Playing Through Pain? Not for Kids

"Kids take longer to recover," Collins said, often weeks longer than college or professional players. Moreover, those who experience immediate amnesia have more persistent symptoms than the small minority who briefly lose consciousness.

The research shows that exertion, whether physical or mental, can exacerbate and prolong symptoms as an adolescent's brain heals. As it resets its vital electrochemical system, significant rest sometimes is what a doctor should order. Class work could be minimized, tests delayed.

The findings are garnering increased attention and support. Last year, the federal Centers for Disease Control and Prevention released a special Heads Up kit that calls the youth problem serious and "often overlooked." Its slogan -- "It's better to miss one game than the whole season" -- was aimed at coaches and trainers. A version tailored to doctors is expected soon.

The CDC also is funding a study, involving Children's and the Pittsburgh medical center, to devise a screening tool to better detect concussions in youngsters and guide pediatricians and emergency room doctors. Hundreds of patients in the Washington area may participate.

And through a federal grant, the Pittsburgh-developed software that assesses an athlete's cognitive function after diagnosis will be adapted for children as young as 5. Sports programs nationwide have relied on ImPACT for several years. St. Albans School in the District uses it to record base-line data on its football players and other teams for comparison after injuries. A parent whose son suffered a concussion underwrote its purchase.

"It gives us really objective data as a jumping-off point for making judgments about whether an athlete is fit to return to competition," St. Albans athletic trainer Jay Driscoll said. "When they say, 'I'm fine, I'm fine, I'm fine,' we can say to them, 'Then pass the test.' "

The program aided Gioia in evaluating Samantha Tomarchio of Ellicott City this summer. The nationally ranked skater took a bad spill with her ice dancing partner at their training rink in June. Even now, the 16-year-old does not remember exactly what happened.

She wishes she could forget much of the next three months. On the ride home, her head throbbed so brutally that the sound of the car's turn signal almost made her cry. The world swirled wildly for days, long past when an ER physician suggested that she could return to the ice. Her alarmed mother took her to a neurologist, who told Tomarchio to give up her driver's education class and many other activities for a while. Well into July, Tomarchio would go blank for seconds at a time.

"It was a stressful summer," Tomarchio said after a workout two weeks ago, skates exchanged for wedge sandals that earlier would have sent her teetering. At night, even her dreams had spun. She very gradually returned to practice and lifts, for a time wearing a hockey helmet for protection.

"I just want to move on," she said.

At least 300,000 sports concussions occur every year in children; there is no estimate of local numbers. The Children's Hospital clinic sees an escalating number of patients, currently more than 500 a year. Gioia is concerned that too many injured youngsters are not adequately treated.

"There's such a gap between what we know and what we do about it," he said.

On the same morning the neuropsychologist nixed Kerry Aldrich's return to soccer -- she still felt a mental fogginess, she conceded after testing, although "it's getting much easier to pay attention" in class -- John Hamilton got Gioia's okay to play in his high school team's afternoon football game. The District 14-year-old had fallen hard during a mid-September practice but continued without complaint. Only hours later, after he arrived home and couldn't tell his mother where he had been, did anyone know he was hurt.

"I thought he was being smart with me," Constance Hamilton recalled. In reality, he didn't remember being on the field.

John improved fairly rapidly, though not fast enough for his team's first game. As he started to suit up again, the coaches and athletic trainer checked in regularly with his mother. "They're probably watching all the players closer now," she said.