It’s difficult to say how many concussions are too many. There is no general rule. The American Academy of Neurology recommends termination of the season after the third concussion within that same season. Important for coaches and parents of young athletes to understand is that an athlete disqualified for a “season” may need to continue to be held out through successive sports. Each young athlete must be considered on an individual basis. Factors to consider will be the number of concussions sustained and the severity of each concussion. The risk level for concussion in a particular sport must also be considered as must the athlete’s age and level of participation. Some other research suggests that an athlete who has sustained three previous concussions in a career should no longer be allowed to participate in contact sport.What is known is that once an athlete sustains one concussion, he or she is at increased risk for sustaining subsequent concussions. Furthermore, with the evidence surrounding the need for additional recovery time, coaches and parents should be extremely conservative when managing younger athletes with concussion. Regardless of the number of concussive injuries, return to play should only be considered after all symptoms have resolved and when the athlete has returned to normal on post-concussion neurological or postural stability examinations such as the SAC, BESS or software-based test.

While there is no scientific proof that mouth guards can prevent concussion,42 there is still agreement among many experts in the field that properly fitted mouth guards are an essential piece of equipment for kids participating in contact sports.13 Not only do mouth guards protect the teeth, there are still some people convinced that mouth guards can help to absorb some of the force the head and brain receive upon contact. Most mouth guards worn by young athletes are “boil and bite” guards. They are purchased at sporting good stores, heated up and provide some dentition to an athlete’s mouth. For better results, consult your dentist or orthodontist. They can custom build a mouth guard that provides even more protection while creating minimal interference with normal breathing and speaking.

Returning to play too soon following a concussive injury, even a bell ringer or a ding, can turn catastrophic.Therefore, once it is decided that an athlete is ready to return to play, coaches, parents, and athletes should follow a stepwise sequence to ensure the healing process is complete. Stepwise Return to Play calls for a gradual and systematic return to physical activity. If the athlete is able to complete the activity without the resurrection of symptoms or deterioration of brain function, he/she can graduate to the next step. If symptoms reappear at any step in the sequence, athletes are instructed to step back. Each successful step forward should be separated by at least 24 hours.

Even though they may be academically-strong students, concussed kids may struggle to return to normal in the classroom. Sometimes what they hear is comparable to what Charlie Brown heard when his teacher spoke… “Wa wa wa wa…” Athletes recovering from concussion can appear normal to school personnel, to parents and to their friends. However they can still be facing significant limitations. Physical changes may include headaches, changes in balance and coordination, visual changes (including sensitivity to bright light), sleep disturbances and fatigue. Cognitively, the athlete may also be experiencing symptoms. These can include attention and concentration difficulties, difficulty understanding complex directions, difficulty expressing thoughts and ideas, short-term memory impairments, trouble with reasoning and judgment, and a difficulty to multi-task. The athlete recovering from concussion can become easily overwhelmed and irritable – and is often overly fatigued. Teachers and Counselors should be aware that concussion is a brain injury that can impair normal brain function. As a result, cognitive activity may be impaired while the athlete recovers. Teachers and Counselors should watch for subtle changes in the student-athlete and report them immediately to the Athletic Trainer or Coach so the athlete will continue to be withheld from physical activity: Poor attention span Difficulty concentrating Difficulty following directions Reduced short-term memory recall Delayed processing Inability to complete routine tasks Easily distracted Sensitivity to light/noise Irritable or Withdrawn Here’s some advice for