Preventing Concussions in Young Athletes: March is Brain Injury Awareness Month

By DAWN TORTAJADA

It can happen to anyone. Traumatic brain injury (TBI), knows no age.  It can happen to active athletes and youth who do not participate in sports, as well as adolescents, adults and the elderly. A bad fall, sports-related injury, motor vehicle crash, or being struck by an object, can all result in traumatic brain injury.  An estimated 2.4 million children and adults in the U.S. sustain a TBI each year, and more than 5.3 million live with a lifelong disability as a result of the injury, according to the Centers for Disease Control.

The scariest part about a concussion is that you can’t see it. Signs and symptoms can show up right after the injury takes place, or may not be noticed until days or weeks after the injury. As a parent, athlete or sports coach, it is important to educate yourself about concussions to help recognize, respond to and minimize the risk of concussion or other forms of brain injuries. March is Brain Injury Awareness Month, and this concussion education can be your guide.

Signs and Symptoms of a Concussion

Persons at risk for concussion may include those who have had a fall, bump or blow to the head from any activity such as sports play/practice, car/bicycle crash, or any injury involving a blow to the head, face or high-impact to the body.  It does not take a direct impact to the head or face to sustain a concussion.  Look for any of the following signs and symptoms of a concussion:

Loss of consciousness (even briefly) dazed or stunned

Inability to maintain a coherent stream of thought

Is unsure of game, score or opponent

Moves clumsily

Answers questions slowly

Shows mood, behavior or personality changes

Ongoing symptoms that may be reported by a person who experienced a concussion may include:

Headache or “pressure” in head

Memory loss

Nausea or vomiting

Balance problems or dizziness

Double or blurry vision

Sensitivity to light

Ringing ears or sensitivity to noise

Feeling sluggish, hazy, foggy or groggy concentration or memory problems

Confusion

Just not “feeling right” or “feeling down”

What should you do if you think your child has a concussion?

·         DANGEROUS SYMPTOMS (seek immediate medical attention for the following):

o   Loss of consciousness

o   Unusual behavior, increased confusion, restlessness, or agitation

o   Unequal pupil size

o   Seizure

o   Repeated vomiting

o   Slurred speech, weakness, numbness or decreased coordination

o   Drowsiness or inability to wake up

o   Worsening of headache

o   Toddlers & Infants:  will not stop crying and is not consoled; will not nurse or eat

·         Seek medical attention.  A health care professional will be able to decide how serious the concussion is and when it is safe for your child to return to regular activities, including sports.

·         Rest is vital. Under the direction of a physician, avoid physical exertion, electronics, social media, meetings and practice until the signs and symptoms have subsided and your loved one has clearance from the physician.

·         If your child is an athlete and a concussion is suspected, immediately remove the child from play for the reminder of the game.  A second concussion on the same day may lead to “Second Impact Syndrome,” which is a life-threatening brain injury that results in death.

·         Concussions take time to heal. Don’t let your child return to play the day of the injury and until a health care professional gives them clearance.  Children returning to play too soon, while the brain is still healing, risk a greater chance of having prolonged symptoms of concussion.

·         Tell the coach should know if your child had a previous concussion.

·         Many children who sustain one concussion have a greater risk of sustaining a subsequent one.  It is imperative to have full recovery prior to returning to academics and activities.

Parents, teachers, coaches and athletes need to be trained and educated on prevention techniques and the signs and symptoms of concussions to assure appropriate management and to minimize the risk of serious and long-term effects. Robert Wood Johnson University Hospital has a variety of resources available for training, education, and clinical care.  For more information, please email Maureen.sharlow@rwjuh.edu or visitwww.rwjuh.edu. You can also visit the Center for Disease Control and Prevention at www.cdc.gov.

Source: Tortajada, Dawn. “Featured Brokers.” Centraljersey.com. N.p., 31 Mar. 2015. Web. 31 Mar. 2015.

Blood test may identify concussion, new study shows

By ANDREW JONES

Physicians may be able to tell if a person suffered a concussion by performing a simple blood test, according to a new study by University researchers. The team of brain injury specialists, which included professors and physicians from Alpert Medical School, pinpointed a set of biomarker proteins whose levels change in a person’s blood following a concussion — also known as a mild traumatic brain injury. The study was published in the March issue of the Journal of Neurotrauma.

The researchers — with the goal of developing a routine diagnostic test for concussions — studied emergency room patients who had suffered from a mild brain injury within the last 24 hours, according to the study. The scientists performed immunoassays on the patients’ blood samples to measure the levels of various proteins in the blood. Using information from previous animal studies, the researchers assessed the blood levels of 18 proinflammatory proteins to determine whether their concentrations also change in humans who sustained a concussion, said Adam Chodobski, associate professor of emergency medicine at the Med School and senior author of the paper.

They found that in the hours following a concussion, the concentration of four of the assessed proteins significantly changed in the blood of the participants with mild traumatic brain injuries compared to that of the control patients. While the proteins galectin, matrix metalloproteinase-9 and occludin were all shown to increase within eight hours following mild traumatic brain injury, the protein copeptin decreased in the same time frame, according to the study.

The study included two control groups: one of uninjured subjects and another of patients who had suffered long bone fractures. The second group allowed researchers to demonstrate that the protein levels do not change in any type of traumatic injury, Chodobski added. But the biomarkers identified in the study cannot detect a concussion with equal precision if the patient has another injury in addition to a concussion, he added.

“These biomarkers can establish with high accuracy the difference between an uninjured individual and a patient with isolated concussion,” Chodobski said.

The project, which was funded by  donor Diane Weiss and the Department of Emergency Medicine, implemented a novel biomarker method, Chodobski said. The traditional biomarker approach involves examination of proteins released by dying brain cells after injury, but the researchers working on this study analyzed the proteins produced by brain cells that were still alive, he said, adding that he hopes it will be used more prevalently following this study.

The research team is interested in commercializing the assay used in the study, said Joanna Szmydynger-Chodobska, assistant professor of emergency medicine and a co-author of the paper. The assay could one day be implemented in emergency rooms as a quick and robust way to diagnose concussions, she added. The team has already filed for a patent and is now seeking additional funding to perform a larger-scale study and develop the biotechnology.


Injury legislation proving ineffective

(AP)

To toughen safety standards in youth sports, medical experts are turning away from lawmakers and toward high school sports associations to implement policies and procedures to prevent deaths and serious injuries.

The National Athletic Trainers’ Association and the American Medical Society for Sports Medicine completed two days of meetings and programs with representatives from all 50 state high school athletic associations Friday at the NFL offices in Manhattan. The goal was to have decision-makers return to their states and push high schools to put into place recommendations on how best to handle potentially catastrophic medical conditions such as heat stroke, sudden cardiac arrest and head and neck injuries.

Some states, such as Arkansas, have passed laws requiring schools to meet certain standards, but Doug Casa, director of athletic training education at the University of Connecticut, said high school associations should be first to act because they have more flexibility to move quickly.

“Trying to get a state law passed, one, can take a long time but two, sometimes a lot of things get attached to the laws that weren’t the original intention. Also, they’re written by people who don’t truly understand the nuances of a football practice or how sports work into the system of a school year. Those are nuances that the state high school association totally gets,” Casa said.

In 2013, best practice recommendations were published in the Journal of Athletic Training, but many states are still lagging in implementation of those guidelines. They include having a full-time athletic trainer on staff, having automated external defibrillators in every school and accessible to all staff members, and having an emergency action plan for managing serious and potentially life threatening injuries. Funding is often cited as the reason schools, many of which are already struggling to make ends, meet fail to implement these recommendations.

According to the NATA and AMSSM, only 37 percent of high schools in the United States have full-time athletic trainers. Only 22 percent of states meet the recommendation that every school or organization that sponsors athletics develop an emergency action plan. Only 50 percent of states have met recommendations that all athletic trainers, coaches, administrators, school nurses and other staffers have access to an automated external defibrillator.

Casa said just 14 states meet the minimum best practices with regard to heat acclimatization, but the ones that have adopted them since 2011 have had no athlete deaths from heat stroke.

Casa cited Georgia, Arkansas, Texas, North Carolina and New Jersey as states that have been leaders in implementing the recommendations.

Jason Cates, a member of the executive committee of the Arkansas Athletic Trainers’ Association who led reforms in Arkansas after a high school basketball player died of sudden cardiac arrest in 2008, said that while legislation can be help to move programs forward, it can also create problems with legal liability.

“At what point in time are we going to legislate ourselves out of sports?” he said. “I think in some states, in some instances (legislation) is the way to go, but my hope is people just get it.

Casa acknowledged legislation is often necessary to fund programs.

With legislation comes politics and give and take. Kevin Guskiewicz, professor and co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina, said that doesn’t come easy for medical professionals.

“It’s hard for people like us that are medical people to compromise on anything because we think we should have it all,” he said. “So that’s where we’re beating our fists on the table at state capital buildings as we’re debating why we need it all. I did learn a lot about compromise.”

Source: “Injury Legislation Proving Ineffective | AthlonSports.com.” Injury Legislation Proving Ineffective | AthlonSports.com. N.p., 30 Mar. 2015. Web. 30 Mar. 2015.


Medical experts look beyond law to make youth sports safer

(AP)

To toughen safety standards in youth sports, medical experts are turning away from lawmakers and toward high school sports associations to implement policies and procedures to prevent deaths and serious injuries.

The National Athletic Trainers’ Association and the American Medical Society for Sports Medicine completed two days of meetings and programs with representatives from all 50 state high school athletic associations Friday at the NFL offices in Manhattan. The goal was to have decision-makers return to their states and push high schools to put into place recommendations on how best to handle potentially catastrophic medical conditions such as heat stroke, sudden cardiac arrest and head and neck injuries.

Some states, such as Arkansas, have passed laws requiring schools to meet certain standards, but Doug Casa, director of athletic training education at the University of Connecticut, said high school associations should be first to act because they have more flexibility to move quickly.

“Trying to get a state law passed, one, can take a long time but two, sometimes a lot of things get attached to the laws that weren’t the original intention. Also, they’re written by people who don’t truly understand the nuances of a football practice or how sports work into the system of a school year. Those are nuances that the state high school association totally gets,” Casa said.

In 2013, best practice recommendations were published in the Journal of Athletic Training, but many states are still lagging in implementation of those guidelines. They include having a full-time athletic trainer on staff, having automated external defibrillators in every school and accessible to all staff members, and having an emergency action plan for managing serious and potentially life threatening injuries. Funding is often cited as the reason schools, many of which are already struggling to make ends, meet fail to implement these recommendations.

According to the NATA and AMSSM, only 37 percent of high schools in the United States have full-time athletic trainers. Only 22 percent of states meet the recommendation that every school or organization that sponsors athletics develop an emergency action plan. Only 50 percent of states have met recommendations that all athletic trainers, coaches, administrators, school nurses and other staffers have access to an automated external defibrillator.

Casa said just 14 states meet the minimum best practices with regard to heat acclimatization, but the ones that have adopted them since 2011 have had no athlete deaths from heat stroke.

Casa cited Georgia, Arkansas, Texas, North Carolina and New Jersey as states that have been leaders in implementing the recommendations.

Jason Cates, a member of the executive committee of the Arkansas Athletic Trainers’ Association who led reforms in Arkansas after a high school basketball player died of sudden cardiac arrest in 2008, said that while legislation can be help to move programs forward, it can also create problems with legal liability.

“At what point in time are we going to legislate ourselves out of sports?” he said. “I think in some states, in some instances (legislation) is the way to go, but my hope is people just get it.

Casa acknowledged legislation is often necessary to fund programs.

With legislation comes politics and give and take. Kevin Guskiewicz, professor and co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina, said that doesn’t come easy for medical professionals.

“It’s hard for people like us that are medical people to compromise on anything because we think we should have it all,” he said. “So that’s where we’re beating our fists on the table at state capital buildings as we’re debating why we need it all. I did learn a lot about compromise.”

Source: “Medical Experts Look beyond Law to Make Youth Sports Safer.” Education Week. N.p., 30 Mar. 2015. Web. 30 Mar. 2015.


Asthma action plan vital for school-age children

More than 7 million children have asthma in America and more than 10 million missed school days are attributed to the disease, the CDC said. However, a child’s asthma that is well controlled can have a drastic impact on those figures. A group of health and school-based organizations — including the National Association of School Nurses — found that children with well-controlled asthma have a greater chance of remaining in class, increasing their academic performance and allowing their parents to remain at work.

The best way to control asthma at school is for families to create an asthma action plan for their child, said Michael Chunn, MD, a Premier HealthNet physician in Mason. An asthma action plan is a step-by-step plan tailored to a child’s disease that allows caregivers to assess and determine the right treatment at any given time.

“An asthma action plan helps increase the communication between home and school,” Dr. Chunn said. “It helps build the trust a parent has for those caring for their child and helps alleviate any anxiety they may have about sending their child to school on days when the asthma may need additional attention.”

An action plan can also serve as a powerful preventive tool for children who would rather choose to ignore their symptoms instead of missing out on school activities.

“A lot of asthmatics, especially as they get older, will minimize their symptoms because taking time to address them has traditionally led to a child missing out on things like sports or recess,” Dr. Chunn said. “However, ignoring those symptoms only worsens their condition. Having an action plan in place at school can help address the asthma before it gets out of hand, increasing a child’s chances of being a part of the day’s normal activities.”

Dr. Chunn said that an asthma action plan should include three main parts:

Assessment of the Child – Detail specific signs that should be assessed or questions that should be asked of the child so the caregiver can determine an accurate assessment of their current state. For example, are they coughing continuously or unable to participate in physical activity without shortness of breath? A tool called a peak flow meter may also be required to determine how well a child’s lungs are working.

Administration of Treatment – The plan should help guide caregivers regarding the proper treatment based on their assessment of the child. This could include use of an inhaler or even seeking additional medical care.

Reassessment of the Child – The child’s condition should be reassessed once treatment has been administered. This can be done by observation and questioning, or through the use of a peak flow meter.

The CDC and the American Lung Association offer asthma action plan templates as a starting point for caregivers. Those can be found by going to their websites at cdc.gov and lung.org and searching asthma. It is important to remember that an asthma action plan should always be created with the help of a child’s physician. This ensures that the plan has all the necessary details and is ordered correctly.

Use of an action plan should always extend beyond classroom time to include after-school sports and other forms of physical activity, Dr. Chunn said.

“It’s extremely important to be able to monitor an athlete’s lung function during the course of a practice and competition,” said Dr. Chunn, who serves as team physician at King’s High School in Kings Mills. “Knowing a child’s condition and needs in advance is very helpful. We don’t like surprises when it comes to any chronic condition. A solid understanding of a child’s disease helps us to better identify impending respiratory problems.”

Source: “Asthma Action Plan Vital for School-age Children.” Asthma Action Plan Vital for School-age Children. N.p., 30 Mar. 2015. Web. 30 Mar. 2015.


Youth Coaches Prevent Over-Use Injuries

By KATHRYN GHION

The throw is the most repetitive motion in baseball, but without proper rest and instruction throwing arms are in danger. Even at a very early age.

“It usually comes from too much too soon, or too much for year round. Playing baseball 10-11 months out of the year where kids used to be three sport athletes and not concentrating on one sport year round,” said West Virginia Wesleyan College Athletic Trainer Drew Mason.

That’s why he helped organize an educational session on Monday night at West Virginia Wesleyan College. The focus was on protecting the throwing arm.

“Protect the arm with pitch counts, following pitch counts, there’s a lot of recommended guidelines with either Little League Baseball, USA Baseball,” said Brian Potter from Tygart Valley Orthopedics and Sports Medicine.

Emergency action plans, or what to do if an athlete is injured during play were also discussed.

“Basically what it comes down to is pretty simple, who’s supposed to do what when. It’s not as simple as just activating EMS anymore. There has to be a plan or something established,” said Mason.

Source: Ghion, Kathryn. “Youth Coaches Prevent Over-Use Injuries.” – WBOY.com: Clarksburg, Morgantown: News, Sports, Weather. N.p., 3o Mar. 2015. Web. 30 Mar. 2015.


Tips for a healthy summer

By VISHAKHA SHIVDASANI

All that abundant sunshine in summer may be a good source of vitamin D, but it can result in dry skin and hair and other ailments. Summer also brings with it dehydration and water-borne diseases. Some vitamins and minerals, however, can counteract the damage caused by the sun. By choosing the right foods, you can fight the effects of some of the common ailments related to hot weather.

Dry skin

Many people like to swim in the summer season. The chlorinated water (even seawater) in swimming pools has a drying effect on the skin. You can heal dry and parched skin with watermelon, grapes, blueberries and strawberries. These fruits are rich in antioxidants and vitamin C. Protein, in the form of lean meats, beans, nuts and seeds, can also help in collagen formation, keeping the skin supple. We tend to sweat more during this time of the year, so drink lots of water to stay hydrated. Water is also the most effective “nutrient” for the skin. Since calcium can be lost through sweating, consume dairy products like skimmed milk, yogurt and cottage cheese.

Sunstroke, nose bleeding and dehydration

Inadequate intake of fluids like water and fresh juices and too much of outdoor activity can lead to sunstroke, nose bleeding and dehydration. Avoid aerated drinks which are high in sugar content and caffeine, because these can cause further dehydration. Instead opt for buttermilk, kanji (a fermented drink made from black carrots) and fresh lime water. More importantly, don’t wait to drink when you are thirsty; strive to increase your fluid intake as much as possible.

Diarrhea, dysentery, jaundice, typhoid and worm infestation

Unhygienic water and food, unpasteurized milk, unclean hands are the reason why water-borne diseases spread. If you eat out often, irrespective of which season it is, get dewormed every six months. Same goes for the cook or whoever prepares the food. Eat cooked food that is piping hot, especially when eating outside. Stay away from cold cuts and salads unless you are sure that the place where you are eating maintains temperature control and adequate standards of hygiene. In summers, make sure you do not leave leftovers out overnight.

Yeast infection

Sitting in a wet bathing suit or sweat-drenched clothes post workout provides the perfect environment for yeast overgrowth. Sugar increases the chances of yeast overgrowth. So cut down on sugar to prevent yeast infection.

Parched hair

Too much exposure to sun and chlorine can cause your hair to feel dry and damaged. To take care of your hair, include protein-rich foods like fish, beans and lentils in your diet. Eating foods rich in vitamin B5 (yogurt), vitamin B8 (eggs), folic acid (beans and green vegetables), calcium (milk products) and zinc (meat and fish) can reduce hair loss and add shine to them.

Muscle cramps

Exercising in the outdoors, such as running, attending a boot camp, playing volleyball or tennis can lead to muscle cramps since they are a result of dehydration. Lack of fluid in the system can lead to an electrolyte imbalance, which causes involuntary muscle contractions. Sodium, calcium and potassium are electrolytes that are lost through sweating during exercise. To replenish electrolytes, have a sports drink. Also eat potassium-rich foods like bananas, raisins, potatoes and spinach.

Source: Shivdasani, Vishakha. “Tips for a Healthy Summer.” Http://www.livemint.com/. N.p., 30 Mar. 2015. Web. 30 Mar. 2015.

 


Experts: Law not enough to make youth sports safe

(AP)

To toughen safety standards in youth sports, medical experts are turning away from lawmakers and toward high school sports associations to implement policies and procedures to prevent deaths and serious injuries.The National Athletic Trainers’ Association and the American Medical Society for Sports Medicine completed two days of meetings and programs with representatives from all 50 state high school athletic associations Friday at the NFL offices in Manhattan. The goal was to have decision-makers return to their states and push high schools to put into place recommendations on how best to handle potentially catastrophic medical conditions such as heat stroke, sudden cardiac arrest, and head and neck injuries.

Some states, such as Arkansas, have passed laws requiring schools to meet certain standards, but Doug Casa, director of athletic training education at the University of Connecticut, said high school associations should be first to act because they have more flexibility to move quickly.

“Trying to get a state law passed, one, can take a long time, but two, sometimes a lot of things get attached to the laws that weren’t the original intention. Also, they’re written by people who don’t truly understand the nuances of a football practice or how sports work into the system of a school year. Those are nuances that the state high school association totally gets,” Casa said.

In 2013, best practice recommendations were published in the Journal of Athletic Training, but many states are still lagging in implementation of those guidelines. They include having a full-time athletic trainer on staff, having automated external defibrillators in every school and accessible to all staff members, and having an emergency action plan for managing serious and potentially life threatening injuries. Funding is often cited as the reason schools, many of which are already struggling to make ends meet, fail to implement these recommendations.

According to the NATA and AMSSM, only 37 percent of high schools in the United States have full-time athletic trainers. Only 22 percent of states meet the recommendation that every school or organization that sponsors athletics develop an emergency action plan. Only 50 percent of states have met recommendations that all athletic trainers, coaches, administrators, school nurses, and other staffers have access to an automated external defibrillator.

Casa said just 14 states meet the minimum best practices with regard to heat acclimatization, but the ones that have adopted them since 2011 have had no athlete deaths from heat stroke.

Casa cited New Jersey, Georgia, Arkansas, Texas, and North Carolina as states that have been leaders in implementing the recommendations.

Jason Cates, a member of the executive committee of the Arkansas Athletic Trainers’ Association who led reforms in Arkansas after a high school basketball player died of sudden cardiac arrest in 2008, said that while legislation can help to move programs forward, it can also create problems with legal liability.

“At what point in time are we going to legislate ourselves out of sports?” he said. “I think in some states, in some instances [legislation] is the way to go, but my hope is people just get it.”

Casa acknowledged legislation is often necessary to fund programs.

With legislation comes politics and give and take. Kevin Guskiewicz, professor and co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina, said that doesn’t come easy for medical professionals.

“It’s hard for people like us that are medical people to compromise on anything because we think we should have it all,” he said.

Source: “Experts: Law Not Enough to Make Youth Sports Safe.” Philly.com. N.p., 29 Mar. 2015. Web. 29 Mar. 2015.


American Lung Association wants to help St. Louis clinics improve asthma outcomes for children

By CAMILLE PHILLIPS

St. Louis area pediatricians will soon have help managing asthma care for their patients. The American Lung Association is implementing a program here to improve the system that primary care clinics use to identify and treat the disease.

The Enhancing Asthma Care for Children program has measurably reduced asthma symptoms for patients in other cities where it has been introduced, said Jill Heins, director of respiratory health for the American Lung Association of the Upper Midwest.

Heins said the program helps doctors create a work-flow process to improve diagnoses and treatment. The program also helps clinics identify environmental allergens affecting children’s asthma and set up asthma action plans with the child’s family.

“Health care professionals have amazing knowledge around the diagnosis and management of asthma (but) they often work in systems where they’re not able to make asthma management work in the flow,” Heins explained.

With better systems in place, children can breathe better and live fuller lives, she added.

“When they can breathe easier, they have fewer symptoms so they can go outside and play recess, they can play in sports, they can do physical activity. When they are in the classroom they can actually concentrate,” Heins said.

Heins said another goal of the program is to reduce emergency room visits, which has two benefits: healthier children and lower health care costs.

United Health Foundation, the charitable arm of insurance provider UnitedHealthcare, is giving the American Lung Association $2 million to bring the Enhancing Asthma Care for Children program to St. Louis and four other metro areas in the association’s Upper Midwest region. The plan is to partner with at least 5 primary clinics a year in each metro area for a total of 15 clinics per city over the course of three years.

According to Washington University pulmonologist Mario Castro, the American Lung Association program is a good fit for St. Louis because many area children aren’t being diagnosed and treated correctly.

He recently completed a study of children in St. Louis with asthma for the Centers for Disease Control and Prevention.

“We found that often health care providers under-recognized asthma as well as under-recognized the severity of that asthma. Some children with severe asthma, in fact, had about a one out of four chance of being appropriately treated based on the national asthma guidelines,” Castro said.

Castro said a correct diagnosis and an asthma action plan can help children stay healthy and out of the hospital.

“Unfortunately we have a huge asthma problem in St. Louis,” he said. “There are a substantial number of kids out there with asthma, and a lot of these children unfortunately end up in our emergency rooms.”

Castro is on the national board of directors for the American Lung Association.

Source: Phillips, Camille. “American Lung Association Wants to Help St. Louis Clinics Improve Asthma Outcomes for Children.” American Lung Association Wants to Help St. Louis Clinics Improve Asthma Outcomes for Children. N.p., 29 Mar. 2015. Web. 29 Mar. 2015.


Concussions among young athletes should be a concern for parents, coaches and lawmakers

The Issue

The rate of concussions among U.S. high school athletes more than doubled between 2005 and 2012, according to an Ohio State University study. More than 4,000 concussions occurred in athletes in boys’ football, boys’ and girls’ soccer, girls’ volleyball, boys’ and girls’ basketball, boys’ wrestling, boys’ baseball and girls’ softball.  High school football saw the highest concussion rate.

Chris Borland, formerly of the San Francisco 49ers, isn’t the only young man walking away from football.

University of Michigan starting center Jack Miller recently cited concussion concerns when announcing he no longer would play the sport.

“I know I’ve had a few and it’s nice walking away before things could’ve gotten worse,” Miller told ESPN. “My health and happiness (are) more important than a game.”

He says he didn’t report a couple of concussions he had. “You’re supposed to be tough in this game — everyone carries that attitude.”

And there it is.

This is what now gives many parents pause about letting their kids play football — or any contact sport.

Parents are assured that concussion awareness is high in youth sports now, and that coaches won’t put a child with a possible concussion back in the game.

But toughing it out remains part of  the ethos of competitive sports. And some coaches still are sending kids back onto the playing field after the kids have sustained hits to the head.

This isn’t a minor matter. Multiple concussions may lead later in life to cognitive impairment, depression and dementia.

Children are particularly vulnerable to concussions, says Jon Bentz,  manager of behavioral medicine at Lancaster General Health Physicians Neuropsychology Specialists.

This is why renowned concussion expert and neurosurgeon Robert Cantu says kids shouldn’t play tackle football before age 14.

Same goes for body checking in ice hockey, and heading the ball in soccer.

Too little is known about the long-term consequences of concussion to the developing brain.

So, Bentz recommends, “Hold off as long as you can until that brain has a chance to mature a little bit more.”

And consider other risk factors, he advises.

Those at an elevated risk for concussion include not just children and teens (particularly girls), but athletes with any prior learning disability, a history of headaches,  a history of depression or other psychiatric disorder, and those with a propensity toward motion sickness.

It is true that today’s helmets better protect football players against catastrophic outcomes, such as skull fractures and brain  bleeds, but they “don’t necessarily reduce the frequency of concussive injury,” Bentz says.

Some new — and pricey — helmets have been shown to reduce concussion risk, but even those have their limits.

And offsetting the improvements in helmet technology is the reality that young athletes today are bigger, faster and stronger, so the force of impact is that much greater, Bentz says.

Coaches of public school sports (including cheerleading) are required by Pennsylvania’s Safety in Youth Sports Act to annually undergo concussion management training.

That law, signed into law in 2011, sets out specific protocols for when an athlete should be removed from play, and when he may return.

But it doesn’t extend to rec leagues and club teams, for which many young athletes are playing these days, often year-round.

The  Eastern Pennsylvania Youth Soccer Association has voluntarily adopted the state protocols.

But we shouldn’t be counting on voluntary adherence to practices we know are essential for the long-term health of our children.

Pennsylvania lawmakers ought to amend the law to include rec leagues and nonscholastic clubs.

And parents need to educate themselves about  concussion risks.

They need to insist that contact be limited — no heading the soccer ball at practices, no tackling five days a week. And they need to keep an eye on practices — or, as Bentz suggests, take turns with other parents to attend practices to ensure that concussion safety guidelines are followed.

The essential rule: “When in doubt, sit it out,” Bentz says.

And here’s another thing parents and midget football coaches need to consider: Why not replace tackle football with flag football for players under 14?

The players still would learn skills, while their developing brains would be left unrattled.

New Orleans Saints quarterback Drew Brees has said he won’t let his sons play tackle football until they are teenagers. “I think you can be too young to go out there and strap on a helmet,” he told USA Today.

Putting off organized, tackle football worked for New England Patriots quarterback Tom Brady.

He didn’t start playing until high school.

Source: “Concussions among Young Athletes Should Be a Concern for Parents, Coaches and Lawmakers.” LancasterOnline. N.p., 29 Mar. 2015. Web. 29 Mar. 2015.