When it comes to youth-sports concussions, Dr. Robert Cantu knows what he's talking about.
Cantu, who serves as the chief of neurosurgery at Emerson Hospital and the co-director of Boston University's Center for the Study of Traumatic Encephalopathy, has long been considered one of the leading U.S. youth-concussion experts.
Now, in a new book just published Tuesday, "Concussions and Our Kids," Cantu lays out a number of potentially controversial recommendations to help prevent youth-sports concussions, including restricting youth-athletes under the age of 14 from playing tackle football, body-checking in ice hockey, or heading soccer balls.
I spoke with Cantu over the phone on Wednesday to discuss his new book; the ongoing youth-sports concussion crisis in the United States; and how to best address youth-sports concussion prevention.
Below, I've posted an edited transcript of our interview:
EdWeek: In the book, you make a couple of potentially controversial recommendations, including a proposed restriction on any child under 14 playing tackle football, body checking in hockey, or heading soccer balls. Why did you choose the age of 14, specifically?
Cantu: It's a good question. Some people at age 14 are physiologically 11 or 10. Other people are skeletally mature adults. So, the age is not perfect, no age would be. I chose it simply because that means high school and above. You have to start playing sports at some point similarly to the way you're going to play them in college, if you plan to play them at college. I use the age of 14—and don't have any problems with 16 or 17 if [the student-athletes aren't] skeletally mature—but the reason besides that is the increased vulnerability of youngsters. ... They're bobble-head dolls with big heads and weak necks.
EdWeek: After age 14, are you still lukewarm about teenagers' participation in contact sports such as football and ice hockey? Are those sports fundamentally unsafe, as currently played?
Cantu: I am if they're skeletally immature. If they haven't developed any pubic or axillary [armpit] hair, I think you can make the case that you should hold them out a bit longer. I feel very strongly that if an individual starts playing a sport in high school, they'll be up-to-speed with someone who's been playing the sport since age 5 by college. It'll make you better at those early years, but it won't make you better by the time you get to college. Tom Brady is a good example. His dad held him out of tackle football until high school, and he doesn't seem to be any worse for the wear, does he?
EdWeek: Hypothetically speaking, let's say my kid just sustained a concussion. What would you recommend I do?
Cantu: The first step: He would be out of all practice and all play. Depending on the severity of symptoms, he would not only be physically rested, he'd be cognitively rested as well. If he has trouble with concentration or memory, I wouldn't ask him to do homework and would scale back his schoolwork to avoid aggravating symptoms. You'd hopefully scale back assignments and still have him go to school, but it's a trial basis.
EdWeek: What's the No. 1 thing parents need to know about youth-sports concussions?
Cantu: Youths are particularly vulnerable to concussion compared to an adult. No head trauma is good head trauma, and repetitive head trauma is just asking for a permanent brain injury. So, don't be paranoid about it if your child receives a concussion. One concussion, most probably, will not have long-lasting implications. It could, in a rare situation, but most likely won't. Understand that cumulative trauma is what sets people up for later-life difficulties. It's not just the number of concussions, it's the total amount of brain trauma that a youngster has taken.
EdWeek: What do you think of the NFL's model youth-concussion legislation, the Zachary Lystedt Law?
Cantu: I think it's not perfect but it's very, very good. I like all aspects of it. The only thing it doesn't do is essentially put teeth into the law. It doesn't say what the education is going to be for parents, athletes, and coaches. It doesn't say what the education or credentials have to be for the medical personnel who are returning people to play. It's a huge first step in the right direction, but the next steps are going to be how it's going to be implemented; in other words, how you make sure it's really being done.
EdWeek: Do you have any advice for the 10 or so states that haven't yet passed youth-concussion laws?
Cantu: Yeah, get on board. You're not looking very bright. How could you not care about the health of your youths' brains?
EdWeek: What do you think are the keys to youth-sports concussion prevention?
Cantu: I think No. 1 is to avoid head trauma whenever possible. I'm a realist; I really don't want to see youngsters subjected to repetitive head injuries. Ideally, I'd like to see nobody subjected to them, but I'm a realist. ... Let's think about this: You can eliminate 60-70 percent of head trauma by taking it out of practice. And it's not necessary to bang heads in practice. Think about where the NFL has come in terms of that. The season is now 18 weeks long; only 14 times in 18 weeks can there be full contact in practice [according to the league's latest collective bargaining agreement]. There have been huge reductions in brain trauma sustained by NFL players just because of the way they're practicing now. In the Ivy League, they've limited contact practices to twice a week. Especially at the youth level, don't bang bodies [in practice]. Hit pads, hit tackling dummies, don't hit heads on heads.
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