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Conservative Management of Youth Concussions, More Education Needed, de Lench Says

Remarks To Concussion Conference

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 of football parents that existed at his High School, as it does at virtually every high school in this country.

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, the amount of time his coaches kept him in the game (100% on defense and 100 on offence)and his willingness, in the words of his coach, to run through brick walls, put him at serious risk of permanent cognitive impairment.

Of course, while there are lots of very protective parents, at the other end of the spectrum, are some parents who are, sad to say, 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 who:

  • are just as invested in their child's athletic success;
  • enjoy basking in the reflected glory of their child's athletic achievements;
  • are content to let their child's very identity become wrapped up in sports; and
  • are unwilling — or unable — to make the decisions that I had to make: to end their child's dream of playing high school sports, to take away something their child cherished, and, in doing so, put their child's very future at risk by allowing him or her to return to contact sports while still experiencing post-concussion symptoms or despite a history of multiple concussions.

Many 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.

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 come to MomsTeam looking for answers, the ones I write about in my book, Home Team Advantage; 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 team, and don't know what to expect of their teammates — the coach, the ATC, the team doctor, the athletic director. Too many parents — and their children — still think that concussions only occur with a loss of consciousness and/or that it isn't dangerous to play with a concussion.

Too many young athletes — from 9-year old cheerleaders to star middies on high school Lacrosse teams — are still failing to self-report their symptoms to the coach, sideline medical staff, their friends or even their parents, forcing clinicians to try to manage concussions somewhat in the dark.

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:

  • to avoid jeopardizing their spot in the starting lineup
  • being labeled a "sissy" by their coach and/ or their parents
  • to demonstrate to the coach and their teammates that they can "take a hit like a man"
  • to show that they can be as tough as their professional heroes
  • believing that the glory of individual and team success, the promise of a college scholarship, or the lure of a lucrative professional career is somehow worth the risk of lifetime impairment.

That silence can, as we all know, be deadly. A case in point was one that I highlighted in a piece I wrote in 2004 for MomsTeam.com, with apologies to poet A.E. Houseman, entitled "To Nineteen Athletes Dying Young." 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 at 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 he 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 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 abnormal neurological symptoms 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 significant risk, of course, of second impact syndrome. 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 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 whom, like so many, fail to report injuries or underreport symptoms, which, at the very least, delays and complicates concussion management and, at worst, places them at risk of a fatal brain injury.