It's not just a risk in football.
No one knows how often the youngest athletes suffer concussions, and it's not clear whether better headgear is going to be the answer.
A new report reveals big gaps in what is known about the risk of concussion in youth sports, especially for athletes who suit up before high school.
It's time to create a national system to track sports-related concussions and start answering those questions, the Institute of Medicine and National Research Council concluded Wednesday.
Despite a decade of increasing awareness of the seriousness of concussions, the panel found that young athletes still face a "culture of resistance" to reporting the injury and staying on the sidelines until healed.
"Concussion is an injury that needs to be taken seriously. If an athlete has a torn ACL on the field, you don't expect him to tape it up and play," said IOM committee chairman Dr. Robert Graham, who directs the Aligning Forces for Quality national program office at George Washington University.
"We're moving in the right direction," Graham added.
But the panel found evidence, including testimony from a player accused by teammates of wimping out, that athletic programs' attention to concussions varies.
Reports of sports concussions are on the rise, amid increasing scrutiny in recent years and headlines about former professional players who suffered long-term impairment after repeated blows.
New guidelines make clear that no matter the athlete's age, anyone suspected of having a concussion needs to be taken out of play immediately and not allowed back until cleared by a medical professional.
Although millions of U.S. children and teenagers play either school or community sports, it's not clear exactly how many suffer concussions, in part because many go undiagnosed.
But Wednesday's report said among people 19 and younger, 250,000 reported treatment for concussions and other sports- or recreation-related brain injuries in 2009, up from 150,000 in 2001.
Rates vary by sport.
For male athletes in high school and college, concussion rates are highest for football, ice hockey, lacrosse and wrestling. For females, soccer, lacrosse and basketball head the list. Women's ice hockey has one of the highest reported concussion rates at the college level.
College and high school sports injuries are tracked fairly well, but there's no similar data to know how often younger children get concussions, whether on school teams or community leagues, the IOM panel said.
Could safety gear prevent kids' concussions?
Some equipment ads make that claim. But there's little scientific evidence that current sports helmet designs or other gear, such as face masks or headbands for soccer, really reduce the risk, the panel cautioned.
Still, it stressed that youngsters should wear helmets and other sport-appropriate safety gear, because they guard against other injuries, including skull fractures and face injuries.
"Parents deserve to know how safe their children's safety equipment really is," said Sen. Tom Udall, D-N.M., who is pushing legislation to curb false advertising and encourage improvements to sports equipment standards. "While we can't reduce every risk, we should do everything we can to stop misleading advertising that gives parents a false sense of security."