarding, one sledding and one at summer camp. I suspected something was dangerously wrong when, in his last game his sophomore year in 1999, I saw him wandering around on defense, seemingly in a daze, unable to remember where he was supposed to play.
That week, I took him to see Cheryl Weinstein, a neuropsychologist at Beth Israel Hospital in Boston. After a battery of neuropsychological tests [5] (the pencil and paper kind), Dr. Weinstein carefully explained that Spencer risked permanent brain damage [6] if he continued playing lacrosse and football. I agonized over the decision, but ultimately decided to be "better to be safe than sorry."
It was a decision Spencer found incredibly difficult to comprehend and accept. He loved playing football and lacrosse (coincidentally, the two boys' sports with the highest concussion rates [7]). Like just about every boy his age, he enjoyed being part of a team. [8] He was proud to wear his crimson and gold football jacket to school. As a football player, he enjoyed his elevated status [9] on the high school social pecking order.
His coaches loved him as well. I will never forget the football awards banquet two years earlier when Spencer's 8th grade coach, in awarding him the MVP trophy, had praised his apparent willingness to, as he put it, "run through brick walls" to make a tackle.
The decision not to allow him to continue playing was one that I had a hard time defending. It meant that I, and particularly Spencer's dad, would have give up something we enjoyed: watching him play and being part of the tight-knit community [10] of football parents that exists at virtually every high school in this country, although probably not as close-knit as the one I came to know in Newcastle, Oklahoma during the filming in 2012 of our high school football documentary, "The Smartest Team.") [11]
My only regret, looking back, isn't that I took away from Spencer something he loved, but that I didn't do it sooner; that I didn't fully appreciate earlier that Spencer's learning disabilities [12], the amount of time his coaches kept him in the game (100% on defense and 100% on offense) and his willingness, in the words of his coach, to run through brick walls, put him at serious risk of permanent cognitive impairment. [Again, I didn't know it at the time, but would later find out that learning disabilities, the way an athlete plays the game, and the sport he plays would come to be considered so-called modifying factors [12] in concussion management and determining whether it is safe to continuing playing collision sports like football and lacrosse, particularly with a multiple concussion history [13]].
Of course, while there are lots of very protective parents, at the other end of the spectrum are some parents who, sad to say, are willing to sacrifice their child's safety and — in the case of concussions, their long term health — at the altar of a winning performance, a touchdown scored, a scholarship won, a pro contract inked.
It is not only fathers who fall into this unfortunate category. There are also many moms:
Some parents admit that they allow their children to play in such circumstances even though they know about the potential for adverse long-term health consequences, like major depression and permanent cognitive impairment. One 2010 survey [15] found that fully fifty percent of parents of children age 12 to 17 playing school sports knew a parent who would have their child return to sports too soon after a concussion.
In the middle — and I submit this is by far the largest group — are the parents who simply don't know what to do. These are the mothers who, like Kerali Davis, one of the moms featured in "The Smartest Team," who come to MomsTeam looking for answers, the ones I wrote about in my book, Home Team Advantage; the ones who wake up at 3:00 in the morning worried sick about their kids' safety, about what sports are doing not only to their kids, but to themselves.
These are the parents who want to protect their children from long term injury but simply don't know how to play their position on the youth sports "team," and don't know what to expect of their teammates — the coach [16], the ATC [17], the team doctor, and the athletic director.
Too many parents — and their children — still think that concussions only occur with a loss of consciousness [18] and/or that it isn't dangerous to continue playing with a concussion. Indeed, a 2010 national poll [15] by Michigan's C.S. Mott Children's Hospital found that less than one in ten parents (8%) of children playing school sports had read or heard a lot about the effects of repeated concussions [4], while fully one third (36%) hadn't heard or read anything about the effects of multiple concussions.
Too many young athletes — from 9-year old cheerleaders to star middies on high school lacrosse teams — are still failing to self-report [19] their symptoms to the coach, sideline medical staff, their friends or even their parents, forcing clinicians to try to manage concussions without all the facts.
Kids fail to self-report because, too often, they are told by their parents, but far more often by their coaches, and, more subtly, by the very culture of sports itself, that they should remain silent:
That silence can, in rare instances, be deadly. A case in point was one that I highlighted in a piece I wrote a while back, with apologies to poet A.E. Houseman, entitled "To Nineteen Athletes Dying Young." [20] Among the athletes I profiled who had died playing sports in the fall of 2003 was 14-year old James Van Slette, a middle linebacker and fullback on his freshman football team in Illinois.
While preliminary autopsy results were inconclusive, I have since learned that Jimmy had suffered at least four concussions in the previous five years, three playing football and one in a car accident. Despite this concussion history, he was able to pass a pre-participation evaluation [4] and was allowed to continue playing despite his parents' (and presumably his neurologist's) concerns.
We also later learned that Jimmy had confided to friends — but not to his family or coaches — that he was having severe headaches (by far the most common symptom of concussion) and might have suffered a fifth concussion in the team's last game of the season three days before he died. It is unclear whether he was experiencing any other symptoms of concussion [21] before that game.
But, because he did not inform anyone other than his close friends that he was experiencing severe headaches after that game, it is possible that his brain was already injured before the game, placing him at risk of second impact syndrome [22].
There is also no way to know whether Jimmy's life could have been saved had he told his parents about his headaches, or if his mother had seen his vomiting as a sign of a potentially life-threatening head injury [23] and instead of sending him back to bed had rushed him to the emergency room.
We don't know precisely why Jimmy kept his severe headaches to himself.
What we do know, however, is that he was an athlete who, like too many, failed to report injuries or underreport symptoms [24], which, at the very least, delays and complicates concussion management and, at worst, places them at risk of adverse long-term health effects [6] or a fatal brain injury. [22]
Unfortunately, there are still far too many coaches in this country - whether it be in youth gymnastics, football, field hockey, soccer, lacrosse, basketball, or skiing - who berate and ostracize players complaining of concussion symptoms [21], who call them "wimps," who yell at doctors and athletic trainers for refusing to let a player with concussion symptoms go back into the game, and have kicked kids off of the team for refusing to play for two weeks because of a concussion. I hear these stories all too often.
Parents have a right to expect that, when they entrust their children to a sports program that it will take reasonable precautions to protect them against harm. In other words, parents have a right to expect that the entire team to whom they entrust their children's safety — including the national governing body for the child's sport, the state association, the athletic or club director, the athletic trainer (if there is one), and especially the coaches - are part of the concussion solution [25], not part of the problem.
In my view, because the signs and symptoms of concussions [21] are not as obvious as a broken leg or a sprained ankle and are often very subtle, because most don't involve a loss of consciousness, and because self-reporting by athletes is critical to the detection and treatment of concussions, the only way parents can sit in the stands without worrying sick about what might happen if their son or daughter suffers a concussion is if they know the program, and especially the coach, takes concussions very seriously, and that every member of the team is using the same concussion safety playbook
For the most comprehensive, up-to-date concussion information on the Internet, click [6]here [6]. [6]
Posted March 14, 2011; revised June 25, 2013
Links:
[1] https://mail.momsteam.com/node/2744
[2] https://mail.momsteam.com/node/3340
[3] https://mail.momsteam.com/node/150
[4] https://mail.momsteam.com/node/156
[5] https://mail.momsteam.com/node/801
[6] https://mail.momsteam.com/node/3289
[7] https://mail.momsteam.com/node/3094
[8] https://mail.momsteam.com/node/1977
[9] https://mail.momsteam.com/node/1978
[10] https://mail.momsteam.com/node/2829
[11] http://www.thesmartestteam.com
[12] https://mail.momsteam.com/node/2695
[13] https://mail.momsteam.com/node/6190
[14] https://mail.momsteam.com/node/1167
[15] https://mail.momsteam.com/node/3092
[16] https://mail.momsteam.com/node/188
[17] https://mail.momsteam.com/node/114
[18] https://mail.momsteam.com/node/145
[19] https://mail.momsteam.com/node/2987
[20] https://mail.momsteam.com/node/299
[21] https://mail.momsteam.com/node/149
[22] https://mail.momsteam.com/node/205
[23] https://mail.momsteam.com/node/146
[24] https://mail.momsteam.com/node/5835
[25] https://mail.momsteam.com/node/163
[26] https://mail.momsteam.com/team-of-experts/concussion-safety-12-point-checklist-for-parents
[27] https://mail.momsteam.com/health-safety/six-pillars-concussion-risk-management-momsteam-approach