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Sports-Related Concussions on the Rise in Kids

Study Shows Hockey and Football Lead Youth Sports in Number of Concussions

By Salynn Boyles
WebMD Health News

Reviewed By Laura J. Martin, MD

Aug. 30, 2010 -- The number of young children treated in hospital ERs for concussions they got while playing on sports teams has doubled in just a decade, a new study shows.

While the concussion rate is higher among high-school-age athletes, researchers say the rate among younger athletes is both significant and rising.

The study represents the first attempt to document the national incidence of sports-related concussions among children in elementary and middle school.

Concussions Most Common in Football, Hockey

The analysis of data from hospital emergency departments across the nation revealed that:

  • Roughly half a million ER visits for concussions occurred among 8- to 19-year-olds between 2001 and 2005.
  • About half were sports-related, and 40% of sports-related concussions involved children between the ages of 8 and 13.
  • Football and ice hockey were the organized sports with the most concussion injuries, and snow skiing, bicycling, and playground injuries accounted for the most concussions occurring from non-team-related activities.

Even though participation in organized sports has declined slightly, team-related concussions doubled between 1997 and 2007 in 8- to 13-year-olds and more than doubled in older teens, Brown University pediatric emergency medical specialist Lisa L. Bakhos, MD, tells WebMD.

"We don't really know why this is," she says. "We know that kids are bigger now than they were in the past, which could be contributing to this trend. And sports seem to be more competitive."

Concussion Risk Higher for Girls

The study appears in the September issue of Pediatrics, along with a new report from the American Academy of Pediatrics (AAP) examining sports-related concussions in children and adolescents.

The report identified football as the organized sport most commonly associated with concussions.

It also confirmed that female athletes have a higher rate of concussions than boys who play similar sports. The reasons for this are not well understood.

One theory is that girls are more likely to sustain head injuries from a hit because they have weaker neck muscles, says pediatric sports injury specialist Mark E. Halstead, MD, of Children's Hospital St. Louis.

"In my experience, girls also tend to be more aggressive in their sports than guys," he tells WebMD. "That may also be a factor."

Long-Term Concussion Risks

Halstead says much more is known about the potential for long-term brain injury and even death from concussions today than a decade ago.

"When I started practicing sports medicine about 11 years ago it was common to send a kid with concussion symptoms back into a game 10 or 15 minutes after symptoms resolved," he says. "That doesn't happen as much these days."

He attributes this, in part, to the increased media spotlight on concussion-related deaths and brain injury among professional and varsity athletes.

The deaths of two North Carolina high school football players in less than two months in 2008 led that state to require a doctor's clearance before high school athletes can play or practice following a concussion.

The AAP wants to see the policy adopted nationwide for all children and teens playing sports.

Halstead says a week or 10 days on the sidelines is typical for most uncomplicated concussions, but many individual factors come into play.

"If a child has had more than one concussion or if the hit was particularly hard, it could be much longer," he says.

Parents and coaches also need to know how to spot concussion symptoms. Halstead says fewer than 10% of kids lose consciousness. Amnesia is more common but does not always occur.

Other common symptoms include:

Symptoms that may not manifest until days after the injury include memory or concentration problems, light and noise sensitivity, sleep disturbances, irritability, and depression.

The AAP recommends restricting both physical and mental exertion until symptoms have resolved. Halstead says schoolwork, playing video games, and even watching TV can all make symptoms worse.

Kids With Multiple Concussions

Finally, the AAP recommends that kids who have multiple concussions consider giving up contact sports for good.

But just how many concussions are too many to keep playing?

"There is no magic number to say you are done forever," Halstead says, adding that factors like the severity of the concussions, whether they occurred in a short period of time, and how long symptoms last all come into play.

For 10-year-old Mick Jones of Nashville, Tenn., the number was three.

When Jones suffered his first concussion in a car accident at age 8, he was told to stop playing football for a year. After he experienced two more concussions in a relatively short period of time, his dad, Kent, says he was done with contact sports for good.

"His doctor told me he would not give him a recommendation," Jones says. "He said the risk for long-term injury was just too great and I agreed. Kids have a long life to lead and it doesn't make sense to risk brain damage or worse just so they can play little league football."

SOURCES: Halstead, M.E. Pediatrics, September 2010; online edition.

Mark E. Halstead, MD, pediatric sports medicine specialist, Children's Hospital St. Louis; executive committee, AAP Council on Sports Medicine and Fitness.

Lisa L. Bakhos, MD, former instructor in pediatrics, Brown University Medical School, Providence, R.I.

Kent Jones, Nashville, Tenn.

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