What’s the story? The fear of concussions in football has resulted in fewer children participating in youth leagues across the U.S since 2009. However, because of the way that local youth programs have handled concussions and having experienced officials and coaches being able to spot one, numbers have remained steady for a local Pop Warner league.

How does it affect me? Coaches and league officials reveal how concussions are handled and how coaches and other personnel are trained to spot one and reduce the risk of one occurring.

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In any sport, there is a risk of injury.

But one in particular has received a massive amount of attention from the media and people around the U.S – concussions, especially in football.

Earlier this month Bennet Omalu, who first discovered the degenerative brain disease chronic traumatic encephalopathy, which results from repetitive brain trauma, and the dire effects it can have, compared playing football to child abuse. He also suggested that stated no one under the age of 18 should play football.

According to the Concussion Legacy Foundation, in CTE, a protein called Tau forms clumps that slowly spread throughout the brain and kill brain cells.

There was a recent study that showed 110 out of 111 deceased NFL players who donated their brains for research showed they had signs of CTE, according to an updated study published in The Journal of the American Medical Association on July 25.

According to nbcchicago.com, the heightened awareness of concussions is one reason youth tackle football league participation across the nation has been declining since 2009. In April 2016, ESPN reported that 3.96 million children ages 6-17 participated in tackle football in 2009. In 2015, that number dropped to 3.21 million.

So, what effect has increased awareness had on participation in youth football in Eastern Jackson County? Not much, if you ask Heart of America Pop Warner president Terry Bowen.

He said about 1,100 children are participating in a league that says it’s “the largest and oldest Pop Warner league in Missouri,” and that number has remained steady for the past couple of years.

That number is consistent with what has been reported elsewhere. According to a report from Forbes, statistics measured by USA football and National Federation of State High School Associations, numbers of participants in flag and tackle football saw a slight increase in 2015.

That doesn't mean there aren't some concerned parents out there.

One of them is Kristi Cipolla, who has a son who plays for the age 11 Independence Bears football team. He suffered a concussion on a playground when he was 5 years old and she knew of the effects of it.

She was hesitant to put her son in a football program at first until Bears coach Jeremy Bowen explained the process of how concussions are handled, which made her comfortable to let her son play.

“I was concerned and worried,” Cipolla said. “The coach is a good friend of ours, and we talked about it. He said if he noticed any signs (of a concussion) or anything that happens on the field, he would take care of our son. We are all watching to make sure he’s safe.”

A fellow parent of a Bears player, Jace Berberich, echoed her sentiments.

“I think (the Pop Warner) league handles it pretty well,” he said. “Anything that looks like it could be a possible head trauma or anything, they will take him out. He’s been taken out once but everything was fine. They are pretty cautious when it comes to that stuff.”

Added another Bears parent Christine McCarthy: “I have two boys who play football and we’ve seen a lot games and a lot contact. We’re not concerned at all. There’s not a lot of head-to-head contact but it happens occasionally.

“I’ve seen it happen twice. The refs are right there and with the children being at a young age, they are more adamant about watching for that. I saw one last year, and everyone jumped on it and they stopped the game. They talked to the boy who got hit and the boy who made the hit. It’s a big deal. They want all the boys to know that it’s not OK to hit the head.”

Being cautious is key to protecting a child from a possible permanent brain injury.

In addition to the risk of getting CTE from a concussion, there is also another concern associated with head injuries called second-impact syndrome. It’s a rare condition in which a second concussion occurs before the first one properly heals. Second-impact syndrome can cause brain swelling and sometimes can be fatal.

That’s why making sure a player is removed from the game after showing symptoms and is kept off the field until the injury is completely healed is critical. Dr. Lori Boyajian-O’Neill, a sports and and family medicine physician at Centerpoint Medical Center who has worked with patients with concussions, said athletes who play sports at high school age or younger are more prone to concussions than a college or professional athlete.

She said athletes who play any sport must be symptom free for several days before it’s safe to return and said the minimum amount of time a player should sit out following a concussion is four weeks. Sometimes, that can be several months.

Boyajian-O’Neill added that the key to making sure that a concussion is fully healed is to have the athlete exercise aside from what they would do in practice. If that athlete is still symptom free even after a certain amount of physical exertion, they can return to play their respective sport.

“If they have no symptoms at rest and have no symptoms after five to seven days of exertion, they can safely return to their sports,” she said. “(Concussions) can last a couple of months, four months, six months, a year,” Boyajian-O’Neill said. “If they have had the symptoms for two to three months, I would have them exercise longer than five days. It just depends on the case. It also depends on what treatments and medicines they’ve had to have.

“If they come to me and say, ‘I feel great. I haven’t had any symptoms for a week,’ I am not going to say, ‘Great, go back out there and play.’ If they have 12 weeks of symptoms, that’s different. We have them run and jump and physically exert themselves over a five-stage period. Every day you can do a different stage. We have to see if they can be symptom free after physical exertion. If they start to feel symptoms again, we have them take a day or two off and resume the stage they are on.”

Those are some of the reasons why Terry Bowen said his Pop Warner league won’t allow a player to return to play or practice until they have a doctor’s note clearing them.

The league has taken steps to help reduce the risk of concussions, including having all of the coaches participate in the Heads Up program, which was developed by USA Football and teaches coaches about player safety and how to help prevent injuries.

Every coach in the league is certified in the Heads Up program, Terry Bowen said. Each coach also has to take a Pop Warner test on safety. That includes teaching the players how to properly tackle an opponent at an early age. Any contact to the head is outlawed and will result in a penalty.

This has helped the Pop Warner league tremendously, Terry Bowen said. He said the league had a 100 percent rating on its insurance policy last year, which covers 48 teams in the Kansas City area, meaning there were no reported injuries.

“The program has been implemented the last five years,” Terry Bowen said of Heads Up. “After five years of training, we are seeing these boys now, who are 10 and 11, they have been with coaches who have taught that since they were 5, so it’s reducing the amount of injuries that we’re having.

“We don’t lead with our head, we lead with our shoulders (on a tackle). We’re wrapping up and finishing the tackle. There is no more head contact on offense or defense. Also there are push blocks, there is no more face-to-face contact anymore. If any of the coaches see someone lead with the head out here, we take them out of the game, explain it to him and then let them go back into the game. We gave parents information on this, so if a parent sees their child doing that, they can teach them at home.”

So what about those times that a player might have suffered a concussion? What do the teams do?

It helps that the referees in the league are all Missouri State High School Activities Association officials who have been trained on how to handle possible concussions. If there is a hit to someone’s head, the official or the coach will take that player out.

The coaches look for concussion symptoms such as headaches, nausea, blackout, disorientation, light sensitivity, blurry vision, fatigue, poor balance, etc. The coaches will then summon the parent of that child and tell them what happened. And the parents determine if the child goes back into the game after the hit, if no concussion symptoms are present after the hit. If an official determines that player is done for the day, they are not allowed to re-enter. If that happens, a doctor’s note must be provided before that player can resume practicing.

“Preventative officiating is key,” Jeremy Bowen said. “All these guys are MSHSAA officials and they are trained to spot a player who might have a concussion. All of the coaches in the league aren’t just dads volunteering, but those who have coached and played sports for years and know what concussion symptoms are.

“We actually start the first two weeks out by spending 10 hours conditioning and training and doing drills without pads. We just don’t start out tackling from the get-go, especially for those kids who have never played tackle football before.”

Concussions are something the league is very cautious with and takes very seriously, Jeremy Bowen said.

“I am not a doctor and the officials are not doctors,” he said. “If a kid has a headache or a (memory loss), or if you see a kid slam his head or get hit hard, or maybe he’s nauseous, those are all signs of a possible concussion, but no one here will diagnose one. That’s only done by a trained professional.

“So if any coaches or any official notice a kid who has fell down or hurt themselves and showing those signs, those are all things we’ve been trained to see and the child is immediately pulled out of the game and the parent is immediately notified. They are out for the rest of the game, no questions asked.”

Added Terry Bowen: “We’re here for the long term. We are not here to win today. We want to make sure (each player) is safe and can enjoy the program for eight years and is able to play in the future.”