There are multiple popular sports played in today's society. Many people interact with sports, whether they are the fan or the athlete. Fans simply admire the game and watch the athletes compete. Athletes play the sport and risk getting injuries. There has been an increase in sports-related injuries, specifically brain damage, which is a result of multiple concussions. If brain damage is being addressed in adult athletes, it should also be addressed in young athletes. The problem needs to be focused on the foundation of a growing athlete since there are many differences between an adult and a child, from physical to intellectual maturity. Peewee football is the beginning of an individual's football career. That should be the time for them to learn about prevention in addition to the game. Practice techniques, equipment technology, evaluation procedures, and education on concussions at every level are ways to prevent concussions. A new protocol needs to be developed for handling concussions in young athletes.

A concussion is defined as a brain injury when there is a "violent moving back and forth of the brain within the skull [because] it stretches the brain" (Gupta). Concussions result when the brain moves to hit one side of the brain then bounces to hit the opposite side. If the axons, signal transmitters of the neurons, are damaged, then brain cell disruptions result in neurocognitive deficits (Meckler).

There are four categories for signs and symptoms of a concussion which include physical, cognitive, emotional, and sleep. 

Physical symptoms of a concussion incorporate fatigue, headaches, blurred vision, light sensitivity, and imbalance. Cognitive symptoms are presented by memory problems, lack of inhibition, lack of concentration, difficulties with problem solving, and language impairment. Emotional symptoms are expressed by intense aggression, nervousness, and depression. Sleep signs of a concussion include irregular patterns such as more or less than usual. (Meckler)

Concussions can occur in many different occasions, from a bicycling accident to a head-on collision while playing a sport. Brain damage is particularly detrimental to children because they are less developed than an adult. Recovery would take more time and be more challenging for a child, this could lead to missing out on school and early signs of depression.

In 2012 through 2013, epidemiologists from the Datalys Center for Sports Injury Research and Prevention in Indiana conducted research to determine the number of concussions per season in different age groups. The number of athletes that suffered from at least one concussion per season was about one in twenty college players, one in fourteen players among high school athletes, and the average was one in thirty of youth athletes (Schaffer). This research only analyzed recorded information by athletic trainers. It is likely that many children are unable to describe their symptoms, which means the number of children who have suffered from a concussion is underestimated. If children were taught from early on about injuries, they would have a better understanding for themselves and would know how to articulate their symptoms for proper treatment. 

Current medical technology is not advanced enough to indicate a concussion or the specific causes. The present-day means of identifying a head injury as a concussion is not sufficient because one protocol for everyone across the board is too broad.  Concussions are difficult to detect because symptoms vary by situation and scientists have not determined the precise mathematical equation of acceleration plus head rotation that causes a concussion. After a person has experienced it once, the chance of getting another is three times more likely. The inability to detect underlying symptoms could lead to insufficient treatment. For this reason, an explicitly detailed checklist should be designed in accordance to a child's anatomy. In 2001, Peter Provonost, an M.D. with a Ph.D., created a checklist for mundane hospital routines (Gawande). After the use of checklists in hospitals, the rate of fatalities and length of stay diminished. The "checklists established a higher standard of baseline performance," because it helped to remember small, yet important, steps that can be overlooked and "make explicit the minimum" steps in complicated procedures (Gawande). Therefore, a specific checklist for youth injuries would decrease the chances of long-term damages to the brain.

According to the Centers for Disease Control and Prevention, as many as 3.8 million sport-related concussions occur every year in the United States. Scientists are currently arguing about how concussions appear in children of various age groups. Symptoms can be very subtle and go unnoticed, which is why the number statistics of reported concussions is most likely underestimated. Long-term consequences from head injuries can be dramatically devastating. To add to the list of symptoms, which can worsen as head injuries are prolonged, a person is subject to develop early amnesia, developmental disorders, psychiatric disorders, and diseases. The most recent subject for controversy is the development of CTE in former athletes. CTE, or chronic traumatic encephalopathy, is a progressive degenerative disease of the brain found in people, mainly athletes, with a history of repetitive brain trauma ("What is CTE?").  The cause is believed to be from repeated shocks to the head. Brain scans have been used to identify signs of CTE but current technology is only advanced enough to test for CTE posthumously. Testing has been conducted on 165 individuals and 131 (96%) resulted positive for CTE ("What is CTE?").  

Those who are affected with symptoms of brain damage, specifically CTE, notice a decrease in their quality of life daily. The recent death of former NFL quarterback, Ken Stabler, also known as "The Snake," has brought more attention to CTE from the public eye. Stabler's death adds to the list of over 100 former pro football players who died with CTE. The individuals diagnosed with CTE are not restricted to football players, but boxers, soccer, rugby, and baseball players as well (Branch). The symptoms of CTE include: memory loss, impulsive behavior, impaired judgment, behavioral disturbances, offset balance, and gradual dementia ("What is CTE?"). CTE debilitates each person's life along with their family and friends. Another significant person is former NFL linebacker, Adrian Robinson, who committed suicide and was tested positive for CTE afterwards.  Very little research has been directed on CTE since the technology is still behind. But, the discoveries that have been made can be used to develop a plan of prevention. It should not take multiple deaths to realize that there needs to be a new way to prevent brain damages before it is too late. Scientists need to start from the beginning of how a child is susceptible to head trauma.

Until recently in the past decade, researchers were not focused on conducting research on adolescents. The main focus of researchers was to find a way to improve the outdated protocol and update the equipment. The protocol is too broad and does not comply with the different structures of younger age groups. Equipment has been updated numerous times, yet the problems of concussions continue to rise. Through an online survey for youth sport coaches, there was only a slim response rate of 34 percent. However, the statistics from those who did respond were significant. For example, "only 61% of youth coaches correctly identified the signs and symptoms of a concussion, and noted several misunderstandings" (Sarmiento, Elbin, and Covassin). That is a risky factor considering "53% of student athletes have reported a history of concussion" before starting high school (Semple et al). Medical specialists need to conduct more research on concussions pertaining to the youth. It would be difficult to validate the effectiveness of a new protocol that is specialized for adolescents without sufficient evidence. 

The studies that have been conducted are mainly focused on football statistics, probably because football is the most popular sport in America and football also has one of the highest rates of concussions according to the NCAA in 2014 (Nicholson). The majority of sports that relate to concussions include a helmet as a necessary precaution. The National Operating Committee for Standards in Athletic Equipment, abbreviated as NOCSAE, conducts a test that every helmet pass to check for protection and has not had any major changes to rules since its implementation in 1973 (Polnerow). Although the test labels helmets to be effective against catastrophic head injuries, such as skull fractures, it does not succeed in preventing internal skull injuries, such as concussions. The Simbex Head Impact Telemetry System, abbreviated as the HIT system, is made up of six single-axis accelerometers that measure and record peak accelerations, impact duration, and location of the impact (Polnerow). An investigation was monitored on 314 Division 1 NCAA athletes from various colleges. Using the HIT system, the data found resulted in various impact magnitudes and frequencies by the position of the player. Although this study differentiated impacts by position, it did not make any discoveries between head impact exposure and diagnosis of concussions. A similar test was conducted on high school football players. These athletes experienced greater post-impact acceleration than collegiate players and Broglio et al, the researchers, assumed the cause to be a less-developed muscle structure (Polnerow). This claim concludes that as research is conducted on younger athletes, researchers are realizing the less developed athletes are more prone to catastrophes. For this reason, more research must be conducted to determine the amount of acceleration and rotation of the head combined that causes a concussion. 

Recently, after the uprising of lawsuits for health problems during and after playing a sport professionally, leagues have implemented fines to reduce the number of injuries. For example, the National Football League has implemented fines and rules restricting head to head contact and tackling a defenseless opposition. Dr. Bennet Omalu is a scientist and physician who has a strong opinion on CTE and strives to share his beliefs with everyone. Omalu says, "Parents who smack their children on the top of the head should stop doing that." Once again, children are more fragile and are not fully developed to take blows to the head like an adult would; considering adults are also susceptible to head trauma. Some former athletes may struggle to find an occupation after their athletic career and Omalu's reasoning is because the rough sport "steals away your intelligence from you" (Pacenti).

One of the most effective ways to prevent head injuries is through advancement in equipment, since the specific causes of concussions are unknown. The latest preventative technologies are helmets, headbands, attachments, and mouth guards. Leading helmet manufactures are in a "race" to design the safest helmet, each claiming to be more effective than the next. Although helmets protect against physical damages to the skull, it does little to solve the problem with brain movement within the skull. The next technological development is a headband collision sensor. Triax Technologies' engineered a headband that wirelessly transmits data to sideline health officials who monitor the data. Another piece of equipment is a device that is attached to a helmet and flashes when a player is hit abruptly to count the number of hits in a season. A different type of equipment that does not go on the head, but inside the mouth, is the Vector Mouthguard. This new mouth guard sensors the measure of force of an impact and alerts the athletic trainers when a collision is hard enough to cause a concussion (Nicholas). The University of South Carolina currently has its athletes wear Vector Mouthguards. All of the new technologies are productive in reducing head trauma, but it does not solve the problem with children. Notice how only upper -leveled athletes are using the new technological advancements. Scientists and medical specialists need to shift their focus on the impact of head injuries in the youth more.

Understanding concussions is one of the most important aspects to preventing the injury. In 2007, the Centers for Disease Control and Prevention invented "Heads Up," an initiative to educate parents, teachers and, specifically "youth sport coaches on prevention, recognition, and response to sports-related concussions" (Sarmiento, Eblin, and Covassin). Based on the "Heads Up" initiative, there is a checklist for the pre-season, midseason, and postseason to validate that the young athlete is behaving normally. There is also a return to play policy for young athletes. The policy includes mandatory removal from game, mandatory bench time, required medical clearance, required training, and informed consent ("Heads Up"). "Heads Up" is a helpful toolkit for information on what is needed to know about concussions and safety for adolescents. It is the right start society needs in shifting their focus of head trauma concerns towards children, not just adults.

From a survey conducted on youth sports coaches, 66 of 321 coaches dealt with a concussion in a season. Only 44 out of the 66 were evaluated by a health care professional. Thirty-five percent of the kids who were suspected to have suffered a concussion were not taken out of the competition after being evaluated by a health care professional or their guardian. That fact plays a role with 23.2% of the respondents who said they do not think concussions in adolescents is a serious problem. The statistics may be a result from lack of education. Prior to receiving the "Heads Up" program, 69.6% of the coaches did not have access to any other materials educating on concussions. After following the initiative, the amount of coaches who believed concussions within the youth is a serious problem increased to 62.6% (Sarmiento, Elbin, and Covaassin). With the program, everyone has a better understanding of how to identify and follow up with head injuries, including parents and school professionals.

Recently, pediatrics have developed a new concussion protocol based on National Institute for Health and Care Excellence procedures (DeMatteo et al).  Based on the pediatric protocol, the first step is to rest without any activity until the child is free of symptoms. Step two is to return to short 10-15 minute exercises twice a day. The third final steps are return to play, carefully. "Physician clearance is recommended prior to steps five and six, which include contact" (DeMatteo et al). All of these steps are significant because gradual return to normal activities allow the body to rehabilitate properly.

The sports audiences mainly pay attention to injuries in professional athletes because they are better known. People neglect to consider the consequences of an adolescent athlete. If a young athlete is injured early on, he or she may not be able to handle normal life pursuits that same way as a person who has never encountered a brain injury would. In conclusion, the factors that contribute to concussions, CTE, and other brain diseases are still unknown. All of the research observed resulted in a theory that repetitive head injuries result in concussions and long-term concussions can lead to a degenerative brain disease. But, because the causes are unknown, the ways to prevent concussions are through technology advancement in addition to specific educational and medical protocols. The new equipment mainly collects data for researchers and health professionals, not solving the problem. The best method to preventing concussions is educating and treating children properly before and after an injury. Adult-based protocols and not suitable for children; therefore, protocols have been recently developed for adolescent athletes, but they can be improved with more research. Once scientists gain more knowledge on concussions, children can be better assessed and this would decrease the rising rate of brain diseases in athletes.

