Kids and concussions: The dilemma facing a doctor

As an orthopedic surgeon, I’m acutely aware of the data and conversations surrounding sports-induced concussions, particularly in football. Encouragingly, the medical community is experimenting with proper treatment, diagnosis, and assessing the long-term effects of concussions; recently the NIH announced details of how it would begin using a sizable grant from the NFL for just this purpose. Yet preventing them continues to be a challenge not just at the professional athlete level, but also among school-aged children.

Recently, I was confronted by a parent — asking point-blank — would I allow my own child to play organized sports, given the inherent risk of injury, especially concussions? Did I feel these sports did enough to sufficiently protect young athletes from life-altering injuries? In other words, do I believe that the risk — now — outweigh the rewards that come with organized athletics?

For a physician who specializes in sports medicine, it’s a tricky question. The doctor in me is acutely aware of the risks, yet also strongly believes in the positive impacts of organized sports on the mental and physical well-being of children and adults. As an individual, I’m intensely mindful of my loved ones’ well-being, yet these sports are in so many ways deeply tied to our children’s (and our own) cultural and social world.

After some grappling, I thought of the rule of 86. That is, when you are 86-years-old and look back at your life, what events will matter the most? For the majority of us, whether we played high school football would probably only top the list if we experienced the lifetime residuals that can occur after a concussion.

Yet even for a doctor immersed in this information, it’s tough to force a child to the sidelines. So my final answer looked something like this. If my son were passionate about playing football I would let him. However, we would start with a discussion of the risks and end with an agreement. If he would experience even a single episode of confusion, loss of consciousness, or any signs or symptoms of a concussion as result of impact, he would retire from the game, no arguments.

I also polled Timothy Ackerman, DO, a colleague of mine at the PinnacleHealth Sports Medicine program. Tim has three children and I wanted to see if our responses differed:

I have three young boys and two of them are old enough to be participating in organized sports. As they advance through the stages of sporting activities, there will be more risk associated with particular sporting events. I feel that participation in sporting activities is an integral part of a child’s development and I would encourage their participation. Yet I would discuss the risks associated with their sport as well as injury prevention, and I would have the discussion with my son about retiring from a concussion prone sport after his first concussion.

So often in this profession, our work takes place after an event — be it an injury or an illness — when the die is already cast. Yet as research and knowledge on how to reduce risk of disease or serious accidents proliferates (and spreads online and through social media), the prevention question is bound to be increasingly common. And sometimes, the answer is far from clear-cut. How have you responded when confronted with this kind of query from a patient?

John Frankeny is an orthopedic surgeon at the Orthopedic Institute of Pennsylvania and founding member, PinnacleHealth’s Sports Medicine Program.  He blogs at The Doctor Blog.

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  • Joel Sherman

    Your policy of one concussion and you’re out of sports is sensible but there is hardly a solid rationale for it. There is evidence that repeated subclinical concussions such as ‘getting your bell rung’ or having to ‘shake it off’ can lead to chronic traumatic encephalopathy (CTE). On the other hand some players with recurrent concussions appear to be fine years later.
    Many years of research will be needed to know what should be done, especially with children. We await the development of reliable techniques to diagnose early CTE during life.

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