How Many Concussions Are Too Many for a Young Athlete?

Question: 

My 16-year old daughter has had two concussions — one while skiing, the other while biking. Now she wants to get into competitive cheerleading. Should I let her?

Answer: 

That depends on several factors. When were the concussions and how close together were they time-wise? If one of her concussions is recent — and especially if she is still experiencing post-concussive symptoms such as headache, fatigue, irritability, and sleep problems — taking on cheerleading or any other sport right now would be inadvisable. Balance can be affected and vertigo or dizziness can also be an issue following a concussion; these symptoms increase the risk of re-injury.

Two concussions within a few months would be a concern, especially if your daughter had not fully recovered from the first concussion before she sustained the second. The first concussion puts her at risk for what is called "second impact syndrome," in which the effects of the second brain injury are more magnified than they would have been had there been no first concussion. And a third concussion, should one occur with the cheerleading, would also have a great effect on the brain and increase her likelihood of having permanent problems.

As for cheerleading specifically, if your daughter is a "tossee" — the one who is tossed into the air and caught or who balances precariously on top of others — then this is particularly a concern. The "tossee" in a cheerleading squad is most at risk for falling. A "tosser" — the one who throws another person and catches her — is at lower risk of injury, but every person in the squad plays an integral role in their own and their teammates' safety.

I would recommend against participating in cheerleading until at least a year has passed since the second concussion. This is a conservative recommendation. There are no standard guidelines as to when a child or adolescent should return to sports after a concussion, though some are being developed in certain states. The guidelines that exist are developed for elite athletes who are now recognized to recover more quickly than younger athletes and are monitored more closely for the effects of a concussion.

Since the brains in children and adolescents are still growing, most experts agree that this makes the young brain more susceptible to the effects of the concussion and that it takes longer to recover.

So … "when in doubt, sit it out."

Posted on BrainLine May 6, 2011.

Jane Gillett

Dr. Jane Gillett was a neurologist certified by the Royal College of Physicians and Surgeons of Canada in both pediatric and adult neurology. She created and developed the Pediatric Acquired Brain Injury Community Outreach Program, Children’s Hospital of Western Ontario. She died in 2011.

Comments (25)

Hi I'm 16 years old and I have had 6 concussions lately I have been very angry and agitated is this something to worry about? I haven't had a concussion in about a year. I don't know if its just teenage fazes or if its something to worry about.

im 17 and have had 4 concussions the doctor said that these are normal signs from getting concussions

I am 20 years old and I play college field hockey. I am also a goalie. I just received my fourth concussion, spanning since my sophomore year of high school, and it has been a year since my last one. Is it time to stop playing?

i guess a big part also in mine were, i have never been knocked out and i also finished every game that i got the concussions in even tho they were major i just never noticed i had the concussion until the next day waking up and being in agony and always feeling cold and just no balance what so ever i couldnt take one step infront of the other without falling.

forgot to say 3 of those were major for the second one that i got in the span of 1 month i couldnt even stand up straight in church for new years eve but yet i have no real problems going on in my head im not depressed nothing like that i just wanna live life to fullest and play hockey because i feel like if i quit hockey thats when the depression would kick in and im sure you love field hockey as much as i like ice hockey

nah bro keep on keepin on id say keep playing if its what you love but if not then quit. last hockey season(midget aaa) i had 2 concussions in the span of a month came back and finished the season and then my second game in this year i got another concussion also simply got one from smashing a beer over my head for god sakes. im currently still planning on playing the rest of my season but if i get another concussion im quitting. i simply like hockey too much to just quit without seeing what happens next and its my last year in minor hockey. this last one i had was just a slight concussion the doctor just said youve bruised your brain again. now it depends if you yourself are willing to take that risk im currently 17 years old and have had 4 concussions that i know of and am willing to get another but thats just me.

I know this post is old but this is for future people I am 18 years old I have had 6 major concussion over some years and those big ones have gotten to me I have chronic depression my doctor is afraid that I will get a sub dural hematoma, and if I get another major concussion I have 3 highly probable our come and those are be in a vegetable state for life, go in to a deep coma, or just flat out die. Head injuries are nothing to joke around with don’t be like me either I know for some people it is hard to talk about what’s wrong but you need to talk for your own good I am at the point were I don’t even know what’s wrong with my own body.

My 13 yo son has had two concussion on record with the MD, but more minor head injuries we managed at home. He was hit in lax in mid-may and while he feels fine, he actually has nystagmus (twitchy eyes) we wouldn't have noticed were it not necessary for him to get checked by an MD. He still isn't cleared for contact sports and we have an appointment with a neurological opthamologist next month. To all of you athletes - you might feel fine but you might be exhibiting other, more subtle symptoms, and the long term impacts are not yet understood. Please get yourself checked asap. I'm hoping I can persuade my son quit lax and soccer and switch to tennis or track. My coworker has a son who has had a drop in IQ due to soccer related concussions. It's really bad.

Hi, Im 17 years old and I've probably had 14 or more concussions in hockey. This past year I have had 4. Is it time for me to stop playing hockey? Or is it safe to continue.

It's time to stop buddy. At least move to a non-contact league.

Im 16 and i play travel softball ive had about 8 concussions 4 of which were bad concussions with terrible headaches, naseua, and being knocked out on impact. The other 4 i have had were not as bad but my symptoms are seeming to get worse the more i have. Should i stop playing?

this depends if your symptoms are frequent if not and you are not experiencing any difficulties you should be fine

It would be advisable to stop playing hockey for a while. If you are experiencing any symptoms of concussion, you should get checked by a doctor who specializes in head injury and concussion.
I would recommend a year off of hockey (or longer if necessary) unless you feel you are ready.
Make sure to check for symptoms such as headaches, nausea, balance problems, dizziness, fatigue, sensitivity to noise or light, loss of appetite, and insomnia. There are more symptoms, but those are the more noticeable ones.

Don't ask people online! Get into a DR. APPT. With a neurologist! Your life + future are more important than hockey! I have never heard of anyone having so so many concussions! Please get professional advice!
I'm 18 and I have 12 concussions and I'm still doing sports would it be a good idea to stop doing sports?

no play sports

As a hockey trainer, and a hockey Dad, I would say 4 concussions over one season is a high number. If you are playing competitively, I would seek out specialist advise to your susceptibility. The reality is, every time you are concussed, you are injuring your brain. Let me ask you this, if you suffered recurring sprains in your knee, would you continue to play? If you are playing recreational hockey, I would suggest taking a year off to fully recover before returning.
The young men stating such a high number of concussions literally need their heads examined by a concussion specialist. Our son is 14 and plays football, basketball and baseball and received his fourth concussion just today during a game and will see the specialist tomorrow and we will follow his recommendation. Granted their is always recovery time and it will be followed to the letter. Recovery and rest are essential in order that he may rejoin his team. Each year there is a baseline done by the district to evaluate potential concussions. I suggest anyone who has kids playing contact sports, have one done.
I'm 15 and have had 6 concussions, one every year from skiing. In the same night recently I got a concussion, went back out, and managed a massive blow to the head. Should I stop skiing?
I’ve had 4 concussions in my life 3 while playing hockey and I’m almost 19 years old haven’t been knocked out on any of them. I got my first one 7 years ago and never had 2 in the same year and had about 1 1/2 years between a couple of them. I was an average student throughout high school. I just get post concussion syndrome and anxiety gets high. I have taken impact test after my 4 concussion and the scores came back of someone who has never had any sort of trauma to there brain. Just deciding when I call it quits on my hockey career so I have a safe future?
I am 13 years old and have 6 concussions
yall should stop playing sports if you have more then 10 concussions\
Hi, I'm 13 and I've had 3 concussions. All three while playing basketball. I got one when I was 12, and the second two in the same year when I was 13. Now if I get a hit to the head I get dizzy, and a headache. Everything gets really bright and looking at my phone is something I can't do. Even a light tap to the head can cause these problems. I don't want to quit sports but if I need to I will. Not sure what to do...

I am a mother of 3 teenage boys that all play a lot of sports. I think if you have these concussion symptoms triggered so easily you should stop playing because your brain has not fully recovered. definitely go and see your family doctor and get expert advice.

Yes this is what has happened to me I don't know what to do.