Category Archives: Safety

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A Safer Family. A Safer World

Category : Advice , Information , Safety

A Safer Family. A Safer World: from UW Medicine/Harborview Hospital, information designed for parents, caregivers, and other caring adults to help them prevent the sexual abuse of children. Available in multiple languages. Here are the links for English and Spanish.

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From the NY Times: Tackle Football and Youth

Category : Information , Research , Safety

Athletes who began playing tackle football before the age of 12 had more behavioral and cognitive problems later in life than those who started playing after they turned 12, a new study released on Tuesday showed.

The findings, from a long-term study conducted by researchers at Boston University, are likely to add to the debate over when, or even if, children should be allowed to begin playing tackle football.

The results of the study by researchers at Boston University, published in the journal Nature’s Translational Psychiatry, was based on a sample of 214 former players, with an average age of 51. Of those, 43 played through high school, 103 played through college and the remaining 68 played in the N.F.L.

In phone interviews and online surveys, the researchers found that players in all three groups who participated in youth football before the age of 12 had a twofold “risk of problems with behavioral regulation, apathy and executive function” and a threefold risk of “clinically elevated depression scores.”

“The brain is going through this incredible time of growth between the years of 10 and 12, and if you subject that developing brain to repetitive head impacts, it may cause problems later in life,” Robert Stern, one of the authors of the study, said of the findings.

The study is consistent with earlier findings by Stern and others that looked specifically at N.F.L. retirees. That research found that retirees who started playing before 12 years old had diminished mental flexibility compared to those who began playing tackle football at 12 or older.

A growing number of scientists argue that because the human brain develops rapidly at young ages, especially between 10 and 12, children should not play tackle football until their teenage years.

Last year, doctors at Wake Forest School of Medicine used advanced magnetic resonance imaging technology to find that boys between the ages of 8 and 13 who played just one season of tackle football had diminished brain function in parts of their brains.

The N.F.L., which long denied that there was any link between the game and brain damage, has in recent years been promoting what it considers safer tackling techniques aimed at reducing head-to-head collisions.

More recently, the league has been promoting flag football as an even safer alternative, an implicit acknowledgment that parents are worried about the dangers of the sport and turning away from it.

Participation in tackle football by boys ages 6 to 12 has fallen by nearly 20 percent since 2009, though it rose 1.2 percent, to 1.23 million, in 2015, according to the Sports and Fitness Industry Association.

Schools across the country have shut their tackle football programs because of safety concerns and a shortage of players. Large numbers of children have shifted to other sports like flag football, soccer, baseball and lacrosse.

The new Boston University study looked only at behavioral changes, based on the phone and online surveys.

There was no examination of physical changes in the brain. (A separate study published by researchers at Boston University in July found that 110 out of 111 brains of deceased former N.F.L. players had chronic traumatic encephalopathy, a degenerative brain disease.)

Still, the findings are yet more evidence that have contributed to an existential crisis for the game, from youth leagues to the N.F.L. Pop Warner, the most established youth football organization in the country, has reduced the amount of contact in practice – where the majority of head hits occur – and changed game rules, including banning kickoffs, one of the most dangerous plays in the game.

Jon Butler, the executive director of Pop Warner, said in a statement that the sport has changed significantly for the better since the players in the Boston University study participated decades ago. He said the organization’s medical advisory committee will review the study and “compare it against the number of recent studies that contradict these findings.”

Pop Warner is facing a class-action lawsuit asserting that it knowingly put players in danger by ignoring the risks of head trauma.

Last year, the Ivy League decided to eliminate tackling at practices during the regular season. The Canadian Football League made a similar announcement last week.

USA Football, the governing body for the sport, is introducing a 7-on-7 version of football that includes measures, like players starting in a two-point stance, designed to reduce the risk of head hits.

Other groups, like Practice Like the Pros, suggest that only flag football be played through the sixth grade and a limited version of tackle football in 7th and 8th grades.

“The curiosity about head injuries and the correct age to play full contact is peaking,” said Terry O’Neil, the group’s founder. “Tackling is the culprit. Everybody associated with the game is worried about the participation numbers.”

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Concussion studies in the news

Category : Information , Research , Safety

Study validates concussion assessment tools for children (published 7/26/17):

  • Woodinville Pediatrics uses the updated version of these tools, SCAT5 and Child SCAT5

General advice regarding concussion from the AAP:

Study of football players’ brains, including a majority of ex-NFL players (published 7/25/17):

  • NY Times article about this study: 
    • “It is no longer debatable whether or not there is a problem in football — there is a problem,” Dr. McKee said.
  • Source article:
    • Relevant comments from the study: “There is substantial evidence that CTE is a progressive, neurodegenerative disease. In this study, 107 participants (96%) had a progressive clinical course based on informant report. In addition, pathological severity of CTE was correlated with age at death (Table 3). However, a postmortem study evaluates brain pathology at only 1 time point and is by definition cross-sectional. In addition, the participants were not observed longitudinally during life. Although associations with age in cross-sectional samples can result from age-related progression within individuals, they can also arise from birth cohort effects, differential survival, or age-related differences in how individuals were selected into the study. Population-based prospective studies are needed to address the issue of progression of CTE pathology and age at symptom onset.The strengths of this study are that this is the largest CTE case series ever described to our knowledge, more than doubling the size of the 2013 report,6 and that all participants were exposed to a relatively similar type of repetitive head trauma while playing the same sport. In addition, the comprehensive neuropathological evaluation and retrospective clinical data collection were independently performed while blinded to the findings of the other investigators.This study had several limitations. First, a major limitation is ascertainment bias associated with participation in this brain donation program. Although the criteria for participation were based on exposure to repetitive head trauma rather than on clinical signs of brain trauma, public awareness of a possible link between repetitive head trauma and CTE may have motivated players and their families with symptoms and signs of brain injury to participate in this research. Therefore, caution must be used in interpreting the high frequency of CTE in this sample, and estimates of prevalence cannot be concluded or implied from this sample. Second, the VA-BU-CLF brain bank is not representative of the overall population of former players of American football; most players of American football have played only on youth or high school teams, but the majority of the brain bank donors in this study played at the college or professional level. Additionally, selection into brain banks is associated with dementia status, depression status, marital status, age, sex, race, and education.36 Third, this study lacked a comparison group that is representative of all individuals exposed to American football at the college or professional level, precluding estimation of the risk of participation in football and neuropathological outcomes.”

Association of Playing High School Football With Cognition and Mental Health Later in Life (published 7/3/2017)

  • “For men who attended high school in the late 1950s, playing high school football did not appear to be a major risk factor for later-life cognitive impairment or depression”

Reassuring News About Football and Cognitive Decline? Not So Fast (published 7/3/2017)

  • “Although the Wisconsin Longitudinal Study provides a rich data set, there is no information on concussion history per se. The study evaluates the overall effect on long-term outcomes of playing football vs not playing football, but it does not directly evaluate the association of football-related exposure to concussion or subconcussion injury…”

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A Single Concussion May Have Lasting Impact-from NY Times

Category : Information , Research , Safety

Credit Getty Images

A single concussion experienced by a child or teenager may have lasting repercussions on mental health and intellectual and physical functioning throughout adulthood, and multiple head injuries increase the risks of later problems, according to one of the largest, most elaborate studies to date of the impacts of head trauma on the young.

You cannot be an athlete, parent of an athlete, sports fan or reader of this newspaper and not be aware that concussions appear to be both more common — and more dangerous — than most of us once thought. According to a report released last week by the health insurer Blue Cross Blue Shield, based on data from medical claims nationwide, the incidence of diagnosed concussions among people under the age of 20 climbed 71 percent between 2010 and 2015. The rates rose most steeply among girls, with the incidence soaring by 119 percent during that time, although almost twice as many concussions over all were diagnosed in boys.

The report acknowledges that the startling increase may partly reflect a growing awareness of the injury among parents, sports officials and physicians, which has led to more diagnoses. But the sheer numbers also suggest that more young people, particularly young athletes, are experiencing head injuries than in the past.

Similar increases have been noted among young people in other nations.

But the consequences, if any, for their health during adulthood have largely remained unknown.

So for the new study, which was funded primarily by the Wellcome Trust and published in August in PLOS Medicine, scientists from Oxford University, Indiana University, the Karolinska Institute in Stockholm and other universities turned to an extensive trove of data about the health of people in Sweden.

A plethora of linked registries in that nation contain information about people’s medical and hospital visits, socioeconomic status, education, physical disabilities and other aspects of their lives, says Dr. Seena Fazel, a professor of forensic psychiatry at Oxford and the new study’s senior author. The registries also allow researchers to compile information about family members.

In this case, the scientists concentrated on all Swedes born between 1973 and 1985 and looked for those who had experienced a head injury of some kind before the age of 25. More than 104,000 people qualified.

The researchers pulled data about these people for 40 years or until someone had either died or emigrated from Sweden.

For each participant, the researchers also compiled comparable medical and other records for a sibling who had never been given a diagnosis of a head injury and compared outcomes both between family members and against the full population of the country.

The results were discomfiting. Young people who had experienced a single diagnosed concussion — which the researchers categorized as a mild traumatic brain injury — were much more likely than the nation’s general population and than their own siblings to be receiving medical disability payments as adults.

They also were significantly more likely to have sought mental health care and much less likely to have graduated from high school or to have attended college than their uninjured brother or sister.

And they were about twice as likely as an uninjured sibling to die prematurely.

The possibility of lingering physical or psychological problems during adulthood rose precipitously, the researchers found, if someone had experienced more than one concussion while young, or if his or her brain injury had been more severe than a concussion.

The outcomes also generally were worse if someone had experienced head trauma after the age of 15, probably because the brain is less resilient than in earlier childhood, Dr. Fazel says. (The researchers did not quantify the causes of the injuries in this study, but past research shows that in the very young, he says, brain injuries usually result from falls, with sports becoming the primary cause in teenagers, and auto accidents the main cause among young adults.)

There was, thankfully, encouraging news squirreled away within the data. While young people who had been hit in the head displayed heightened risks for physical and psychological difficulties as adults, most, in fact, were fine.

“The majority of individuals who had diagnoses of brain injury in our study did not experience adverse outcomes,” Dr. Fazel says.

Unfortunately, it is impossible at the moment to identify which children or teenagers who experience head trauma may be most at risk of struggling in later life and which will instead recover without apparent complications, he says.

So the message of this study further underscores that, whenever possible, we should take steps to prevent childhood head injuries. While “there are lots of benefits from sports,” Dr. Fazel says, it may be important to consider changes to the rules or equipment in contact sports, like football and soccer, to try to reduce head trauma.

If a young person does suffer head trauma, he continues, more and longer-lasting monitoring is also probably a good idea. Such monitoring may be especially important if the child shows any signs of “a decline in psychosocial performance,” he says, such as a drop in grades or a change, even subtle, in personality. A neurologist can provide useful assessments, and regular follow-up neurological assessments may need to be continued, even into adulthood.

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Concussion recovery time study, from New York Times

New research shows that athletes who leave the game immediately after a concussion recover twice as fast as athletes who keep playing. Credit Fabrizio Costantini for The New York Times

High school athletes who kept playing in the minutes after a concussion took nearly twice as long to recover as those who left the game immediately after the head trauma, a new study shows.

The finding, published in the journal Pediatrics, is believed to be the first to focus on one of the most difficult social challenges of treating concussions: a pervasive sports culture that encourages young athletes to keep playing through pain. Medical guidelines call for benching the athlete immediately after the head injury to prevent long-term complications and the potentially devastating consequences of a second hit.

“Kids are often reluctant to acknowledge a concussion,” said Dawon Dicks, a youth football coach with CoachUp in Andover, Mass. “The kid may want a scholarship and want to go to college, or it could be that ‘Dad or Coach wants me to play.’ That’s when they’re going to start to be a little dishonest in what they’re truly feeling.”

The latest study tracked the neurological symptoms of 69 athletes who visited the University of Pittsburgh Medical Center Sports Medicine Concussion Program after suffering head trauma during a contact sport. The athletes, who ranged from 12 to 19 years old, came from football, soccer, ice hockey, volleyball, field hockey, basketball, wrestling and rugby.

The sample included 35 athletes who were removed from games right after getting a concussion and compared their symptoms and recovery to 34 athletes who kept playing in the game or match after taking a hit. The study found that players who stayed in the game after head trauma took an average of 44 days to recover. By comparison, athletes who left a game immediately after signs of concussion took only an average of 22 days to recover.

While there were no meaningful differences in recovery time among girls or boys, and no differences by sport, that may be because of the size of the study. Researchers say that while the sample size was small and involved just one clinic, the results clearly highlight the importance of physical and cognitive rest promptly following concussion.

The findings may help doctors promote the message that taking immediate precautions after concussion will actually allow the athlete more opportunities to keep playing, not fewer. Resting immediately in the 24 to 48 hours following a concussion (and then slowly returning to normal activities under the supervision of a physician) reduces the possibility of further stress on the system and allows brain cells to heal faster so that athletes can get back to their sport more quickly. “It’s something that we consistently preach to coaches, parents and kids,” said R.J. Elbin, who led the study while at the University of Pittsburgh but who now is director of the Office for Sport Concussion Research at the University of Arkansas. “However, until now, there really has not been any data that supports this idea.”

Estimates show that each year in the United States, there are up to 3.8 million sports-related concussions, which can happen when there is a blow or jolt to the head that causes the brain to bounce within the skull, stretching and damaging brain cells. Symptoms of concussion may include dizziness, confusion, nausea and sensitivity to light.

Young athletes are particularly prone to prolonged recovery and complications from concussion. “The developing brain has been shown to be more vulnerable to the physiological effects of the injury,” said Tad Seifert, a neurologist and director of the Sports Concussion Program for Norton Healthcare, in Louisville, Ky.

Despite increased awareness of the dangers of concussions and efforts to educate those in the sports community on how to recognize and treat the head injury, an estimated 50 to 70 percent of concussions go unreported. While some athletes and coaches may not always recognize the signs of concussion, the larger concern is a sports mind-set that frowns on leaving the game.

“The idea of being a football player is that we’re tough. We get back up. We don’t cry. We don’t make a big deal out of it,” Mr. Dicks said. “There is the idea that you must sacrifice your body and your brain for the overall greater good of the team.”

Mr. Dicks said he tries to counter that notion and teaches his athletes about the severity of concussions, which can not only sideline players from sports for a few weeks but can also cause pain, trouble sleeping and difficulty in school for months or longer. But awareness varies depending on the economic resources of the school.

At the private high school where Mr. Dicks used to coach, “they go above and beyond to make a big deal out of concussions,” Mr. Dicks said, and noted that there was a certified athletic trainer at every practice and game looking after the health of the athletes. “At the urban high school where I coached, a kid might get a handout about concussion.”

The study authors acknowledged that their data did not show whether the athletes who kept playing following concussion suffered additional head impacts or simply continued physical exertion. Further research is needed to determine exactly why staying in the game post concussion can slow recovery times.

Hearing that leaving the game speeds recovery may finally motivate young athletes to stop playing as soon as they’re hit, said Dr. Jeff Bazarian, professor of emergency medicine and physical medicine and rehabilitation at the University of Rochester. “Now, armed with this study, I think I’m going to be able to say to athletes who did not come out of the game right away that, ‘your recovery might take longer than average because of that,’ ” he said. “I can tell my athletes that this is one thing you can do something about, maybe not this time, but next time.”

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