Coaches target safety in youth football

Clinic promotes proper blocking and tackling techniques in order to prevent concussions


Football has been sacked the past few years because of the growing concern about concussions and injuries.

So, a group of 40 youth football coaches huddled up at the Pat Bowlen Fieldhouse at UCHealth Training Center, near Centennial, on June 25 for the USA Football Heads Up Football Player Safety Coaches Clinic.

“The game is under attack, especially at the youth level,” said Steve Shore, a coach for the Englewood Pirates in the Jeffco Midget Football Association. “The injuries are a concern of the parents and is the game worth it compared to the injury level?

“This clinic is crucial because to save the game, we have to come up with better ways to coach these kids and keep them safer.”

Greg Miller, a Northglenn High school graduate, assistant varsity football coach at Legacy and USA Football master trainer, conducted the four-hour clinic.

The topics discussed were concussion recognition and response and proper helmet and shoulder pad fitting. Videos were available to reinforce proper tackling and blocking mechanics, focusing on reduced helmet contact.

According to the American Academy of Orthopedic Surgeons, the chances of a youth football athlete suffering a concussion over the course of one season are 75 percent. And 62 percent of the major impacts in youth football occur during practice and not in games.

In March, USA Football released the results of a study conducted by the Physical Activity Council for participation of athletes between the ages of 6 and 14.

There was an increase of 1.9 percent from 2,128 million participants in 2014 to 2,169 million in 2015. But there has been a drop in participation from 3 million in 2010, according to the USA Football study.

Miller has seen a change in blocking and tackling techniques because of the increased attention on injuries.

“It absolutely has to start at the youth level,” he said. “It’s great to see it spreading to the upper level of college and pros, but to really get a chance we have to start at the youth level. We really need to teach better fundamentals for tackling and blocking.

“It has changed for the better. There is more awareness about injuries. It was something that was there years and years ago but we just weren’t as aware of it as we are today…”

Changing improper tackling and blocking basics for some players, especially more experienced ones, can be a challenge.

“It’s not that it easy to change,” Miller said. ”You have to be aware of the change that needs to happen. When coaches see a player that maybe doesn’t have the proper fundamentals, we have to be aware of that and really work with that player.”


Benton, Jim. “Coaches Target Safety in Youth Football – Colorado Community Media.” Colorado Community Media. HRH, 30 June 2016. Web. 06 July 2016.

Section III Athletics endorses Heads Up Football safety program

Section III Athletics endorses Heads Up Football safety program

Heads Up Football is a comprehensive program developed by USA Football to advance player safety in the game of football

Section III Athletics is tackling the ever-present issues of sports concussions and player safety. Beginning this summer, the organization – along with the New York State Public High School Athletic Association and the State Football Committee – is endorsing USA Football’s “Heads Up Football” program.

“Section III is recommending that all varsity coaches (including assistant coaches) complete the Heads Up Football® High School Coach Certification program, which consist of four courses found on (Concussion in Sports, Heat Illness Prevention, Sudden Cardiac Arrest and Equipment Fitting/Blocking/Tackling),” according to a press release.

After completion of all four courses, each coach will receive $1 million in general liability insurance from USA Football.

Heads Up Football® is a “comprehensive program developed by USA Football to advance player safety in the game of football”, the press release said.

The Section III Football Committee recently hosted a pair of in-person trainings for one coach per school to attend the Heads Up Football® PSC Clinic conducted by master trainers. The first training, led by Ken Stoldt, was held on June 21 at East Syracuse-Minoa High School, while the second event was on Tuesday at Sauquoit Valley High School and led by Matt Gallagher.

Officials from Section III met with USA Football in May to learn more about the program and later began setting up for the trainings.

“Roughly 75% of the schools were able to make it. We met with USA Football about a month and a half ago to get (the trainings) organized. … To get everything lined up to do it, we wanted as many people here as we could,” Section III Football co-coordinator Keith Kempney said. “We were very pleased with the high numbers that we had with the short notice.”

Officials from Section III Athletics had previously discussed the advantages offered from USA Football with coaches from Section IV and Section VI, leading to their endorsement of the organization.

“We determined it was better and safer to use these techniques that they practice. It was better and safer, so it’s a win-win,” Kempney said. “It’s not mandated by the state at this time. Section III definitely endorses it, they support it. It’s not mandated, but we’re kind of hoping that the state might come up with mandates, though that’s for down the road. For now, we’ve had tremendous response and feedback from the coaches thus far.”

The released added, “Section III believes that our number one priority is the safety of our student-athletes. Heads Up Football High School helps prioritize the health and safety of our players by offering proper tools and resources that help provide a safer experience for our athletes.”

Section III Athletics Executive Director John Rathburn said the joint efforts with USA Football are vital to the safety of the players.

“I strongly believe that coaching certification is critically important for the safety of the game, and what USA Football teaches us can only enhance the educational training that all of our coaches already have,” Rathburn said. “Let’s give them a place to go where they can learn the game, and parents can have the confidence that our coach have received the proper certification.”

Barbosa, Victor. “Section III Athletics Endorses Heads Up Football Safety Program.”, 29 June 2016. Web. 30 June 2016.

Baseline concussion tests can help better treat injured athletes


ELDRIDGE, Iowa – Concussions are not always easy to detect or treat and that’s why North Scott High School teamed up with Genesis to help treat them better.

For North Scott athlete Triston Richardson, it’s something he knows all too well, getting a concussion.

“I’ve had one in wrestling and two in football and then one just outside of both,” said Senior Triston Richardson.

The brain injury can be hard to treat especially because you can’t see it.

“There are a multitude of symptoms and they all kind of blend together,” said Physical Therapist Karen Steidler.

North Scott High School teamed up with Genesis to try and change that with a series of tests.

“Test their balance, their vision, their short term recall and their memory and long-term recall,” said Steilder.

The tests are done when the athlete is healthy.

“To get a better accurate testing for our student athletes and kinda a better protocol for return to play,” said Activities Director Jason Schroeder.

When something does happen during a sport they can run the athlete through these tests again and compare the results and know how to treat the student.

“Then we know there’s something more serious going on, they start physical therapy, they start speech therapy and then we can help regain the ability for their brain to function,” said Steilder.


Hepner, Christina. “Baseline Concussion Tests Can Help Better Treat Injured Athletes.” WQADcom. WQAD, 28 June 2016. Web. 29 June 2016.

Safeguarding Young Athletes From Concussions

When Erick Goble of Glen Ellyn, Illinois, then 8, whacked the back of his head on the ice during a hockey game, he complained of a headache and was benched for the rest of the game. Afterward he claimed he was fine, and he played in another game the next day. But his headache persisted, so his worried parents whisked him to the pediatrician, who diagnosed a mild concussion. The doctor’s orders included staying home from school for a day and laying off all intellectual activity, including homework, electronics, TV and reading, for a week. Erick also sat out gym, recess and hockey practice.

All seems well two years later, and Erick now plays competitive travel hockey. However, Rita Colorito, his mom, says that as the kids become bigger and more aggressive, she’s taking all head bumps much more seriously. Indeed, concern about the long-term effects of concussion is rampant these days in the wake of revelations that pro football players have suffered permanent brain damage from the abuse they took during their playing years. And it’s increasingly clear that the risk of worrisome head injury is not limited to the most serious athletes. The Centers for Disease Control and Prevention says that more than 170,000 children and teenagers go to the emergency room every year for sports-related brain injuries – and that’s a small fraction of the kids who hit their heads during practices and games.

While most kids recover from concussions within a few weeks, a few struggle with the aftereffects for months or years. They can include headache, dizziness, fatigue, irritability, anxiety, and problems with concentration and memory. To lower the risk, Practice Like Pros, an anti-concussion group endorsed by several NFL coaches, advocates flag football only for younger players, and very limited full-contact practices in high school. The U.S. Soccer Federation changed its rules late last year to prohibit “heading” the ball by players 10 and under, and to reduce headers in practice for players between ages 11 and 13. Early this year, the coaches of the Ivy League voted to eliminate full-contact hitting from regular season football practices, and also to explore ways to reduce hits to the head in hockey, soccer and lacrosse.

It’s easy to see the danger of concussion – which is caused by a rapid acceleration of the head that causes the brain to bounce around or twist in the skull – in football and soccer, where head impacts have long been part of the game. But any sport, from swimming to cheerleading, can pose some risk. “Being a flyer in cheer is more dangerous than playing football,” says Dr. Robert Cantu, co-founder and medical director of the Concussion Legacy Foundation, a Boston-based not-for-profit dedicated to raising awareness of the dangers. There doesn’t even have to be a blow to the head: A youngster can give his brain a severe jolt just by slamming into a goal post with his chest and shoulder.

With new urgency to understand the cumulative effects, scientists are studying sports-related head impacts on several fronts. “We don’t know a lot of the answers, and we’re learning on the go,” says Dr. Dennis Cardone, co-director of the Concussion Center at NYU Langone Medical Center in New York. He says the unanswered questions are many: for example, whether there’s a maximum number of concussions that is “safe,” and to what extent “subclinical” hits – impacts that fall short of concussion – may cause permanent damage. Sensors in the helmets of football players reveal hundreds of hits in people who have never been diagnosed with a concussion, Cardone says. “If you add it all up over a lifetime,” he says, these players might be at “a big risk for long-term consequences.”

The National Collegiate Athletic Association and the Department of Defense have begun enrolling thousands of college athletes for a three-year study of concussion and its aftereffects. The National Institutes of Health is underwriting a two-year study of 400 adult amateur soccer players who have been playing since their youth. While results are not yet available, an earlier pilot study by the same researchers found brain abnormalities and cognitive problems in amateur soccer players who frequently headed the ball, even when they had no history of concussion.

“It’s remarkable how common it is for players to have concussive symptoms related to heading that they don’t recognize or acknowledge as concussion,” says Dr. Michael Lipton, a neuroradiologist at the Albert Einstein College of Medicine in New York and lead investigator of the NIH study. “Things like disorientation, dizziness, balance problems and nausea are not at all rare in people who just keep playing.”

Colorito says the cumulative effects of lots of small concussions concern her just as much as the danger of one big one. Erick, now 11, can’t wait until he turns 12 and is allowed to “check,” or actively disrupt the opponent’s possession of the puck. “Some kids drop the sport when checking starts, but Erick’s looking forward to it,” Colorito says. Because checking increases the risk of injury, his league’s governing organization requires players to complete a checking clinic to learn safe techniques. Erick’s coaches take a seminar every fall on concussion assessment, and Colorito says they benched Erick recently when he was knocked down and then failed a quick short-term memory test. “He remembered the words they asked him to repeat an hour later, but the coach still kept him out, which we appreciated.”

Besides trying to make sure their kids play for enlightened coaches and keeping an eagle eye on injured players, what should parents know in order to keep their children safe?

First, while most kids survive a first concussion unscathed, the second one could be another story. “Long-term problems related to head injury in general are due to or exacerbated by multiple injuries,” Lipton says.

When children do get injured, it’s important to assess them carefully before sending them back into the game. “‘Second impact’ is a real phenomenon, when a football player takes a big hit, is concussed, sort of recovers and then doesn’t get up when he’s tackled,” says Dr. Yvonne Lui, chief of neuroradiology at Langone, whose research has shown changes in the brain up to a year after a concussion. “Those players can develop dramatic and life-threatening brain edema.”

Second, some people are more vulnerable to serious aftereffects, especially those with conditions like depression, anxiety, attention deficit hyperactivity disorder, migraines or learning disabilities. “If you have a brain challenge and then put a brain injury on top of it, the underlying challenge can become much worse,” Cantu says. He recommends that parents of kids with any type of neuropsychological issue steer them away from activities associated with head injuries.

And finally, bear in mind that “the worst take-home message” is that you should avoid sports out of fear of concussion, Cardone says. “We should still be promoting sports and physical activity.”


Gardner, Elizabeth. “Safeguarding Young Athletes From Concussions.” US News. U.S.News & World Report, 28 June 2016. Web. 28 June 2016.

Youth football coaches talk concussions, player safety

LAMBEAU FIELD (WBAY) – Youth football coaches spent Saturday reviewing safety techniques at Lambeau Field.

“These are kids. We have to protect their lives first and foremost,” said Mike Walters, a coach for Catholic Youth Football Club in Milwaukee.

USA Football, the sport’s national governing body, holds hundreds of training sessions every year educating coaches and parents about keeping kids safe on the football field.

Saturday, coaches went over how to properly fit a helmet and shoulder pads.

Also concussions were a big talking point because it has become such a concern for parents in recent years.

“We have made a strong emphasis on youth and high school of keeping the head out of the game. Keep the head out of contact. Don’t lead with the head. Don’t lead with your face mask. Use your hands,” said David Keel, a master trainer for USA Football.

Coaches learned the signs of a concussion and adopted the mindset of “When it doubt, sit them out.”

The more they learn, the more information they can pass onto parents.

“Anytime you can educate the public of what is going on whether it’s practice plans, whether it’s how much time you practice, heads up football, keeping the head out of the play that type of stuff, mom knows it, dad knows it, grandpa knows it, little brother knows it, its going to make a difference in the safety of the game,” said Bobby Diaz, a player safety coach.

These coaches want football to be around in the decades to come, so they say safety is the bottom line.

“We want our sport to continue to grow in popularity as it has and to become safer and better for all participants,” said Keel.

For more information on USA Football and their “Heads Up” football program, click here:

McCardle, Ellery. “Youth Football Coaches Talk Concussions, Player Safety.” WBAY. WBAY, 25 June 2016. Web. 27 June 2016.


Understanding risk and protocols key to concussion management

BALTIMORE — Former Pro Bowl running back Brian Westbrook doesn’t know where he’d be today without former Philadelphia Eagles athletic trainer Rick Burkholder.

On Oct. 26, 2009, Westbrook suffered his first concussion when he was hit in the back of the head and blacked out during the Eagles’ game against the Washington Redskins. Two days later, he wanted to practice again.

Burkholder stopped him.

“Burkholder said, ‘We’re not going to let you touch that football field until you’re absolutely ready,’” Westbrook said. “It was that decision and those words that changed my life dramatically for the better. It’s what allows me to go out there on the radio and TV and speak to young people today without worrying about head and brain disease.”

Westbrook spoke at the National Athletic Trainers’ Association Convention in Baltimore on Thursday, where a panel of athletic trainers gave tips on preventing concussions in youth and high school sports. NATA also unveiled new research and guidelines related to concussions, osteoarthritis and sudden cardiac death.

Among children, those ages 15 to 17 visit the emergency room the most often, while thousands of high school athletes have long-term complications resulting from injuries. Many youth athletes, their parents and coaches don’t understand the risk of severe injuries during competition. Westbrook, for example, didn’t even consider the thought of getting a concussion until he endured his first one.

Tamara McLeod, the director of athletic training programs at A.T. Still University’s Arizona School of Health Sciences, said most states have laws that require high schools to educate athletes about concussions, but usually these teachings are basic and don’t grasp the athletes’ full attention.

“Some of them just give a handout,” McLeod said. “The key is education before the injury happens.”

McLeod has studied and advocated for a collaborative approach to care that includes athletic trainers, school nurses, administrators, teachers and coaches when it comes to managing athletes’ care and preparing them to return to play.

According to NATA, only 12 states have a written emergency action plan; 16 states meet “minimum best practices” for heat acclimatization; and only 25 states have access to an “external defibrillator on a school property and at all school sanctioned athletic activities.”

By using video of professional athletes, McLeod said she’s had more success getting her message across, but she believes each age group should be targeted in a different way to emphasize concussion protocol. Heads Up Football, a USA Football education program, is another way to inform coaches and players on concussions, she said.

University of Connecticut kinesiology professor Douglas Casa studied Fairfax County High Schools in Virginia, and found that athletes playing under Heads Up Football certified coaches underwent 25 percent less injuries and 43 percent less concussions.

McLeod said that every school needs to have a policy for athletes who experience concussions, including treatment, how to ease athletes back into competition and when to allow them to play again. Having an athletic trainer helps this plan work, said Kristen Kucera, an assistant professor at the University of North Carolina at Chapel Hill’s Department of Exercise and Sport Science.

“Athletic trainers specialize in the prevention, recognition, management, treatment and rehabilitation of sport injuries and illness,” Kucera said.

Westbrook said athletes and their parents should be informed about the risk of concussions when they begin playing tackle football. The NFL has reduced the amount of physicality in practice since Westbrook began playing in the league, but he said it’s still difficult to manage injuries while coaches pressure their athletes to return to action.

“So many coaches expect you to be back on the field after two days,” Westbrook said.

The National Trainers’ Association launched a campaign called “At Your Own Risk” to educate, prevent and heal athletic injuries. The website includes an interactive map with the sports safety protocols for all 50 states.

According to the National Center for Catastrophic Sport Injury Research, there 80 catastrophic injuries and illnesses among high school and college athletes, with 78 percent at the high school level, from July 2013 to July 2014.

In 2015, 50 high school athletes died during sports or physical activity and high school athletes lead t the nation in athletic-related deaths.

Westbrook said he was lucky to have an educated athletic trainer when he played for the Eagles, but not all athletes are that fortunate. Some players put themselves at risk of long-term injuries by returning to competition too early, or not informing their coach or athletic trainer about concussion symptoms.

If Westbrook had not waited to recover, he might join myriad other football players who display symptoms of Alzheimer’s disease and chronic traumatic encephalopathy.

“As athletes, we’re not thinking about injury,” Westbrook said. “We’re thinking about playing. I want [athletic trainers] to say, ‘We’re not trying to keep you off the field, but we want to make sure when you’re on the field, you’re the best player you can be.”


Melnik, Kyle. “Understanding Risk and Protocols Key to Concussion Management.” USA Today High School Sports. USA Today Sports, 23 June 2016. Web. 24 June 2016.

County law will mandate concussion training for youth sports coaches

The Erie County Legislature is poised to approve a new law Thursday that will make concussion safety courses mandatory for all coaches of youth sports in Erie County. The law, which would take effect immediately, is expected to pass overwhelmingly just as schools are letting out and summer youth sports move into full swing.

Meanwhile, the Legislature also is slated to adopt the final component of County Executive Mark Poloncarz’s lead prevention initiative, which would involve hiring more county employees to nearly double the number of environmental health inspections the county does now and improve services to children with high lead levels in their blood.

The concussion training law would fine youth sports organizations $100 to $200 if they cannot produce records showing that all of their coaches have taken concussion safety courses either in person, through their sports organizations, or online. The requirement would primarily affect smaller, independent youth organizations that engage in contact sports.

The proposal requires that coaches of any “contact or collision sports” take a free concussion safety program offered by the County Health Department or online through the Centers for Disease Control and Prevention’s HEADS UP to Youth Sports.

“The state already mandates the coaches of public schools have this training,” said Legislator Patrick Burke, D-Buffalo, who co-sponsored the law along with Majority Leader Joseph Lorigo, C-West Seneca. “It just seems crazy to me that not everyone is mandated to have this concussion training.”

Though the new law would take effect immediately, Burke said he expects the county will give sports organizations a grace period prior to enforcement of the new requirements.

The Legislature also:

• Is expected to adopt the final piece of the five-year, $3.75 million lead poisoning prevention plan: hiring of five additional home inspectors, a nurse to follow up on child lead poisoning cases, a supervisor and a clerk. The county plans to advertise the new positions immediately, said Poloncarz spokesman Peter Anderson.

These jobs were held up by the Legislature until the county was recently awarded a $3.4 million grant by the U.S. Department of Housing and Urban Development to offset the program costs.

Erie County has one of the highest rates of childhood lead poisoning in the state, according to data from the CDC.

The Legislature also:

• Will decide whether to approve Erie Community College’s $108.5 million budget for next school year, which raises student tuition by 3 percent, hikes student technology fees, and cuts 50 vacant positions.

• Will vote on the recommendations of the Erie County Charter Revision Commission, including lengthening Legislature terms from two to four years and making it easier for elected officials to get raises after an intervening election.


Tan, Sandra. “County Law Will Mandate Concussion Training for Youth Sports Coaches – The Buffalo News.” Buffalo News, 22 June 2016. Web. 23 June 2016.

Radnor Board of Health hears concussion update

Radnor >> Pediatrician Dr. Andrew Forman said that he sees two or three patients, out of about 120 a week, for evaluation of concussions. However, Forman said that many more are treated in emergency rooms or urgent care facilities.

Forman, chair of the Radnor Township Board of Health, said that about 85 percent of the cases that he sees at his practice in Paoli are related to sports, usually high school football or soccer players. And he has seen several patients with multiple concussions.

Emilija Sagaityte, 15, a sophomore at Radnor High School and an intern with the Board of Health, gave a presentation to the BOH Monday about sports head injuries. About 21 percent of the 1.6 to 3.8 million youngsters who get head injuries get them as a result of sports, she said.

A traumatic brain injury or a blow or jolt to the head that disrupts normal functioning can have a wide range of effects from unconsciousness to death, she said. A concussion is a mild form of a TBI and temporary. Symptoms include pain in the head or neck, nausea, dizziness and confusion, ringing in the ears, exhaustion, difficulty walking, talking or sleeping and seizures.

Students need to rest after experiencing a concussion and cannot participate in school or sports, Sagaityte said.

Multiple concussions in children and teenagers can cause problems including headaches, memory problems and difficulty concentrating, as well as loss of physical skills, she said. Those kids who experience multiple concussions are at risk for permanent damage, she said.

Numerous concussions over many years can lead to chronic traumatic encephalopathy (CTE), she said. This condition can result in trouble moving, depression, suicidal thoughts and actions, memory loss, dementia and drug and alcohol abuse.

She showed pictures of a healthy brain and a football player and boxer who suffer from CTE. People’s brains continue to develop until around age 25. However, neurons can’t regenerate, she said.

The Acute Concussion Evaluation form (ACE) is available to diagnose concussions and seven to 14 days waiting period is recommended. A multistep protocol ensues with no school or sports, then gradually resuming activities after being cleared.

However, about 47 percent of people don’t realize that they have a concussion. Sometimes they believe the symptoms are from other illnesses like the flu, she said.

“There is also the problem of honesty because when a player fills out an ACE form they do have to be honest with their symptoms because not every single one can be noticed by an outsider,” Sagaiyte said. “And if they want to resume the game they might not be honest with what they are experiencing. And this can lead to misdiagnosis.”

There is also an issue of parent and coach awareness, she said.

RHS athletic director Michael Friel told Sagaiyte that the players now have better helmets and playing time in full pads is limited. In wrestling students learn proper falling and tackling techniques and in lacrosse they have begun a foul rule where players that hit over the shoulder suffer a penalty, she said.

There is also a baseline test that a player takes when healthy. If they are hit in the head, they take it again and the results are compared, she said.

Also, Kevin Schneider, RHS athletic trainer told Sagaiyte that he sees most concussions in football, soccer, wrestling, ice hockey and lacrosse. He sees 20 to 30 concussions per year at RHS.

In an effort to stop concussions, soccer groups are requiring that younger players do not “head” the ball and allow only limited “heading” for older players. There is also the issue of wearing helmets in sports that traditionally didn’t, such as some soccer and lacrosse programs. Also, military technology is now being used to prevent head injuries and improve helmets. Another football helmet from the University of Washington with multiple layers spreads out the impact of a blow, she said

Both Forman and Friel agree that education is important for athletes so they are aware of what a concussion is and the results, she said.

“At the very minimum they should be aware that a concussion is a significant injury,” she said.

Forman praised Sagaityte’s presentation and added that it’s important for parents to know that there can be long-term damage from concussions because neurons don’t regenerate. However, because brains are plastic, there is a process called “remolding,” he said. What becomes a problem is when someone has repeated concussions that “can cause some real long-term issues.”

Also, Forman added, “It’s important for families to know there is no test for concussion, no CAT scan, or MRI that says, ‘Yes you had a concussion.’ It is that mesh of symptoms. The impact testing helps us figure out if a child is ready to return to play.” Also, information continues to grow about concussions so the health board will continue to keep the community updated, he said.

Stein, Linda. “Radnor Board of Health Hears Concussion Update – Main Line Suburban Life – Main Line Media News.” Mainline Media News. MNN, 21 June 2016. Web. 23 June 2016.

Are kids getting more concussions than we realize?

Every year, almost half a million (PDF) children across the United States visit emergency rooms for concussions. But recent studies find that number may undercount just how many kids really have concussions.

In fact, a study published in the June 20 edition of the journal Pediatrics estimates that the number of concussions among those 18 years old and younger is higher, possibly between 1.1 million and 1.9 million annually.
Currently, national rates of concussion from the Centers for Disease Control and Prevention are based on emergency room visits only. However, very few concussion diagnoses actually happen in the ER. According to researchers, more than half a million children with concussions were not seen in the ER or by a physician at all.
Analyzing data from three national databases tracking concussion — MarketScan, the National Electronic Injury Surveillance System and the National High School Sports Related Injury Surveillance System — researchers in the new study found that between 115,000 and 167,000 children’s concussions were diagnosed in the ER. Doctor visits accounted for just 378,000 concussion diagnoses. The vast majority of children’s concussions, between half a million and a million, were seen by an athletic trainer.
Another study done this year of the Children’s Hospital of Philadelphia system evaluated more than 8,000 youth concussion diagnoses and found that 82% were made in a doctor’s office; just 12% of diagnoses were made in the ER.
The bottom line is that most kids are getting diagnosed outside the emergency room, and as a result, the number of concussions among children may be much higher than thought.

‘We aren’t looking in the right places’

According to the CDC, which helped fund and support the research from Children’s Hospital of Philadelphia, that study “highlights a substantial gap in how the United States currently estimates the nation’s burden of pediatric concussions, and underscores the need for better surveillance.”
Kristy Arbogast, lead author of the paper, said, “If, as a country, we’re relying on [emergency room visits], we’re probably missing a meaningful majority of [concussions] that we aren’t counting because we aren’t looking in the right places to count.”
President Obama’s 2017 budget includes a request for $5 million to establish and oversee a National Concussion Surveillance System that would track concussions through a national household telephone survey system.
Arbogast is a scientific director at the Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia. She and her team looked at concussion diagnoses in that hospital’s system, which, along with the hospital and doctors’ practices, includes two urgent-care centers.
They found that while there tends to be a lot of concern about concussion among high school athletes and older children, a third of concussion diagnoses happened in children younger than 12. Children under the age of 4 were most likely to get their diagnoses in the ER, while older children were more likely to go to a pediatrician’s office.
Despite concerns over underreporting, Arbogast believes that the findings were very positive, because pediatricians were being utilized over ERs.
She said that concussion diagnoses can be very nuanced and that ERs weren’t always best equipped to diagnose them. “Until we get objective measures of concussion — we don’t have a blood test; we don’t have an X-ray — we believe a pediatrician is best suited to diagnose a concussion because of its subjective nuance presentation.”
Dr. Ari Brown, a pediatrician and author of “Expecting 411,” agreed: “Families can and should utilize their child’s primary care provider first for most of these injuries. Most children do not need an imaging study. They just need a thorough medical evaluation, education on brain rest and return to play/learning, and follow-up to ensure the injury has resolved.”

When should you go to the hospital?

Tamara McLeod, director of the athletic training program at A.T. Still University in Missouri, said there are some red flags that warrant an ER trip, including:
  • if the child’s mental status is deteriorating
  • if the child can’t carry on a coherent conversation
  • if the child continues to vomit
  • if their eyes aren’t tracking and they can’t keep their gaze on you
“With children, any loss of consciousness, you probably want to have them evaluated in the ER,” McLeod said.
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However, Dr. Jordan Metzl, a sports medicine specialist at the the Hospital for Special Surgery in New York, said the ER should not be the first stop.
“The ER is very expensive, not a cost-efficient way of doing care,” he said. Instead, Metzl advises to first talk to your health care provider.
Metzl said recent awareness of concussions has heightened parents’ concern about the issue. “The end result is this almost hysteria about this injury. … The vast majority of young athletes [conditions] resolve within less than a day and never have any problems the rest of their lives.”
But Metzl added that “concussion is a serious injury when it happens. … For a long time in the sports medicine world, we probably didn’t do nearly good enough job taking care of it.”
Kounang, Nadia. “Are Kids Getting More Concussions than We Realize?” CNN. Cable News Network, 21 June 2016. Web. 22 June 2016.

Almost 2 Million U.S. Kids Get Concussions a Year: Study

MONDAY, June 20, 2016 (HealthDay News) — Close to 2 million U.S. children and teens may suffer concussions annually, say researchers who add that the prevalence of head injuries among American youth has been underestimated for years.

Using data from hospitals, doctor visits and athletic trainers, the investigators estimated between 1 million and 1.9 million concussions occur annually among kids aged 18 and younger due to sports and recreation injuries.

But more than half a million of these head injuries aren’t seen in emergency rooms or by physicians, which is why official tallies are usually too low, they noted.

“There is a lot of uncertainty in how many concussions from sports and recreation occur each year because many concussions are not reported,” explained lead researcher Dr. Mersine Bryan, a pediatrician at the University of Washington and Seattle Children’s Hospital.

“Better surveillance for concussions due to sports and recreational activities is needed, so we can understand how kids are getting concussions and ways we can prevent concussions,” Bryan added.

These head injuries are often serious. According to the U.S. Centers for Disease Control and Prevention, a blow to the head resulting in concussion can stretch and damage brain cells and create chemical changes in the brain.

For this study, researchers used three national databases to try to target the total number of childhood concussions. Other research has typically been limited to high school head injuries or ER visits, they noted.

They found that among children diagnosed with concussion, nearly 378,000 were seen by doctors; from 115,000 to 167,000 were treated in emergency rooms; and roughly 3,000 to 5,000 were hospitalized, the researchers found.

But between 500,000 and 1.2 million concussions were reported to certified athletic trainers, the researchers added. These accounted for 23 percent to 53 percent of sports- and recreation-related concussions among high school students, Bryan said.

Concussions were tagged as sports-related if medical records mentioned a sport, whether the injury was from a fall, collision or another mechanism. Head injuries were deemed recreation-related if they occurred in playground-type settings or during activities such as bicycling or skateboarding.

One brain specialist said that even these new estimates are likely way too low.

Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Nicklaus Children’s Hospital in Miami, said doctors’ coding errors on medical forms can result in questionable findings.

“The main problem I have with these estimates is that they are based on diagnostic codes,” he said. “Many doctors do not use the code for concussion. I see it time and again — they use a code like closed head injury, because it’s easier to click on.”

If researchers only look for the concussion code, they’ll miss a lot, Kuluz said.

A study published in May in the journal JAMA Pediatrics also found that many childhood concussions go unreported.

In that report, four out of five children were diagnosed at a primary care practice, not the emergency department.

Responding to that report, Dr. Debra Houry, a CDC injury specialist, said more must be done to track pediatric concussions treated outside the ER.

“Better estimates of the number, causes and outcomes of concussion will allow us to more effectively prevent and treat them, which is a priority area for CDC’s Injury Center,” Houry said.

Kuluz said that parents should suspect a concussion after a head injury “when their child is acting different in any way, when they are dazed or confused or dizzy — even if it’s short-lived.”

If you do suspect a concussion, take your child to an emergency room, he said.

But not every child with a bump on the head has a concussion, Kuluz said. “It’s okay to wait a day to see if the symptoms disappear. It’s not always necessary to rush your child to the emergency room,” he added.

“However, if symptoms persist or worsen, or if there is a change in their consciousness, their thinking or the way they act or are sleepy or vomiting, they should seek immediate attention,” Kuluz said.

Complete rest is essential after a concussion to help the brain heal, according to the CDC.

The report was published online June 20 in the journal Pediatrics.

More information

For more on concussion, visit the U.S. Centers for Disease Control and Prevention .


Reinberg, Steven. “Almost 2 Million U.S. Kids Get Concussions a Year: Study.” The Sentinel. The Sentinel, 21 June 2016. Web. 23 June 2016.