New protocols are designed to limit potential problems caused by head injuries in all youth sports.
When Dr. Tom Kaminski watches a group of 8-year-olds playing soccer and sees some of them heading the ball, he can describe it only one way:
Kaminski has played and coached soccer. He has worked with the National Soccer Coaches Association to develop safety guidelines for coaches. He loves the sport and wants it to keep growing throughout the United States. But he understands that there must be limitations in place to protect its youngest players from concussions and other traumatic head injuries.
Last fall, the United States Soccer Federation ruled that no child under the age of 10 may head a ball in practice or a game and that those players 11-to-13 will be limited in the frequency of their headers. Further, all players will be trained in the proper way to direct the ball in the air by combining torso, neck and head to create a safer, more effective way to strike the ball.
“That’s fantastic,” Kaminski says.
Kaminski is a professor at the University of Delaware and the director of the Athletic Training Education Program at the college. He understands the consequences of concussions on young athletes and is working to minimize the potential for long-term issues caused by repeated injuries. He is part of a growing national movement designed to limit the potential problems caused by concussions in all youth sports. While publicity and attention have been directed to the NFL and its problems in that area, youth sports are beginning to take the issue more seriously. According to data included in a 2013 class-action filing against U.S. Soccer, nearly 50,000 high school soccer players sustained concussions in 2010, more than those suffered by athletes in basketball, baseball, softball and wrestling combined.
While the soccer world responds to the concussion issue, there is progress in Delaware, too. According to Jane Crowley, a neuropsychologist with the Nemours Children’s Health System, legislation passed recently in the state House and Senate that expanded “drastically” a previous law about concussion prevention.
“Education is happening on a global level about this,” Crowley says. “What this new legislation does is educate more people, so they are making decisions on a personal level to help athletes.”
Joe del Tufo
The new protocols are designed to make sure short- and long-term athlete safety are stressed. For instance, when a player suffers an injury that is or could be a concussion, he or she is not allowed back into the game for the rest of the day. “Not all concussion symptoms emerge that moment,” Crowley says. Also, referees are being trained to notice signs that a player may have been concussed and to remove that player from action. The same goes for teammates, classmates, counselors and teachers. The goal is to prepare anyone who comes into contact with young people who participate in sports to recognize potential problems and to act.
“We see people in our concussion clinic who have been turned in by another team member,” Crowley says.
In 2011, Delaware instituted concussion protocols for 61 public high schools and 58 middle schools. Under the regulations, parents must sign and return an information sheet each year, and coaches are obligated to remove any athletes who might be concussed. Those players removed have to get medical clearance to return to action.
In September of this year, Gov. Jack Markell signed legislation that extended the regulations to independent schools, travel teams and youth organizations not governed by the state. Rep. Debra Heffernan, D-Brandywine Hundred, was one of the sponsors of the bill and said the goal was to impact “pretty much every child that is involved in recreational sports.”
While soccer and other sports work to create procedures to prevent and detect concussions, higher contact sports like lacrosse, and of course, football are also working to make their sports safer. Kaminski says that a major part in that attempt is to make sure protective equipment is up to date and fits properly. “I see kids all the time with helmets that are too big,” he says. Just like the NFL and college games, which are lessening the amount of contact in practice and policing blows to the head during competition, so too are high school and youth leagues working to expose players to fewer collisions that could lead to concussions.
A lot of it comes down to the coaches. Are they being trained properly? That’s a question parents should ask when considering whether to let their children play for a certain team. How do coaches teach tackling in football? Are lacrosse players being shown proper checking techniques?
“The onus is on the coach,” Kaminski says. “Parents are becoming much more interested in who is coaching their children. Five years ago, they just dropped their kids off at practice and figured that the coach must be trained properly.”
Archmere Academy in Claymont recently received the National Athletic Trainers’ Association Safe Sports School Award for its overall commitment to protecting its students from injury—including concussions—during all P.E. and athletic activities at the school. In order to receive the award, a school must foster a safe environment continually across a variety of categories, from proper equipment to pre-sport physical examinations, to the creation of emergency measures to the establishment of proper recovery protocols.
Despite the growing commitment to education and efforts to reduce potentially dangerous shots to the head, football is becoming a tougher sell. According to USA Football, about three million children, ages 6 to 14, played football in 2010. Last year, despite a modest, 1.9 percent increase from 2014, only 2.17 million participated. “I’m not a big proponent of kids playing tackle football at a young age,” Kaminski says. “They can learn the entire game playing flag football.”
Tower Hill School head Jack Holloway believes that as long as football coaches teach proper techniques, trainers observe concussion protocols, and equipment is up to date, football remains a good pursuit for pre-teens and teenagers. Tower Hill trainer Mike Phillips is very careful not to let players back onto the field until they are healed and ready for action—not to mention at full strength in the classroom. “We err on the side of caution,” Phillips says. “If an athlete gives us any indication of trouble, we hold them out.”
There are risks associated with football—and many other pursuits, according to Holloway. He believes that creating the proper environment for a player will limit exposure to concussions and that the need for young people to be active—and safe—often outweighs some of the trouble that could arise.
“We are looking at what we can do to minimize risk for our athletes,” Holloway says. “But the No. 1 health problem for teenagers is obesity. We have taken a look at all the risks but have also looked at all the benefits of youth and high school sports and put it all together so that we can make sound decisions.”
And keep moving forward to prevent concussions.
Proper nutrition is a game-changer for young athletes.
Whenever Mike Phillips talks to parents about making sure their young athletes are eating right, he sounds like someone who can’t stand the idea of watching anything on TV in old-fashioned regular definition, or worse, black-and-white. The man prefers vivid hues and is convinced that approach will lead to healthy participants who perform at higher levels.
“The plate should be colorful,” says Phillips, an athletic trainer at Wilmington’s Tower Hill School. “It should have a wide assortment of fruits and vegetables.”
It’s hard enough for adults to eat right on a daily basis. In a world where food, especially the kind that is served through a drive-through window, is so readily available, it can be hard to make healthy choices. But as parents shuttle their kids from one activity to the next, they must not neglect their diets. It is imperative that they understand the best ways to fuel their young athletes.
“Eating right will have an effect on children’s overall health, as well as their performance,” says Dr. Bradley Sandella, D.O., of Christiana Care Health System.
Both Phillips and Sandella believe that proper hydration is vital for any athlete, particularly younger children, whose fluid reserve tanks aren’t so large. And the best way to do that is with water. “You can never go wrong with water,” Sandella says. Drinking before, during and after practices and games is vital. And though there are plenty of sports drinks available, claiming to provide the necessary ingredients and electrolytes to prepare an athlete for competition and to replenish what is lost during play, most contain a lot of sugar. For instance, 12 ounces of a sports drink contains 21 grams of added sugar, or almost two-thirds of the recommended daily allowance for an adult male and three short of a female’s suggested intake. In other words, a 10-year-old shouldn’t be consuming that much.
Both Phillips and Sandella understand that these sports drinks have some benefits in terms of electrolyte replacement, but both recommend parents dilute them with water. “Cut them in half with water,” Sandella says. “You’re getting the fluid and electrolyte replacement, but you’re cutting the sugar in half.”
While sports drinks have plenty of added sugar, the true enemies of good nutrition, particularly in children, are sodas, which are packed with the stuff. Those should be eliminated entirely, or at least consumed rarely. Close behind are the kind of fruit drinks that have little juice, gobs of sugar and very little nutritional value. Tower Hill doesn’t have a soda machine, and its students can’t get access to sports drinks during the school day. “The message to our students is that they should be drinking water,” Phillips says.
In addition to consuming regular portions of fruits (bananas, apples and berries are excellent) and vegetables (leafy, green varieties are best, while carrots are filled with B-complex vitamins, and beets and beet juice contain anti-inflammatory agents), children should be eating plenty of lean protein every day. Sandella says the ideal serving is 1-1.2 grams of protein per kilogram of weight. Since the metric system can be tricky, figure on about two or three ounces or so of protein for someone weighing 75 pounds. Fish, poultry and soy are the leanest protein sources. Parents serving red meat to their children should focus on the leaner cuts. Eggs provide protein, but parents should beware of the yolks, which contain cholesterol. An egg-white omelet can be quite tasty and also packed with protein.
As young athletes get into their teenage years, their protein needs expand, as they try to build more muscle. This will often lead them to supplements. Sandella says young athletes should use whey protein powders, but parents should be wary of additives, like sugar and artificial sweeteners. And the protein should be as purely whey as possible and not hydrolyzed, hydrogenated or denatured. And watch out for pure, powdered soy protein, which can be damaging.
“Most of the supplements are pretty decent,” Sandella says. “But you want the purer proteins.”
Sandella says that products like Muscle Milk are all right, but he stresses the need for balance. Teenagers shouldn’t be getting all of their protein from supplements. They need diets that include protein from a lot of different sources. Also, make sure that the bread children eat is made from healthier grains. And watch out for sugar. Even wheat and multi-grain products can contain high levels of added sugars.
Athletes getting ready for competition shouldn’t eat too close to game time. That allows the digestive track to clear and helps performance. But for those who must eat close to playing, Sandella recommends quick snacks like raisins or dates and low-fat yogurts, which he says clear the system quickly. It’s about performance, but it’s mostly about health. Those children who fuel up with the right foods will be ready for anything.
“You have to have a balanced diet,” Phillips says. “You need good foods, rather than pre-packaged products. Raw foods are better for you. But most importantly, you need to be drinking a lot of water to stay hydrated.”
And remember that colorful plates are better than meals served out of a fast-food bag.
“At the recreational stage, a parent should be about the child having a good time,”
Sportsmanship is not limited to the athletes.
Every now and then, Tower Hill School Athletic Director Jack Holloway walks over to a parent during a game for a little chat. It’s nothing all that dramatic, and Holloway certainly doesn’t want to embarrass anyone, but he feels it necessary to deliver an important message about sports.
“I have to remind them to have fun,” Holloway says.
In most cases, the recipient of Holloway’s message has forgotten some of finer points he delivered earlier in the season about sportsmanship. Perhaps said mom or dad was yelling at the referee, or grousing about a coaching decision. Worse, he or she could have been hollering at some of the players.
“We work at sportsmanship really hard,” Holloway says. “That doesn’t mean we don’t have some problems.”
As the emphasis on sports from pre-school through high school grows, so do the roles of parents, who find themselves devoting more and more time to their children’s athletic pursuits. As that activity increases, so do the opportunities for improper behavior, which can work to the detriment of the young athletes. Holloway’s gentle reminders to overzealous parents help maintain order, but often there is no one on hand at the Little League game, youth wrestling tournament or kids’ soccer showcase to prevent parents from getting out of line. Perhaps more important, it’s impossible to be in the home, when children’s earliest attitudes toward sports are being formed. At a time when some kids are spending up to 30-40 hours a week participating in athletics, it’s important to have perspective.
“I played baseball through high school, and I see kids today at 9 and 10 years old playing more games in one year than I played during my whole high school career,” Holloway says.
Dr. Meghan Walls is a pediatric psychologist for Nemours Children’s Health System and has done considerable work on youth sports and how to create a good environment for children as they participate in athletics. For her, the process starts with the proper parental attitude when kids are beginning their athletic journeys. Providing options is important. Sure, mom may have been a top soccer player, or dad might have been a football hero, but that doesn’t mean their child will want to follow the same paths.
“There’s a bunch of sports, so parents should make sure their children are interested in what they play at an early age,” Walls says. “After three or four years, a little specialization is OK.”
Walls says it’s important for parents to let their children know that they have confidence in them, but it’s also good to set expectations. For instance, they will have to attend practice and maybe even kick or throw a ball in the backyard every so often in order to develop skills. But Walls cautions that the proper level of pressure is “low to moderate” and those parents who force their kids to do something they don’t want to do will often create a bad situation.
“You want to tell kids ‘You have to practice’ and to remind them that ‘You signed up for this,’” Walls says. “But you can’t exert extreme pressure. You can’t create anxiety. There’s research that’s been done with adolescents that says they’re most concerned with what their parents will think.”
According to Matthew Robinson, a professor of Sport Management in the Business College at the University of Delaware, “the best way to put it is that parents should be supportive” in their children’s athletic endeavors. Robinson says youth sports success depends on a triangle that includes the parent, coach and child all working together. That means the parent needs to make sure the coach has been trained properly and then back off. When mothers or fathers get too involved they “take over the activity from the child,” according to Robinson, who says there are several stages to a child’s athletic development. It starts with “romance,” when the kid falls in love with the sport. That’s a vital step. Skill development and mastery come later, but without a real affection, the activity won’t be worthwhile—and more importantly—fun.
“At the recreational stage, a parent should be about the child having a good time,” Robinson says. “I’m a competitive person, and I’m not saying competition is bad. At certain levels, it’s important. At the youth level, a child should want to enjoy himself and want to come back for more.”
Robinson says it’s important for the child to “own” the athletic experience. That means he or she will remember to bring a water bottle and cleats to practice and will be the one reminding the parent that there is practice at 6 p.m. It’s unreasonable to expect a 5-year-old to do that, but 10-year-olds can certainly handle that type of responsibility.
Parents have to be careful not to tie their self-esteem to their children’s athletic accomplishment. If a girl’s soccer prowess gains her dad a certain elevated status at the snack bar, that’s almost unavoidable, but it’s not a good idea for the parent to pressure the young player to perform so that the attention to the parent will continue. Walls asserts that positive reinforcement will lead to better self-esteem.
Finally, there is the relationship with coaches. It’s important for those directing teams to have meetings at the beginning of each season with parents to describe what will happen. Whether it’s a recreational or competitive pursuit, early guidelines can make a big difference. And when it’s time to speak with a coach, parents should do it away from the fray, the better not to embarrass their children. However, those who can teach their kids to advocate for themselves in a calm, mature manner will be teaching the best lessons and ensuring a more positive experience.
“The first goal is always enjoyment,” Walls says. “That should be first. Let the child guide it. If the child wants to play on every travel team, and parents have the resources to do that, great.
“But we have to make sure we don’t overschedule our kids. Do they have time to do their homework and spend time with their friends while playing 35 hours of baseball a week? If not, you have to create some balance.”