Concussion in the Young Athlete

The American youth-sports movement has changed dramatically in the past 30 years. Whereas adolescent sport was once confined mainly to boys playing on school-sponsored teams such as football, basketball, and track, the sports world for children and adolescents today is markedly different. As of 2006, there were ∼30 million children and adolescents under the age of 18 involved in athletics in the United States. Because of the tremendous success of Title IX of the Education Amendments of 1972, there are nearly equal numbers of males and females currently participating on school-sponsored sports teams.In addition to the evolution of participant demographics, a number of other changes have occurred also, including an increased number of sport types available for children and teens, an increasingly competitive youth-sports world, and a trend toward year-round sport specialization for promising young athletes. These changes have caused discussion in the child health community. Is there such a thing as too much sport? When does participation become unhealthy? How much activity can children tolerate safely? Pediatricians are frequently asked to consult on these issues as they relate to child and adolescent health.Medical issues for young athletes have reflected these changes in the youth-sports climate. Anabolic steroid use, stress fractures, and overtraining syndrome are all examples of issues that have arisen in the pediatric and adolescent athlete in the past 30 years. Child health experts, and particularly pediatric sports medicine specialists, are often involved with consulting families and youth-sport organizations about these concerns.Concussion, however, has been slow to receive the appropriate recognition as a serious medical problem in the sports medicine community and even slower to receive this recognition in the youth-sports community. Once thought to be a relatively benign condition, concussion, especially when severe and recurrent, has now been associated with both short-term and long-term neurologic sequelae.The importance in young athletes, however, does not stop there. Unlike other sports-related injuries such as those to bone and soft tissue, which heal faster in young athletes than in adults, new data suggest that minor traumatic brain injury heals slower in children than adults with similar grades of concussion. Furthermore, second-impact syndrome, a rapid and often fatal condition associated with a second head injury while the person is still symptomatic from a first, has been described mainly in adolescent athletes.Because increasing numbers of young athletes (estimated at 300000 per year) suffer some grade of concussion, pediatric health professionals increasingly will be asked to give appropriate counsel regarding safe return to activity and relative risk of recurrence.For the child health professional involved in the sideline or office-based care of young athletes, knowledge about the evaluation, grading, and return to activity for concussive episodes is an extremely important issue. Residency programs will hopefully recognize this as part of the broader importance of including pediatric sports medicine in the pediatric curriculum to fully train pediatricians of the next generation. For example, office-based or sideline concussion management, learning to administer a sideline assessment-of-concussion test to predict severity, and understanding when to return an athlete safely to competition should be as much a part of the residency curriculum as is assessing a newborn infant and providing Apgar scores to predict newborn health.