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updated 8/30/2010 9:30:49 AM ET 2010-08-30T13:30:49

Emergency room visits for school-age athletes with concussions have skyrocketed in recent years, suggesting the intensity of kids' sports has increased along with awareness of head injuries.

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The findings in a study of national data don't necessarily mean that concussions are on the rise. However, many children aren't taken for medical treatment, so the numbers are likely only a snapshot of a much bigger problem, doctors say.

"It definitely is a disturbing trend," said lead author Dr. Lisa Bakhos, an ER physician in Neptune, N.J.

The study examined concussions in organized youth sports involving ages 8 to 19. ER visits for 14- to 19-year-olds more than tripled, from about 7,000 in 1997 to nearly 22,000 in 2007. Among ages 8 to 13, visits doubled, from 3,800 to almost 8,000.

While awareness has increased, many parents, coaches and players still don't understand how serious concussions can be, Bakhos said. Many often seem less concerned with the injury than with how soon kids can return to sports.

"They want to know if they can play tomorrow, and you're just like, 'No!'" she said. "It's not just as simple as get up, shake it off and you'll be fine.

Youth football: Is it safe to play?

"If they're not treated properly, with rest, then they can have long-term problems," Bakhos said. Those include learning difficulties, memory problems and chronic headaches.

The study appears in Pediatrics, published online Monday, along with a report about sports-related concussions from the American Academy of Pediatrics' sports medicine council.

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A concussion means the brain has been jostled. Symptoms aren't always obvious. There usually is no loss of consciousness. And a concussion doesn't show up on an imaging scan unless there is bruising or bleeding.

Symptoms can include headache, nausea, dizziness and trouble concentrating, and may last about a week. Sometimes it can take months to recover.

Potential concussions should not be "toughed out," say the authors of the Pediatrics report. Affected athletes should always be examined by a doctor or someone else with medical expertise.

Treatment is mainly rest — both physically and mentally, avoiding activities that require concentration and focus. That may mean reducing schoolwork or staying home. Video games, computer use and TV can worsen symptoms and should be avoided, the academy report says. Some doctors advise against aspirin and similar painkillers right after a head injury because they might raise the risk for brain bleeding.

Above all, anyone with a concussion should not return to sports or other physical exertion until their symptoms have disappeared.

Multiple concussion can lead to permanent brain damage
"If you go back in too early, that can be devastating," said Dr. Kevin Walter, co-author of the report and a concussions specialist at Children's Hospital of Wisconsin in Milwaukee. Resuming sports too soon risks another concussion that could be deadly or cause permanent brain damage, he said.

A concussion should not be dismissed as "not a big deal," Walter said. "In my mind, how the hell can a brain injury not be big deal?" he said.

Sports-related concussions have made recent headlines because of research about brain damage, depression and memory problems including Alzheimer's disease in retired NFL players who had repeat concussions.

Researchers believe young athletes may be more vulnerable than adults to lasting damage from these head injuries because their brains are still developing. Several states have adopted or are considering tougher limits on when athletes can resume play after a concussion, as have some schools, amateur leagues and the NFL.

Dr. Michael Koester, chairman of a sports medicine committee at the National Federation of State High School Associations, said young athletes increasingly are playing and practicing year-round to stay competitive, a trend that increases chances for injury.

Evan Nolte, 16, a top high school basketball player in Atlanta, says the injuries "are more serious than people think."

Evan hit his head hard on the floor during a tournament earlier this year when he dived for a ball and another player landed on top of him. He didn't think he had a concussion, and only sat out several minutes before returning to the game.

A few days later, he was elbowed in the head in another game. Evan sat out the rest of the game, feeling disoriented. His doctor diagnosed a concussion the next day and told him to avoid sports for a few weeks. When Evan had trouble focusing in class, and complained that his head was spinning, his parents took him to Children's Healthcare of Atlanta's concussion clinic.

The clinic is among an increasing number of centers nationwide that use computerized or written tests to measure mental function after concussions. Evan's results showed some deficits. His scores improved after several days, but it took him about a month to feel 100 percent.

Now he's back to training. At 6-feet-7, Evan plays competitively 10 months of the year and plans to play in college. Coaches from top schools have already shown interest.

Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Video: Should your child play football?

  1. Transcript of: Should your child play football?

    MATT LAUER, co-host: This morning on TODAY'S FAMILY , kids and concussions. A new study out today reports the number of children seeking medical care for concussions they suffered playing competitive sports has more than doubled. One common culprit

    is football, which leads to the question: Should your child play? Football can be a brutal sport. At times unmerciful and unforgiving. And if you get hurt, the credo is just shake it off.

    Dr. MARK ADICKES (Orthopedic Surgeon, Memorial Hermann Medical Center): Football players are supposed to be tough guys. And so you don't want to come out, you never want to come out.

    LAUER: Ands former NFL offensive lineman Mark Adickes knows a thing or two about pain.

    Dr. ADICKES: I mean, if you can put your own finger back in place and continue to play, that is a badge of honor.

    LAUER: So when Adickes ' young son expressed an interest in playing the sport he'd made a career of, it gave him pause, especially because now in his second career as a surgeon he knows the long-term effects of head injuries way too well.

    Dr. ADICKES: Both of these brains are irreparably damaged. Both of these pictures can be seen after what seems like an innocuous concussion .

    LAUER: Of the 1.2 million high school football players, 55,000 players sustain concussion injuries every year.

    Dr. ADICKES: I think that the parents are very aware of what is going on with concussions. I think that the world of football is still a little bit too macho, you know, knock-the-snot-out-of-them kind of -- kind of game.

    LAUER: But now concussion awareness is coming right from the top. The NFL is hanging posters in their team locker rooms warning players of head injuries and reminding them other athletes are watching.

    Dr. HUNT BATJER (Helped Draft NFL Concussions Poster): That's one of the reasons we're reaching out to the -- to the youth athletes to educate them early into the potential long-term implications of these types of injuries.

    LAUER: And now some high schools are on the lookout as well.

    Dr. ADICKES: They're going to throw a number of words and then it's going to go back and repeat some words and you're going to have to answer was this one of the words or not.

    LAUER: Second Baptist School in Houston , Texas , where Mark Adickes ' son Micah plays varsity football , administers mandatory baseline neurological tests to its players at the beginning of each season.

    Dr. ADICKES: When you press the start button, you will have three seconds to place your fingers on a Q and P keys to respond to the stimuli.

    LAUER: And then again after severe impact to retest cognitive function. The player can only be cleared to play again by a trainer, not a coach. As for Mark Adickes , he is choosing to let his son play. But for other children he would ask parents to give pause.

    Dr. ADICKES: The life lessons learned playing football are just -- are too numerous to even name. I mean, overcoming adversity, goal-setting, delayed gratification, leadership. But if your kid is playing football in a league where there either is not good equipment and you can't provide it for them or if they're playing in a league where the coaching is such that they're learning techniques that are going to get them in trouble, then they're better off not playing.

    LAUER: As we mentioned, Mark Adickes is a former NFL offensive lineman who's now an orthopedic surgeon at Memorial Hermann Medical Center . That's in Houston . His son, Micah and Micah 's friend, Ethan Hackett , are freshmen who play varsity football . Guys, good morning to all of you.

    Dr. ADICKES: Good morning.

    LAUER: That number jumps out at me, Mark , 55,000 concussion injuries among young people every year. That's a lot of kid getting -- kids getting knocked around.

    Dr. ADICKES: It really is. I mean, it's a rough sport. The scary thing is that there are probably more. Because football is a macho sport where your injuries are a badge of honor, I think -- I think a lot of these go unreported.

    LAUER: You say it's a rough sport and you almost make it sound like it's just going to happen. But it avoidable? In other words, within that rough sport are there ways through coaching and better equipment and technique to lower the number of these injuries?

    Dr. ADICKES: Well, I think that there definitely is. I think the helmets have improved dramatically. But with these better helmets guys can hit harder so technique is equally as important.

    LAUER: So you talk about pressure. I mean, Micah and Ethan , you're both playing football . You take a shot in a game tomorrow and you don't know which end is up, is there pressure spoken or unspoken for you to get back in the game?

    Mr. MICAH ADICKES: No. Our coaches, I mean, if you're hurt, you're hurt. They're not going to pressure you to go back in the game. There's plenty of guys out there to go back in the game. And if you -- if you're feeling bad, you're feeling sick, you're hurt, just get out of the game.

    LAUER: Ethan , do they talk to you specifically about these kinds of injuries? Do they talk to you about the dangers and risks of concussions?

    Mr. ETHAN HACKETT (Freshman Varsity Football Player): Well, yeah. We take the test before and it just sort of goes through everything about concussions and everything so we know the symptoms and everything.

    LAUER: We talk about the NFL getting involved here and they're hanging these posters in their locker rooms saying "other athletes are watching." They're talking about these guys right there.

    Dr. ADICKES: Without a doubt.

    LAUER: And by the way, a study today in the Journal of Pediatrics , a huge jump not only in high school students, middle school , elementary school students experiencing these concussions. Are we going to make a real change until those NFLers , their idols, start coming out doing television commercials warning of this?

    Dr. ADICKES: Well, I think part of it is is that they watch the way the NFL guys hit. And so if there are some subtle rule changes, like they've made, you can't hit the defenseless receiver, you can't hit the quarterback a certain way, if they make some subtle rule changes I think it'll help because it sets an example for these guys.

    LAUER: And one thing I know you want to make very clear, it's not the risk of getting a concussion , the real risk is another concussion .

    Dr. ADICKES: Once you have a concussion , your brain is healing. And it's not something you can see. It doesn't show up on MRI or CT . And if you get hit again before you're fully recovered, that's when bad things happen, your brain can swell.

    LAUER: And just walk in here, you mentioned helmets at the beginning. Proper helmets have some sort of a label or an imprint on them so you know you're getting the proper protection?

    Dr. ADICKES: That's true.

    LAUER: So you got to be careful. Get the proper equipment, get the proper technique and discuss this. You happy you made the decision you made?

    Dr. ADICKES: Absolutely.

    LAUER: Yeah, it's OK he plays?

    Dr. ADICKES: Yes, it's fine.

    LAUER: Yeah? OK, good. You have no choice now anyway. Yeah. Good luck. You guys good this year?

    Mr. ADICKES: Yes, sir.

    Mr. HACKETT: We're good.

    LAUER: Good, good. I like to hear that. Micah , Ethan , Mark , thanks so much. Appreciate it.

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