New Tennessee Law Addresses Youth Sport Concussions



Brooke de Lench was watching one of her sons play in a high school football game, and what she saw worried her. He looked slow. Confused. Uncoordinated.

No one else seemed to notice, but she saw enough to set off alarm bells. It wasn’t just that he was having an off day. A visit to the doctor confirmed her fears — her son was suffering from the residual effects of at least one concussion, and possibly more.

“I was told to never let his head to be in a collision again,” says De Lench, the founder of MomsTeam.com, a website whose mission is to empower parents of young athletes through information and resources. While her son recovered, the experience was frightening enough to launch De Lench on a mission of spreading the word about the dangers of concussions and other sports injuries.

“I think parents really need to understand the ramifications,” says De Lench, author of Home Team Advantage: The Critical Role of Mothers in Youth Sports.

Concussions can happen in any sport, not just football. They occur in soccer, baseball, lacrosse, basketball, wrestling, hockey, cheerleading; no activity is immune.  

Concussions are brain injuries that occur when a blow to the head or body causes the brain to move rapidly inside the skull. Concussions can also be caused by a fall, or a collision between players or with an object such as a goalpost. Even a mild blow to the head can have serious consequences.

STATE LAW PROVIDES GUIDELINES

Now, Tennessee state law requires schools to adopt guidelines and educate coaches, athletes, and families about the symptoms and dangers of concussions. Both public and private schools, as well as sports and recreational leagues for children under age 18 that require a fee are affected by the new law.

According to Tennessee’s Department of Health website, the law is designed to:
1. Inform and educate coaches, youth athletes, and parents, and require them to sign a concussion information form before competing.
2. Require the removal of a youth athlete who appears to have suffered a concussion from play or practice at the time of the suspected concussion.
3. Require a youth athlete to be cleared by a licensed health care professional before returning to play or practice.

YOUNG ATHLETES AT RISK

Recent research has shown that because of the way their brains are growing, adolescents are more sensitive to the effects of a sport-related concussion than adults or children. In addition to long-term damage, youth athletes who have suffered a concussion are at risk of Second Impact Syndrome, a rare but usually fatal condition. If a child who has not completely recovered from a concussion receives a second blow to the head, it can cause massive swelling in the brain that can lead to sudden death.

Various studies reveal frightening facts: Brain changes in children who have sustained a mild traumatic brain injury, or concussion, persist for months following injury — even after the symptoms of the injury are gone, according to a study published in The Journal of Neuroscience. The research suggests that, among other things, concussions alter the brain's white matter — the long fibers that carry information from one area of the brain to another.

Yet 41 percent of student athletes returned to play too soon after a concussion, according to another report. The study found that a 16 percent of high school football players who lost consciousness during a concussion returned to the field the same day. More than 20 percent of concussions in boys’ and girls’ soccer and basketball were repeat concussions. In fact, 16.8 percent of high school athletes suffering a concussion had previously suffered a sport-related concussion, either that season or in a previous season.

De Lench, a former athlete herself and strong supporter of youth sports programs, understands the desire for kids to return to play. For many kids, being an athlete is how they define themselves. It is not only part of their identity, but a huge part of their social life.

“Kids should not be pulled out of sports. Sports are critical — critical! — for some kids. Pulling them out is not the remedy here,” she says. “We need to empower parents to make sure coaches are trained properly, to make sure kids get the right kind of physical training such as neck-strengthening, and to make sure kids are taught to self-report symptoms.”

So what are the most important things a parent and coach should know about concussions?

First, seek professional medical attention if your young athlete shows any of these signs of injury:
• appears dazed, stunned, confused, or clumsy
• exhibits a loss of memory, mood, or behavior changes
• suffers a brief loss of consciousness

Be aware that some symptoms may not show up for hours or days, so pay attention to your child’s well-being.

All concussion management guidelines, old and new, agree that no athlete should be allowed to return to play while exhibiting post-concussion signs or symptoms. Some call for at least one symptom-free week before returning to practice or play. Because activities that require concentration and attention might exacerbate the symptoms and delay recovery, children should limit exertion and school-related activities until symptom-free (e.g. no homework, no text messaging or videogames, and staying home from school).

“The decision to return to play requires careful deliberation," notes Dr. Paul Klimo, chief of pediatric neurology at Le Bonheur Children's Hospital. "The child or athlete must be symptom- and medication-free before they return to play. In fact, the focus should be first a ‘return to learn’ rather than a ‘return to play’. Once cleared to play, the return should be gradual,” says Klimo. “If a child has suffered multiple concussions already, I would strongly recommend to the child and parents that another sport by pursued. You don’t hear many concussions occurring in golf or tennis!”

For young people ages 15-24, sports are second only to motor vehicle accidents as the leading cause of brain injury, according to the U.S. Centers for Disease Control and Prevention. But even far younger children have suffered concussions on the field and on playgrounds.

“The more parents know, the more they can make a difference,” De Lench says. “I always tell parents to think about the life-cycle of their child. Think about how that child will feel when they are 30 or 40 and they have cognitive issues or pain from injuries.
“You as a parent need to understand that you are the guardian of your child and their future.”

Additional Resources
cdc.gov/concussion/sports/index.html • The U.S. Centers for Disease Control and Prevention has info on concussions and youth sports, including an online training course for coaches.

health.state.tn.us/tbi/concussion.htm • The State Dept. of Health website on concussions includes a sample policy and signature forms.

MomsTeam.com • In addition to concussion safety, this site includes health, nutrition, & support for parents of athletes.

Concussion Warning Signs
While playing sports, child may appear
• Dazed or stunned
• Is confused about assignment or position
• Forgets an instruction
• Is unsure of game, score, or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness, even briefly
• Shows mood, behavior, or personality changes
• Can’t recall events either prior to hit or fall, or after

Athlete’s self-reporting
• Headache or “pressure” in head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light
• Sensitivity to noise
• Feeling sluggish, hazy, foggy, or groggy
• Concentration or memory problems
• Confusion
• Does not “feel right” or is “feeling down”

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