MELISSA BLOCK, HOST:
The score at the Pop Warner Pee Wee football game was a stunner, 52 to nothing. The number of concussions was shocking as well - five, all on the losing team, boys between 10 and 12 years old. A team official says in the case of one boy, his eyes were rolling back in his head. But during the September game in central Massachusetts, the mercy rule was not invoked and the game went on, with the last concussion coming on the final play of the game.
Now, Pop Warner has suspended both teams' coaches for the rest of the season and the three officials who refereed the game are permanently banned from officiating Pop Warner games in central Massachusetts. It's the latest story to highlight the problem of brain injury in youth sports, a subject Dr. Robert Cantu cares deeply about. He's a neurosurgeon who specializes in athletic brain trauma and author of the book, "Concussions and Our Kids."
Dr. Cantu, welcome to the program.
DR. ROBERT CANTU: Thank you, Melissa.
BLOCK: Do you hear many similar stories to this one from the world of youth football?
CANTU: I don't really have similar stories in the sense of five concussions in a single game, but certainly we've cared for over the years, many, many youngsters that have had concussions playing in youth sports.
BLOCK: Let's talk about some of the attitudes around youth football. The coach from the winning team, Southbridge, told the New York Times that it was up to the other coach if he wanted to call a timeout. He said, my team is not dirty. All the issues were on their side of the field. This is a football field, not a Hallmark moment. And a parent on the losing side told the Times, every kid who was out there wanted to play and not give up.
Which raises all sorts of questions about whose responsibility it is to intervene when the game gets really, really rough.
CANTU: Well, it does and I think that's why the Pop Warner officials have come down the way they have. They certainly don't want coaches with that kind of a mentality. You don't want youngsters to be viewed as having given up, but clearly with a game out of hand like this, there was certainly no good reason to continue to play it.
BLOCK: How easy is it to diagnose concussion in kids?
CANTU: It's really tough, especially at the youth level, where it's rare that you have medical expertise on the sideline. I guess there was some at this game, which is all to the credit of the two teams. But it's not easy. Youngsters don't necessarily use the same words that we adults do to describe the 26 post-concussion symptoms and they often don't know what those symptoms are and they often don't know when they've had a concussion.
BLOCK: You've used the metaphor of the bobblehead doll to talk about why this is such an issue for young children.
CANTU: Yes, youngsters are at much greater risk than adults in terms of concussion, both because their brains are not myelinated fully. Myelin is the coating of nerve fibers like coating on the telephone wire. It gives it better transmission, but it also gives it greater strength. So a child's brain is much more easily damaged from acceleration forces imparted to it. And as you mentioned, youngsters have disproportionately large heads, very weak necks.
And this combination means that a force delivered to a youngster will have much greater injurious effects to the brain.
BLOCK: Dr. Cantu, I've read that there are something like 3 million kids playing tackle football in this country, as young as 6, 6 to 14. You have said that you don't think kids should play tackle football at all until they're in high school. How realistic is that?
CANTU: Well, I think that if parents determine that they don't want to accept the risks that their youngsters are being subjected to that they'll make demands of youth football, that they play flag football, that they teach them the skills of tackling, but the tackling be done with dummies and not bashing bodies and bashing heads. Several years ago, I went to the leaders of USA Football and basically expressed my concerns of having seen chronic traumatic encephalopathy in teenagers, my concerns of all the youngsters that we've seen whose lives have been altered because of head injuries.
And I said, it's insane to be putting 5-year-olds out there and letting them bash heads. And they said, to me, basically, Bob, look, we wouldn't care if we were playing flag football, but the parents won't sign the kids up for flag football, so we have to offer them tackle football.
BLOCK: We've been focusing on football injuries but what about other sports? What's your advice to parents, say, for kids who play hockey or soccer?
CANTU: Well, the brain doesn't know whether it got violently rattled from playing ice hockey, from playing soccer or from football. And so, we feel strongly that soccer heading should not be started until the age of 14; that full-body checking in ice hockey should not happen until the age of 14. Now, ice hockey is almost there. Two years ago, when we started the book, the age was 11. Now it's up to 13, so they're almost at 14.
BLOCK: I suppose it's one thing to have these rules on the books. It's an entirely other thing at the individual arena or football field or soccer field.
CANTU: Yes, unquestionably. But I think even if we don't see these changes occur, I think pressure is being brought to change the way the sport is played, to change the way the sport is practiced. Already, USA Football and Pop Warner has limited to just two hitting drills a week, cutting roughly a third the amount of trauma that can be obtained in practice. And that's all good.
BLOCK: Dr. Cantu, thank you so much.
CANTU: You're welcome, Melissa. Thank you.
BLOCK: That's Dr. Robert Cantu. He is clinical professor of neurosurgery at Boston University School of Medicine. His book is "Concussions and Our Kids." Transcript provided by NPR, Copyright National Public Radio.