Lack of ZZZs May Increase Injury in Teen Athletes

Teens always seem tired, except maybe on Saturday night. As parents of adolescents, we’ve all been there. We encourage them to get sleep to be at their best: to get good grades, be sharp in school and at work, to stay awake and alert playing in goal and even to act polite at the dinner table.

But there may be something more important that comes from enough sleep. That’s an immunization against injury. A recent study from Connecticut shows that athletes who slept “at least 8 hours per night were 68% less likely to be injured, compared with athletes who slept less. Interestingly, the level of sports participation, commitment in terms of hours of training and practice, number of sports, private coaching or an attitude of “having fun in sports” did NOT correlate with increased injuries. The study was reported in the November 2012 issue of Infectious Diseases in Children. (

No mention was made of types of injuries but we can be sure that head injury and concussion figure in this data. It’s startling to me when I review ImPACT tests on athletes at school, whether baseline tests or post-injury tests, how often students report 4-5 hours of sleep the night before. So in addition to making them prone to bad moods, inattention and trouble learning, we now can point out that lack of sleep may well have contributed to the injury itself.

All this seems logical to parents who are perennially concerned about teens’ lack of sleep. But this might not be so evident to coaches, certified athletic trainers and athletic directors. Of course, “policing” or encouraging good sleep habits starts at home. But sometimes a student will hear the advice with a more open mind from a mentor on the team.

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“The Roots of Football”

Headlines have made us dizzy about the sport of football and raised questions that challenge the very core of American culture.

  • Is it more dangerous than it used to be or are we just becoming a nation of sissies?
  • Is it ok to let our children play this All American national sport or is it simply too risky?
  • How old should an adolescent be before being allowed to play tackle football?

In a recent article. “The Roots of Football” (published in The New Republic and excerpted in The Week), Rich Cohen, chronicled the history of the sport and noted that “(football) expressed certain truths about American life: the danger of the mines and mills, dirt, struggle, blood, grime, the division of labor, the all-importance of the clock.”

His assessment speaks to one of the thorniest issues I have grappled with personally as I have supervised concussion management in my patients as well as in school and college health and the issue is this:

If a student undergoes a baseline neuropsychological test and has results in the very lowest percentiles–showing that even before engaging in a season of tackle and head rattling he is intellectually low functioning according to these test standards—should we really allow such a student to play and risk further dysfunction? Should parents give specific consent for their sons to play football if we know that their cognitive functioning and perhaps long term brain function may be in jeopardy? Does it become a game for smart kids who have something to spare? Or does it become a game where we knowingly sacrifice our lowest functioning students? What about the racial, socioeconomic and ethical issues that this raises in our communities?

Of course we need separate and appropriate standards for our youth from those the NFL is imposing on its players. Cohen says: “There has always been an implicit bargain for football players: They trade tomorrow for right now, handing their middle years over to their youthful selves to devour in the course of a few seasons.”

As a pediatrician it seems obvious that we should develop a different standard for our children, teens and young adults. And maybe what we can hope for is a “trickle up” effect so that NFL players will no longer admit to lying about their symptoms when concussed because they have a responsibility to be good role models. When star players admit they would no longer allow their own sons to play football, as Terry Bradshaw did recently, you know change is in the works. It will “take a village” for all of us to manage this change in the game, to prevent head injuries, manage concussions, and keep our children and their legacy as safe as possible.

Are We Ready To Change The Rules?

For years I have been advocating for the safer prevention and management of concussions, particularly but not exclusively among the young people in our schools and colleges. At the same time, as a pediatrician, I am concerned about obesity prevention, fitness and good healthy habits and would not discourage any good, salutary physical activity. 

So it is with some hesitation that I express concern about Dr Robert Cantu’s recent position at a FIFA conference in Europe where he “urged the outlawing of tackling in football, heading in soccer and body-checking in ice hockey in youth matches” in players under age 14. My concern is that this will be construed as an extremist call to discourage the love of these sports in kids.

Read the coverage in full here:

As a pediatrician specializing in adolescents and a mother of seven young adults, I am acutely aware of individual developmental differences. If we looked at a line-up of normal fourteen year olds they could vary by 50 pounds in weight and 8-10 inches in size.

To make a blanket recommendation about sports based on age alone, which I do not believe is substantiated by any current research but represents Dr Cantu’s opinion, is to invite criticism from skeptics and nay-sayers about current concussion recommendations.

The cause of improved management of traumatic brain injury and concussions is best served by more research combined with good common sense. Perhaps Dr Cantu’s recommendation is borne of the “common sense” approach. To be fair, Dr Cantu and his colleagues in Boston are involved in important studies and research to bring more investigative science to this discussion.

In the mean time, most states have now developed strong recommendations for public schools to follow and have begun raising awareness about this newest public health issue—concussion prevention and management. We all need to support safety without harming the greater cause of sports and athletic participation for our young people.