Concussions in professional football players make the headlines, but child and adolescent soccer players, especially middle school girls, aren't often in the spotlight. In fact, concussion rates may be higher among middle school girls who play soccer than among their high school counterparts. According to Cynthia LaBella, a pediatric sports medicine specialist at Northwestern University's Feinberg School of Medicine in Chicago, writing in JAMA, this suggests that "the need for medical supervision for girls' elite youth soccer may be at least equal to that for high school sports."

Most studies of concussion in athletes use data on only those athletes who seek medical attention. Researchers at the University of Washington took a different approach, sending weekly e-mail surveys to parents of female soccer players, ages 11 to 14 years. Each parent contact reported whether her or his daughter had experienced a hit to the head followed by concussion symptoms, such as memory loss, headaches, or dizziness. Among 351 soccer players, 59 (17%) had concussions, yet fewer than half were evaluated by a qualified health professional. More than half of concussions resulted from contact with another player, and heading the ball caused about a third. Concussions were 23 times more likely in games than during practice. Common symptoms lasted about nine days and included headaches, dizziness, light sensitivity, and confusion.

Players, parents, and coaches are in need of education regarding the importance of reporting concussion symptoms and requiring medical evaluations before children can return to play.

"The school nurse is the touch point for athletes," LaBella said in an interview with AJN. Female soccer players visiting the school nurse for headaches or dizziness should be asked about recent head trauma, and if concussion is suspected, referred to a physician. When students return to school after treatment for concussion, "the nurse becomes the case manager who helps them navigate their way back to classes and sports," LaBella said.-Carol Potera

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