Parents

We provide materials to help you make informed decisions about your child’s health and safety.

Active kids are healthier children and lead longer, healthier lives. Our educational materials explain the benefits of being active and the risks that come with different sports. They also provide information to help you participate in decisions about your child’s treatment, return to school and return to sports if your child is injured.

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Concussion
Exercise & Health
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Concussion Key Facts

A concussion is an injury to the brain. Recognizing it is critical for a full recovery.

All injuries to the brain are potentially serious. The signs and symptoms of concussion may include headache, dizziness, memory loss, confusion, loss of balance, nausea and more.

An athlete with a possible concussion should immediately be removed from play.

If a sideline check suggests a concussion, the athlete should not return to play on the same day, and should see a licensed healthcare professional who is knowledgeable about concussions right away. Returning to play too soon can be dangerous or even deadly.

Getting better after a concussion usually just takes time.

Treatment normally involves stopping exercise and sports as well as mental activities that make symptoms worse, then gradually returning to activities.

Most athletes improve quickly after concussion.

Most athletes can safely return to school and sports within a week or two, although younger athletes may take a bit longer. Some athletes may take months or longer to fully recover. By law, a healthcare provider must approve an athlete’s return to play.

If symptoms persist, see an expert.

If the signs and symptoms continue to linger beyond 10-14 days, see a licensed healthcare provider who is an expert in diagnosing and treating athletes with concussions.


Concussion Basics

A concussion is a brain injury that changes the way the brain works. It is often caused by a direct hit to the head, face or neck. A sudden jolt to the body or a hard fall to the ground can also send enough force to the head to cause a concussion.

Nearly four million athletes and active people suffer a concussion every year. Most—90%—get better in a matter of days. But because all concussions are potentially serious, it is important to recognize and properly treat them early.

This information is for you if you want to learn more about concussions, including knowing the signs and symptoms, and what to do when you recognize one.

Why It Is Critical To Report Concussions

Many athletes don’t report their symptoms, and many coaches fail to recognize them.

It is important to report a concussion both to speed an athlete’s recovery and to prevent a potentially more devastating repeat concussion. The risk of a repeat concussion appears to be highest in the first 10 days after a concussion, and this heightened risk may continue for some time. During this period, the brain is more vulnerable to injury, even from minor hits or impacts.

The Treatment Is Usually Just Time

Recovering from a concussion is usually just a matter of time. For most, symptoms last about a week. Some people will improve almost immediately, while others take longer. Every athlete is different.

Experts recommend an initial period of brief rest followed by a gradual return to increasingly more demanding activities.

Deciding Whether to Go Back to Sports

Deciding whether a child can safely return to sports—or whether sports risk too much harm—is the responsibility of a trained healthcare provider judging the individual circumstances of a particular young athlete. Informed athletes and parents are their critical partners.

Their choices usually include:

  • Returning the athlete to the same sport after fully recovered
  • Returning to a different sport or activity that has a lower risk of concussion
  • Stopping sports and activities that pose even a small risk of concussion

To participate in the decision-making conversation, parents will need to understand the risks and benefits of returning to play, and discuss with their child’s healthcare provider how they feel about them.

Concussion FAQs

What activities cause the most concussions in young people?

A 2011 report from the Centers for Disease Control and Prevention found that bicycling caused the most visits to hospital emergency departments for concussions in males and females age 19 and younger.

When broken down by sex, the number one cause of concussions (or “mild traumatic brain injuries”) was football among males and playground injuries among females.

The report tallied total number of concussions (not rates) from each type of activity. As a result, it was not able to show which activities caused the most concussions per 1,000 kids participating in the activity. By that standard, a lower-participation sport such as horseback riding would rank higher on the list.

Can blood tests or imaging scans diagnose a concussion or detect recovery?

Blood tests can’t yet reliably diagnose a sports-related concussion or track the brain’s progress toward recovery. Imaging tests are usually not recommended for the same reason. Researchers continue to explore new technologies, but there is no perfect test.

If symptoms worsen or don’t improve as expected, a healthcare provider who specializes in the diagnosis and treatment of concussions might recommend magnetic resonance imaging (MRI) or computed tomography (CT). These imaging tests can identify dangerous conditions such as a skull fracture or bleeding in the brain (called a hematoma). But these situations are unusual and undertaken with caution, in part because CT scans expose athletes to potentially harmful radiation.

What is the chance that a youth athlete will have a concussion?
Source: Dompier 2015

Source: Dompier 2015

Scientific evidence on concussions in athletes younger than high-school age is scarce. No organized method exists for collecting data across age groups and sports.

Despite these limitations, a 2015 study sheds some much-needed light on the risk of concussion in youth football. Researchers enrolled more than 3,000 football players ages five to 14 from 118 teams in six states. Athletic trainers attended each practice and game, and diagnosed the injuries.

They documented players’ concussions during two seasons:

  • Out of 100 youth athletes who played football for a full season, three had a concussion and 97 did not. (See chart.)

The authors reported similar rates of concussion at all three levels of football—youth, high school, and college.

smaller study of 351 female middle-school soccer players reported a considerably higher rate of concussions. Over the course of four years, parents used a sideline symptom checklist to diagnose injuries and report them through an online surveillance system. Among these elite players, 13 out of 100 had a concussion each season. The researchers believe the rates reported in other studies may be artificially low because many athletes do not report concussion symptoms to their coaches or athletic trainers.

What is the chance that a high school or college athlete will have a concussion?
risk_of_concussion_in_high_school_and_college_athletes-transparent

Source: McCrea 2013

Reported rates of concussion in high school and college vary widely. Estimating the true risk is difficult. In part, that’s because definitions of concussion vary from place to place and methods of collecting data are uneven. It’s also because many concussions are never reported.

One large, carefully performed study may provide a helpful estimate. In that study, researchers examined concussion data from 18,531 male and female athlete-seasons over the course of 10 years. The athletes all played collision or contact sports—football, soccer, lacrosse and ice hockey.

The results? Out of every 100 athletes who played a sport for a full season, three had a concussion and 97 did not. (See chart.)

Other studies have reported higher rates. For example, among high school athletes who play football or girls’ soccer for a full season, about 10 out of 100 report a concussion. Other studies have described much lower rates, especially in noncontact sports such as baseball or gymnastics.

 

 

Which high school and college sports have the highest and lowest risk of concussion?

The rate of concussion in specific sports varies widely from study to study, so it is difficult to rank sports from highest risk to lowest with true precision.

Risk in men’s sports. Most research shows that the risk of concussion among men is highest in rugby, football, ice hockey, lacrosse, soccer and wrestling.

Risk in women’s sports. Among women, soccer, lacrosse, ice hockey and basketball usually have the highest rates of concussion.

In sports where men and women play the same game by similar rules (for example, soccer and basketball), women generally have a higher rate of reported concussions than men. This may have to do with differences in physical characteristics or playing styles. It is also possible that women simply are more likely to report their injuries. To the surprise of some, the risk of concussion among women soccer players appears to be similar to that of male football players.

In virtually every sport, the rate of concussions is substantially higher during competitions and games than during practice. But injuries in practice are just as serious and deserve the same amount of medical attention.

The table below provides a rough estimate of concussion risk across a variety of high school and college sports.

Concussion risk in high school and college sports

(Sources: Zuckerman Am J Sports Med. 2015; Black Clin J Sport Med. 2016; Willigenburg Am J Sports Med. 2016; Graham IOM 2014; Marar Am J Sports Med 2012)

Why do some people take longer to recover than others?

Although research shows that concussion symptoms go away within a week for 90% of athletes, some take longer. The risk that recovery will take longer than 10-14 days may be greater in athletes who:

  • Had a greater number of symptoms at the time of their concussion (four or more)
  • Had more severe symptoms at the time of concussion, such as loss of consciousness (blacked out) or amnesia (memory loss)
  • Did not immediately report symptoms of a concussion and continued to play
  • Had a previous concussion
  • Had a recent concussion

Athletes in certain sports seem to be at greater risks of prolonged recovery. In one large, careful study:

  • Lacrosse players had more than twice the risk of a long recovery compared to soccer or football players
  • Ice hockey players had three times the risk of a long recovery

Athletes ages 13 through high school may also take longer to recover than college-age athletes, especially if they have had more than one previous concussion.

And recovery may be more difficult for people with certain medical conditions that they had before their injury. These include migraine headaches, depression, anxiety or panic attacks, learning disabilities and attention deficit/hyperactivity disorder, although some recent research has raised questions about these risk factors.

The current evidence suggests that male and female athletes are at similar risk for experiencing persistent symptoms and a prolonged recovery.

What should I do if the symptoms don’t go away?

A few athletes have symptoms that linger for weeks or months. In a study of high school and college athletes, about two out of every 100 athletes with concussions reported symptoms that lasted longer than one to three months.

Athletes with lasting symptoms report continued headaches, disturbed sleep, fatigue, slowed thinking and other problems. These can take a heavy emotional toll. Athletes may feel frustrated, irritable and restless.

If symptoms persist beyond 10 to 14 days, athletes should seek help from a comprehensive concussion program or a healthcare provider who specializes in the diagnosis and treatment of concussion. Healthcare providers who specialize in concussion management include:

  • primary care sports medicine physicians
  • physiatrists
  • pediatricians with sports medicine training
  • neuropsychologists
  • neurosurgeons
  • neurologists
Do helmets prevent concussions?

The short answer? No.

Helmets can prevent skull fractures, bleeding in the brain and other head and face injuries. But they can’t absorb the full force of a jolt that disrupts the brain and causes the many problems experienced by an athlete who has a concussion.

Do helmets lessen concussion severity? Research suggests that among athletes who have concussions, those who play sports with helmets and those who play without helmets have similar outcomes in the first few days after injury.

To the extent that helmets help, older helmets in good repair seem to offer the same level of protection as newer ones.


Learning Center

English

Concussion management video A 15-minute video on the importance of understanding concussions and guidelines for removal from play and return to play after a concussion. Stanley Herring, MD, director of SHSI, serves as host.

Pocket Concussion Recognition Tool. A sideline tool to help parents, coaches and athletes recognize a concussion and know when a brain injury is an emergency.

Heads Up: Concussion resources for parents of school athletes. An extensive set of resources from the Centers for Disease Control and Prevention that include:

Heads Up: Built for tablets and smartphones, “Rocket Blades” is a visually appealing experience with fun gameplay that entertains kids 6-8 while teaching about concussions.

Heads Up: Concussion fact sheet for parents

Heads Up: Facts about Concussion and Brain Injury. A 20-page brochure about concussion, its signs and symptoms, tips for healing and where to get help.

Heads Up: Your Child’s or Teen’s Helmet. Video and fact sheets for 11 sports and recreational activities, from cycling and snowboarding to hockey and football.

Español

Heads Up: Hoja informativa para los deportistas y sus padres acerca de las conmociones cerebrales

 

Recent News
& More

State Laws Have Reduced Concussion Risks In High School Kids, Study Finds

Laws spearheaded by the director of UW Medicine’s Sports Health and Safety Institute, Stan Herring, MD, and colleagues have led to a noticeable nationwide decline in repeated concussions among teenage athletes. (Washington Post)

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Can You Predict Future Brain Damage? Hundreds of Pro Fighters Are Helping Researchers Find Out

The ambitious goal: to identify early signs of trauma-induced brain damage from subtle changes in blood chemistry, brain imaging and performance tests — changes that may show up decades before visible symptoms such as cognitive impairment, depression and impulsive behavior. (STAT)

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Concussion Recovery Is Slower in Girls, Mounting Evidence Suggests

Recent findings suggest female children and adolescents are more susceptible to head injuries, and may take longer to recover. (Scientific American)

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Is MRI Needed in Children with a Sports-related Concussion?

The UW’s Rob Bonow, MD, recently spearheaded a study with researchers that reviewed over 5 years of records from pediatric sports concussion patients. The study indicated that magnetic resonance imaging (MRI) in children with persistent symptoms after concussion rarely identified brain injury. (News-Medical.net)

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Head Trauma in High School Football May Be More Complicated Than We Thought

The increasingly polarized discussion over the risks of football has made an honest reckoning of the emerging science difficult. Nevertheless, several common-sense guidelines can be followed today. (Scientific American)

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Movement, play and sports: What are the benefits?

The sports and activities children love often come with risks. But sports, movement and play also yield abundant benefits, and can enhance the physical, mental and social health of children long into the future.

The benefits of physical activity

  • Physical activity in childhood and adolescence can increase muscular strength, improve the ability to perform complex movements, build bone, improve mood, and increase heart and lung fitness.
  • Physical activity can help prevent inactivity-related diseases that occur in childhood, including Type 2 diabetes, asthma, high blood pressure, atherosclerosis (fatty buildup in blood vessels), asthma, sleep apnea and depression.
  • Physically active children are more likely to be physically active adults—and less likely to meet an early death or develop heart disease, breast and colon cancer, diabetes, obstructive lung disease, depression, anxiety or osteoarthritis.
  • Physical activity can help to prevent obesity and aid in its treatment.
  • Physical activity leads to better brain structure and function. It can improve thinking and mental performance, including focus, memory, attention and academic achievement.

SPORTS, MOVEMENT AND PLAY CAN ENHANCE THE PHYSICAL, MENTAL AND SOCIAL HEALTH OF CHILDREN LONG INTO THE FUTURE.

Understanding Heat Stroke in 7 Steps

Athletes can develop life-threatening exertional heat stroke for a variety of reasons, but virtually none is acceptable among trainers and coaches who put player safety first. Summer training deaths from heat stroke serve as regular, harsh reminders of the importance of knowing how to prevent, recognize and properly treat this devastating condition.

Learning Center

How much physical activity do children need? Discover all the easy and enjoyable ways to help your child meet the recommendation of the Physical Activity Guidelines for Americans.  (Centers for Disease Control and Prevention, June 2015)

Making physical activity a part of a child’s life. What you can do to get—and keep—your child active. Find activities that your child enjoys and fit into your child’s schedule. (Centers for Disease Control and Prevention, June 2015)

Global Recommendations on Physical Activity for Health, 2010. This in-depth report provides background on the health significance of physical activity, recommended levels of physical activity for different age groups and more. (World Health Organization, 2010)

Recent News
& More

Obesity In Children and Teens Rose Sharply Worldwide Over Past 4 Decades

In just over four decades, obesity levels in children and teenagers have risen dramatically worldwide, though that rise has been far from uniform, according to a new study. (NPR)

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This Mistake Can Cost the Lives of Athletes in Cardiac Arrest

Athletes are dying from cardiac arrests that occur during play because teammates, coaches and other bystanders don’t know how to best save their lives, a new study claims. (Chicago Tribune)

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How did Conor McGregor shed weight for his fight against Mayweather?

In order to prepare for his superbout with Floyd Mayweather Jr., Irish MMA fighter Conor McGregor first had to conquer the scale. His nutritionist explains how he prepared for the big fight. (STAT)

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Can You Run So Much You Get Rhabdo and Your Muscles Break Down?

A runner reading about a dangerous side-effect of high-intensity training wonders what her risks are. Dr. William O. Roberts explains the risks, and how to avoid it. (Runner’s World)

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Why a thriving brain needs a lifetime of exercise

There’s growing evidence that brains thrive on regular physical activity all the way from childhood to old age. (Sydney Morning Herald)

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Hydration in the heat for young athletes

Young athletes, parents and coaches frequently ask about safe ways to hydrate in the heat. They want to know how much—and what—to drink to safely perform at their best.

The answers aren’t simple. The scientific research is inconclusive, and experts disagree.

To help sort out the science and provide practical advice, we talked to E. Randy Eichner, M.D., professor emeritus of medicine at the University of Oklahoma Medical Center and former team internist for the Oklahoma Sooners football team. Eichner spent 14 years caring for Sooners football players in dauntingly hot conditions. And for three years he also served as a physician for the Hawaii Ironman, one of the longest, most grueling, and hottest athletic competitions in the U.S.

Muscle cramping in the heat

Muscle cramping is the bane of athletes playing in the heat. This painful problem can range from annoying to disabling. Find out why they happen, and how to prevent them from happening again in the future. Experts urge players who are at risk to salt their food and eat healthful salt-rich foods. Fad remedies can delay proper care.

Learning Center

Hydration. This site includes videos and information on hydration, including how to know if an athlete is hydrated, how much to drink and what to drink. (Korey Stringer Institute)

Hydration Kit. This two-page handout lists hydration supplies, from electrolyte freezer pops to pumper-style cooling stations. The handout provides prices and links to websites where individuals or teams can purchase them. (Korey Stringer Institute)

Exercise and fluid replacement. ACSM Position Stand. In-depth information and recommendations on hydration for athletes written by the leading experts in the field. (American College of Sports Medicine)

Recent News
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How Much Protein Do We Really Need?

Dr. Elizabeth Kirk, a Ph.D. in nutritional science, breaks down the benefits of protein and how it affects athletes’ overall performance and muscle mass. (University of Washington)

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Hydration 101: It’s More Than You Drink

UW dietician Jill Irvine explains that a 1.5% loss of water can trigger dehydration, leading to changes in mood, decreased energy and decreased mental clarity. Read about the best ways to keep from getting thirsty, including a list of foods with high water content. (University of Washington)

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Nutrition Science Isn’t Broken, It’s Just Wicked Hard

Unfortunately, news can’t wait until the scientific community reaches a consensus. So here are a few strategies you can use to identify which headlines you should pay attention to. (Washington Post)

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What to Know About Rhabdomyolysis, the Potentially Fatal Condition Caused by Extreme Exercise

Rhabdomyolysis is a rare but real risk of high-intensity workouts. Here’s how to spot the symptoms, and prevent it from happening to you. (Health)

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Winter Sports Safety Tips

Winter is a great time to enjoy outdoor sports, particularly downhill and cross-country skiing, snowboarding and snowshoeing. You can enhance your enjoyment of these winter activities and reduce your risk of injury by being prepared and following a few commonsense rules. (University of Washington Medicine)

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