My youngest son has always been big for his age, and by age eight he outweighed his ten-year-old brother.  Based on his size and athletic abilities, I signed him up for the bantam football league run by the local high school’s football coach.  I assumed that due to the players’ smaller sizes, the risk of serious or catastrophic injury was relatively small.

We knew many families who had children in the football program, and thought it was run with basic age appropriate safety measures in place.  We didn’t realize the football program was run without any oversight other than the volunteer board.  Since the league had entered into a facilities rental agreement with the high school, the school believed it had no liability and felt no duty to provide oversight.

When I signed him up, I mentioned he had never played before (his normal fall sport is soccer) and was told that would not be a problem.  We weren’t told that due to a small turn out for the third and fourth grades, he was placed in a practice group with wide experience discrepancies that would make practice difficult for the volunteer coaches to manage.  We weren’t informed about the importance of properly fitted helmets, or the need to regularly check them for appropriate inflation.  (We later learned the helmet provided to him was one size too large, and that without regular maintenance, it loosen up as the season progressed.)

Most practices focused on a tackling drill where the boys would separate into a line of ball carriers and tacklers.  After each turn, the boys would run to the end of the opposite line.  When my son was injured, he was matched up against a larger and more experienced fourth-grader.  He took a hard hit as a ball carrier and struck the back of his head against the ground.  Towards the end of the two hour practice, he ran as fast as he could to make a tackle, but when he forgot to stay low, he clashed face masks with the ball carrier, rebounded quickly, and forcefully struck the back of his head against the ground again.

The hit was loud enough to get the attention of the parents watching practice.  He was hauled to his feet by a coach, set back a few steps between the two lines of players, and allowed to cry as the drill restarted.  I approached while waving him towards me, but it became apparent he was unable to walk off the field on his own.  I feared having to walk through the tackle drill.  Thankfully, a parent who coached games intervened and escorted him to me.

I checked his pupils and didn’t notice anything out of the ordinary.  Once he was able to talk, he told me his head and neck hurt.  As time went by his headache decreased in severity, so I took him home.  I asked him a series of questions from an internet site on concussions and was unable to identify any signs of confusion or speech impairment, so I decided to wait until the next day to call the pediatrician.

In the morning he told me he had a headache, but there was no outward sign of pain.  I didn’t realize a dull ache was indicative of a concussion.  I drove him and my other two children to school, and called the pediatrician from his classroom.  I had no idea taking him to school could impede his recovery or exacerbate his symptoms.

Although I told both his teacher and the school nurse I suspected he had a concussion, and expressed concerns about recess, he was sent to gym class while still experiencing a concussion headache.  When I picked him up for his evaluation, he told me he wasn’t able to run as fast as normal, and had been unable to do the flex arm.

Based on his evaluation form, he was supposed to have full academic accommodations, including a reduced workload and breaks for rest/naps, and no gym.  I often volunteered in his classroom, and didn’t notice a material reduction in his workload.  He generally had enough energy to go to school, but wanted to rest once he got home and struggled to complete homework.  I arranged to bring him home an hour early so he could avoid recess and get extra rest.  We stopped taking him to any activities outside of school.  His television viewing and computer usage were strictly limited, and video game playing was totally eliminated.

When his headaches continued past the first few weeks, he was accused of lying by his principal.  Since his vestibular system problems were only evident during postural stability testing, the principal doubted he truly had balance problems.  I asked my son about his headaches each day and my notes clearly show they went away on the weekends and returned during the school week.  I had no reason to be suspicious, because there were consistent patterns for likely triggers, such as usage of a math software program in the afternoons.

When I picked him up from school for his third concussion evaluation, his hair was drenched in sweat from walking laps during gym.  When he failed to show any balance improvement, his pediatrician said his lap walking had most likely exacerbated his concussion symptoms, and that we wouldn’t be able to tell if his balance had improved at rest until his next visit.

The following day, even though I sent an email indicating his balance had not shown improvement, during a conference with his teacher and principal, I was accused of failing to recognize that he no longer required accommodations.  I was upset about his lack of improvement, and was frustrated that my concerns were brushed aside.  I was told that with the beginning of the next school week, he could no longer leave early.

Luckily, there was a five day fall break scheduled for that week, and I was able to ensure he had a lot of rest.  He went in for an evaluation the Monday immediately following the break, and his balance showed marked improvement.  Unfortunately, when he returned to school, he got another headache during afternoon computer lab.  His pediatrician said if his headaches continued past a certain point, he would need to see a pediatric neurologist.  I decided to bring him to a sports specialist for a second opinion.  The specialist said normally a scan is done to check for structural problems when symptoms last so long.  We decided to hold off on the scan, and he suggested a gradually increasing daily walking program, beginning with twelve minutes and increasing by two to three minutes per week.

Based on internet research, I added fish to his diet and provided omega three supplements.  I also covered his windows so he could take rest breaks in a darkened room.  By his next visit, he exhibited additional improvement, and only complained of lingering fatigue.  We were told to keep all restrictions in place and to hold off from full participation in gym for a few more weeks.  Due to his age and the length of his recovery, as an extra precaution we agreed he would not participate in organized sport activities for the next few months.

My son’s concussion initially did not seem severe and he was able to function well and maintain good grades at school.  However, he had vestibular system problems, headaches, difficulty falling asleep, and fatigue for weeks and was not cleared to participate in gym for over two months.  My advice to parents is to never assume a sports program is run with age appropriate safety measures in place.  Ask questions about player safety and injury prevention, recognition, and response even if you know other families participating in the program (if the answers aren’t satisfactory, do not allow your child to participate in the program).

Additionally, regardless of how mild a concussion may initially seem, insist on complete cognitive and physical rest, with a gradual step-wise return to a full schedule.  It’s better to be conservative and allow full recovery, than to face guilt and regret weeks or months later.

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