One of the most influential people in your child’s sports experience is the coach (or coaches). These people set the team culture, organize team activities, and make decisions on equipment. Most (if not all) high schools and youth sports leagues require coaches to complete a standard training program that minimally includes training in first aid and CPR and basic sport specific skills and drills. More recently, training is also required in concussion recognition and management. For those sports that require equipment (e.g., football and boys lacrosse) coaches may or may not have training in recognizing proper fit and use of equipment. As a parent it is important to understand what is required by your organization’s governing body when it comes to training for coaches.

Key Governing Organizations:
When focusing on youth sports and private leagues, many have a national organizing body that set policies and procedures for your local league. These organizations not only have bylaws and guidelines for rosters and tournaments, but also often dictate policy on training for coaches and safety guidelines for athletes. It is important to be familiar with the policies set by the governing organization. There are hundreds of youth sports organizations out there ranging from the Amateur Athletic Union (AAU), Police Athletic League (PAL), YMCA/YWCA to USA Football and Little League. It is always important for parents to research their leagues to understand what the league governs. When investigating your governing organization you will want to consider the following: 1) required training for coaches, 2) concussion policy and education, 3) game safety rules, and 4) specific equipment guidelines. Not all leagues govern the same things, but to give you a head start on some of the major national organizations that govern youth sports check out this list:

- USAFootball
- PopWarner Football
- AmericanYouth Football Organization
- LittleLeague Baseball & Softball
- BabeRuth League Baseball & Softball
- Amateur Softball Association of America
- US Lacrosse (Boys & Girls)
- American Youth Soccer Organization
- US Soccer (Boys & Girls)
- USAHockey (Boys & Girls)

A majority of states have some form of concussion legislation meant to protect young athletes. This legislation not only sets guidelines for how concussions are evaluated and managed following injury but also requires education of parents and coaches on the recognition of the signs and symptoms of concussions. Given the growing demand for education and training there are several qualified groups that offer training in this area. Two of the more common programs are Concussion Health and the Centers for Disease Control (CDC) “Heads Up” on Concussions program. Concussion recognition is also part of the Athletes Saving Athletes program offered by A4IA. Remember, the state legislation focuses on school sports, not private youth leagues. You should check with your local league and national governing body to obtain the details of the concussion program and policies in your given league. I would advocate for all leagues to have a standard concussion policy if one is not already in place and it should include education for coaches and parents.

Many sports require that participants wear protective equipment of some kind. The amount and type of equipment varies by sport and position. When utilizing equipment it is important to note the following: 1) equipment is appropriate to age group, 2) fit is appropriate and reassessed regularly, 3) participant wears/uses equipment as intended, and 4) equipment is in working order and not worn or broken. Failure to follow these guidelines can increase the likelihood of injury. Equipment has a specific purpose and its effectiveness improves when worn properly. Given this, it is important to remember that no equipment will prevent all injuries.

Helmets are one of the most commonly worn pieces of equipment in sports, especially given the popularity of tackle football in the United States. Helmets in conjunction with a facemask are designed to prevent skull fractures and other injuries to the face. Many recent technological changes have been made in an effort to decrease the occurrence of concussions, but helmets cannot eliminate concussions completely and do not prevent the possibility of neck injuries. All helmets whether football, lacrosse, hockey, or baseball are certified by a national organization. Football helmets must be reconditioned annually in order to ensure their effectiveness. The National Operating Committee on the Standards for Athletic Equipment (NOCSAE) certifies football, lacrosse, baseball, and softball helmets. Hockey helmets are certified by The Hockey Equipment Certification Council (HECC) in the United States.

Resources for fitting equipment: USA Football & US Lacrosse

Mouth guards are another common piece of equipment. There is a wide variety of options when selecting a mouth guard. Just like a football helmet, one of the most important factors in its effectiveness is fit. When fitted properly the wearer should still be able to breathe and speak normally. The purpose of mouth guards is to prevent dental injuries. There is no current research that validates the claim that mouth guards help prevent concussions. Be careful when spending additional monies on a mouth guard because it states that it will help prevent concussions, an unproven claim. Heat and mold mouth guards typically cost much less than customized mouth guards made by a dentist. Both can be effective, but typically, the fit is much better with a custom mouth guard if the cost is not prohibitive. The key to the best fit with a heat and mold mouth guard is to follow the molding instructions carefully and be sure to suck on the mouth guard when molding, do not bite it.

Resource for selecting and fitting mouth guards: American Dental Association

Football Skills:
Tackle football is a very popular sport in the United States with about one million participants in high school football alone. The recent focus on concussions has also put focus on the health and safety of participants. While Pop Warner already has weight and age guidelines in place, there has been a renewed focus on teaching proper tackling technique to young participants. The USA Football Heads Up Tackling program focuses on training for coaches and helping kids use proper technique on the field.

Baseball Pitch Counts:
Pitch counts were first instituted in Little League baseball in 2007 after research showed that the number of pitches thrown was a primary factor in elbow and shoulder injuries in participants. Since that time, coaches and teams have been expected to follow pitch count guidelines. The USA Baseball Medical and Safety Advisory Committee published pitch count guidelines in 2006 that can be accessed by clicking HERE. If you would like a brief summary of the guidelines used by Little League Baseball, click HERE. A full rule book can be purchased from Little League Baseball/Softball.

I place particular emphasis on pitch counts because a recent study by Fazarale, Magnussen, Pedroza and Kaeding (2012) in Sports Health: A Multidisciplinary Approach demonstrated that coaches were deficient in their understanding and application of pitch counts for their players. The 95 coaches (of 228 asked) who completed the survey were only able to answer 43% of the questions regarding pitch counts and rest periods correctly, while 73% reported that they followed the recommendations. While many coaches feel they are following the guidelines, they may not be. Parents should always follow up and be sure key guidelines are being followed.

As parents, you always want your child to participate in sports as safely as possible. A big part of that is following up with coaches and asking the right questions about their training, coaching philosophy and technique. Coaches set the culture for the entire team and have the best opportunity, outside of individual parents, to create an environment of respect and safety first. Understanding a coach’s philosophy on checking equipment regularly, concussion programs, and following specific sport safety guidelines will go a long way toward ensuring the safety the entire team and league.

To review questions 1 - 4 of 5 questions parents should ask:

Does the league/high school have an Emergency Action Plan (EAP) in place?

Is there an Athletic Trainer available?

Is someone who is trained in CPR and AED available at all times?

Is there an AED available?

Submitted by Heather L. Clemons, MS, MBA, ATC