Love Of Sports Can Start Early; So Can Injuries

Concussions make up about 15 percent of all high school sports injuries, according to Children's Hospital Boston. But how can parents decide whether children should play sports, and how to keep them safe? Host Michel Martin talks with three "sports" moms, including a pediatrician who studies concussions in children.

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MICHEL MARTIN, HOST:

I'm Michel Martin and this is TELL ME MORE from NPR News. They say it takes a village to raise a child, but maybe you just need a few moms in your corner. Every week, we check in with a diverse group of parents for their common sense and savvy advice.

This hour, we've been talking about the growing concern over concussions and brain injuries in sports and these concerns have trickled down to youth leagues as insiders in the football world, like former NFL stars, Troy Aikman and Curt Warner, and influential sports commentators like Michael Wilbon, among others, have questioned the wisdom of letting their own kids play the sport.

So we want to continue this conversation by talking about how this issue is affecting young athletes and the parents who are, after all, the ones who sign them up to play. We decided to call on moms who have children in sports with some of the highest concussion rates. We wanted to find out how they feel about this issue and what steps they're taking to keep their kids safe.

I'm joined now by Lisa Kelly. She is the mom of an 11-year-old who plays ice hockey. After her son suffered a concussion, she organized local programs to try to make the sport safer. Dani Tucker is one of our regular contributors to our parenting roundtable and a mom of two. Her son played football all through high school. And, also with us, Dr. Shireen Atabaki. She is an associate professor of pediatrics and emergency medicine at Children's National Medical Center. She specializes in brain injury and concussions and she's also a mom of three and one of her daughters plays soccer.

Welcome, ladies, moms. Thanks for joining us.

DANI TUCKER: Thank you.

LISA KELLY: Thank you.

SHIREEN ATABAKI: Hello.

MARTIN: So, Dr. Atabaki, I'll start with you because, earlier in this program, we talked with Chris Nowinski of the Sports Legacy Institute. He's been, you know, promoting a lot of and he's behind organizing a lot of the research of brain injuries in athletes.

And one of the things that he mentioned is that he's actually more concerned about youth sports than he is about professional sports, in part because, you know, in the professional sports leagues, there are medical professionals on the sidelines, that they have the latest equipment for players. And in, you know, youth sports, maybe the standards can be all over the place. And I wanted to ask if you share that concern.

ATABAKI: Yeah. I definitely do. It's an area that we're going a lot of research around and creating many programs because what we noticed is - you know, I'll tell you a story. About six years ago, when my youngest son was about a year old, I went to a big European sports concussion meeting in the alps and I was the only representative of pediatrics there. Everybody else was representing professional sports teams in Europe and the United States, you know, the hockey teams, the NFL, the soccer teams, professional soccer teams, and a lot of focus on concussion and the risk of athletes for injury.

They were monitoring these athletes really closely, sitting them out, providing appropriate care for them and lots of research going on and nothing in children. So, about two years ago, the CDC funded myself and a team from Children's Hospital to go out and figure out what's going on in the pediatric world, because our feeling, our gestalt, was that nothing much is happening. We're not recognizing this condition in children, especially where they come and are seen primarily, which is in the emergency department, even after a sports injury. And we're not providing any appropriate management plans for these children.

So we actually did a survey of some big emergency departments around the United States that primarily see children at 22 hospitals and we found that only one site had any kind of specific concussion diagnostic tool for children and that was our site and that was because we had been involved in this research.

And we also found that about 80 percent of the sites felt that they need better care plans for the children they're discharging, so what's happening right now is a lot of children with concussion or head injury get an injury or blow to the head. They develop symptoms, for example, loss of consciousness, headache or vomiting. Then they are sent to an emergency department, maybe the school nurse or the athletic trainer sees them, sends them to an emergency department.

Unfortunately, the only diagnostic decision we're making there is whether or not to get a CT scan.

MARTIN: That's important. So let me bring some of the other moms in and we'll dial back around to you and ask you, what do you think parents should be asking if their kids are involved in sports?

So, Lisa Kelly, your son is 11?

KELLY: Yes, that's correct.

MARTIN: And he plays ice hockey and - so you're a hockey mom. He's had how many concussions since he...

KELLY: He has had four.

MARTIN: What about what Dr. Atabaki said? Are you finding that's the case, is that - are you finding out well after the fact when you sought care for him? Do you find that you generally don't know until well after the fact or are you just so attuned to this now that, you know, you're right on point?

KELLY: Well, I have a distinct advantage of being a nurse, so I'm a little in tune more than the average parent to monitor for the signs and symptoms of concussion. What I did find in my experience is that working with the coaches - in ice hockey, they're so busy watching the game, when a hit occurs, they may do the mandatory five minute time out, but they're not really reevaluating the player when they go back in.

And, often times, I think the parents are the frontline for concussion because, when you bring them home, to recognize some of the signs because the symptoms, which is what the child experiences, they often won't report. But the parents can recognize some of the signs when they get home, if they did not see the hit, per se.

So what can happen is, if they have a collision on the ice, you bring them home. They can't play video games, they can't watch TV, their reflexes are slow, they feel a little tired, they may or may not complain of a headache.

In all of his concussions he did not have a telltale signs. One occurred at practice and I actually wasn't watching the practice and I usually do, and I had heard from a parent that he had a backward collision on the ice, he was skating backwards to players and collided, he took his helmet off and he had the classic, the gaze look, that sort of stunned look, and he really couldn't focus. And so, again, I'm more in tune to some of the concussion signs, but getting the child to report the symptoms to the coach, as well as the coach is to become more in tune to some of this, I think that's definitely where education that comes into play, as well as with parents.

MARTIN: Was that your scariest moment, if you don't mind my asking?

KELLY: Absolutely. He blacked out for five minutes on the ice and I'm sitting there tapping on the glass the one time trying to see if he's moving, and they're saying he's OK. He's OK. Yet, I see no limbs are moving. And so oftentimes I've gone out the ice myself and we've had a couple of times where we'd spent actually two nights in the hospital on two separate occasions with concussions.

MARTIN: Dani Tucker, your son Devon played football through high school.

TUCKER: Yes.

MARTIN: Do you mind if I ask, what was your scariest moment? And how seriously do you think his coaches to this?

TUCKER: I think they took a very serious. I have as well as other parents were happy with our coaches but we also did our part to watch the kids. I mean, you talk about Devon played for years, from since he was 5 on up, and we played in an urban area where these kids play hard. I mean, and my scariest moment was one of our homecoming games, I think Devon was 14, and we had three ambulances come through that game. It was the longest game we'd ever had. But you couldn't stop them kids from playing. You know, my mother went to go take him home and I just looked at her, I was like you try, you know? And he just acted like we did not exist - do not embarrass me, do not take me off this field. But there were three ambulances that came through there and we had what, two concussions and a broken leg and you could not stop that game. He just could not stop that game. But they played hard. You know, what can you tell them? You know, they play hard.

MARTIN: How about stop playing?

TUCKER: No. That's not an option.

MARTIN: How about...

TUCKER: Not an option, especially for you're talking about kids in my urban area where for them this is their outlet, this is their hope and dream, many of them who want to go pro or have dreams of going pro. And...

MARTIN: Or even just get a scholarship.

TUCKER: Oh right. Just right. Many of them got scholarships to high school, you know, that they would never have been able to go to had not they been scouted, so this is kids are...

MARTIN: So you're talking not even college scholarships. You're talking scholarship to go to...

TUCKER: Right. To high schools.

MARTIN: ...secondary schools.

TUCKER: Right. Right.

MARTIN: Yeah.

TUCKER: The top high schools that they couldn't go to so, you know, and we dealt with this for years. This wasn't the only time. We had a few times when ambulances had to come through there and we had to deal with concussions and things. But it's part of the game.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. Our moms are here and we're talking about growing concerns over brain injury in athletics and how that affects youth sports in particular. I'm joined by Dani Tucker, mom of two. Her son played football. Lisa Kelly is a mom of one son who plays ice hockey. And Dr. Shireen Atabaki is an associate professor of pediatrics at Children's National Medical Center. And she's also a mom of three kids who play sports.

Lisa Kelly, I understand that you took the bull by the horns here. What did you do?

KELLY: I had approached the coaches for his team, whether they would like concussion education. In USA Hockey, there are certainly rules and regulations and training that they go through, but certainly to supplement that I thought would be a great advantage to the team. And I had a resounding yes from not only the coaches but from the hockey director of the rink that we play out - or used to play out of. The hockey director Michel Petit had mentioned that he had nine concussions and his last one ended his career. So he certainly was open to having us do the education. Not only did we do the players, the coaches, we did the players and the parents. And so we used that three-prong approach to help the athletes, as well as set up the impact testing system, which Dr. Atabaki referred to earlier. We do have at our hospital. We're lucky enough to have a Safe Kids Coalition and leadership right in our hospital at St. Mary Medical Center, and we were able to setup impact testing for those kids as well, which is a return to play system.

MARTIN: But, you know, Dr. Atabaki, I want to ask, you know, how concerned are you that even with these kinds of measures in place that kids who are experiencing concussions at this young age may be setting themselves up for long-term consequences. Do we have any data on that?

ATABAKI: We do and the data is very alarming. It's interesting because interviews or surveys of high school athletes, especially football players, have found that about 50 percent of the state they've had a concussion or at least some of the signs or symptoms of it at least once during their football playing career and they're not reporting it often because they don't want to be removed from the game. And in a lot of students and athletes that we see in the emergency department arena, the first thing they ask is, when can I go back to play? You know, can you give me an excuse? Can I go back tomorrow to play? I have a big game this weekend. And they can, you know, they can barely stand up, they're so dizzy and throwing up and might have had loss of consciousness, have a severe headache. So it's very interesting, they for a variety of reasons they do all want to go back to play.

We are seeing some alarming things going on in one of the significant ones is depression and prolong post-concussive syndrome. So the majority of concussions resolved in about two weeks and about 20 percent of young people - and it's more frequent in the younger population - go on to have prolonged symptoms lasting more than two weeks.

MARTIN: Well, I'm going to ask you here, and this is obviously, you know, a complex topic and we don't have the time to offer parents a training session, you know, here. But it would be helpful, I think, for you to give us some guidelines about what parents should be doing on the sidelines when they're playing - and not just when they're playing but also at practice. And you get us started?

ATABAKI: Yeah. Definitely. I think, you know, we even have to take a step back and look in the playground, even there, you know, for school nurses. So, you know, athleticism starts very young at a very young age in school. So, you know, a lot of states now have legislation; you know, if in doubt, sit it out. So if a child appears, a young person, a young athlete, appears to have any signs or symptoms of concussion they should really sit them out, you know, no immediate return to play or sport. And I feel like if somebody impacted or if somebody witnesses - let's say a young child, a young athlete as they head-to-head injury and they fall on the ground and somebody witnesses, they need to pull them out and interview them, basically, go through some questions.

MARTIN: There's some common symptoms. We have developed acute concussion evaluation for the emergency department. There's one outside the emergency department, basically, concussion checklist. And some of the common signs are headache, nausea, vomiting, dizziness, irritability; in the longer term, changes in behavior, depression, repetitive questions. A lot of the kids will ask the same question over and over, you know, where am I? They don't know where they are, they're disoriented.

Lisa, I'm going to ask you, what advice do you have for a parent who wants to implement some of the changes that you have for a local team but, you know, but who is not a medical professional like you and Dr. Atabaki? You're a nurse, she's a doctor, presumably, you know, you have some standing there, people will listen to you. But for parents who aren't but are still concerned, do you have some advice that you would offer about how to get something like this going?

KELLY: Oh, absolutely. There's a Safe Kids USA website, SafeKids.org, and they actually can go on there. There's 49 states that have this representation and there is more than 600 coalitions. They have concussion programs and education programs are there. You actually can find out who your leadership is in your state and try to arrange concussion education. They oftentimes are holding symposia throughout the United States that they can attend. And in my case, they actually came and helped us run through workshops right on site at the rink. So I think the best avenue was doing it on site at the facility directly where the sport occurs. That's the way we had the greatest representation there.

MARTIN: Dani, what do you think about talking to other parents, or either you have a question for the other guests, or maybe you have some advice about how other parents can feel, you know, emboldened to get involved in this, particularly if you don't want to be that one, right? You don't want to be the parent that the coaches are rolling their eyes when you show up because you're always worried that your child's playing time will be affected if you come off as too much of a noodge, right? So what advice do you have?

TUCKER: Well, I totally agree with what these ladies have said. I mean, that's important. I love the education. Our coaches did it for us, you know, the training and just - but for me, especially for parents, and because I come from the urban neighborhoods where - especially when the kids get older the parents don't come. Don't do that. Come. And not just to the game, come to the practice because your eyes help the coaches. The coaches are coaching. And one big thing about what I liked about where Dede(ph) played was the parents, there were a few of us that were so involved that we were extra arm of that coach. You're watching these kids, you want to watch out for whatever is going on in them. You're at practice and you're at the games. Be a part because that will help. And when you see something that happens and you can also, you know, monitor a child or just do your part. It's very important because when they get older you have a tendency for it to fall on just a few people because parents don't come. They see it is, oh, you're going to play and I got this to do and I got that to do. Don't do that. Be there. That's very, very important. Be at the practices. Be at the meetings. Be at the games. Be an active part and participate. That helps.

MARTIN: Or have a buddy or maybe you can have a, you know, a buddy and share that responsibility...

TUCKER: Oh yeah. Well - Mm-hmm.

MARTIN: ...with you friend say I'll go to this one if you go to that one.

TUCKER: Right. Right. Exactly.

MARTIN: And you agree to watch each other's kids.

TUCKER: But some sort of system where you are active and not inactive and then you won't have to worry about, oh, I didn't know or why did the coach do this and why - because you're there and you see it and you're an active part.

MARTIN: But what if you're not able to be there? I mean, that's part of the reason some parents have their kids in sports so that they - because they have to work.

TUCKER: Then get to know someone. Get to know someone that is there. I mean, of course, we had moms and dads who didn't know. But I had my mom, she was so sweet, called me all the time. She worked every game, she had to work so that was, you know, Dede's best friend and I took him, and she would communicate with me all the time. Even though she wasn't there she was still an active part of what was going on in her son's life.

MARTIN: Dr. Atabaki, any final thought from you?

ATABAKI: Yeah. I think that really as a community of parents, physicians and educators, we need to move this to the next level and protect our kids, both from concussions and the repercussions of not recognizing this disease. So we need to provide both management of the sport and play after a concussion, you know, if in doubt, sit it out, that I think I loved that adage, but also cognitive management. I don't think kids should sit out completely from school but a graduated return to play sport and school work.

MARTIN: Do you though, I have to ask you, though. This is where I'm going to put the question to you because you are a doctor and this is your area. What do you make of these professional athletes saying they wouldn't even let their kids, retired professional athletes saying, I would not let my child play?

ATABAKI: Yeah. I, that's...

MARTIN: Does that give you pause?

I think it's going to be impossible, especially for the child of a professional athlete who is probably going to be gifted in that area. I think that we need to have regulation just like we did for boxing that's going to emerge over the next decade, you know, to protect young people's brains. And we really need to move towards this issue. It's a very important issue. Over 600,000 children a year are presenting to emergency departments. There's several million head injuries a year in the United States and that's just the tip of the iceberg. We just really need to recognize it, be vigilant and tell the kids that it's important. It can affect your life. It can affect your brain later down the line if this is unrecognized and untreated.

Dr. Shireen Atabaki is an associate professor of pediatrics and emergency medicine at Children's National Medical Center. She's also a mom of three kids who play sports. She was here in our Washington, D.C. studios, along with Dani Tucker, one of our regular parenting contributors and a mom of two. And with us from Philadelphia, Lisa Kelly, the mom of an 11-year-old son who plays ice hockey.

Thank you all so much for joining us.

TUCKER: Thank you for having us.

KELLY: Thank you for having us.

ATABAKI: Thank you.

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MARTIN: And that's our program for today. I'm Michel Martin and this is TELL ME MORE from NPR News. Let's talk more tomorrow.

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