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Mass. DPH head offers advice to parents concerned about new concussion findings

After covering new Boston University research linking contact sports with brain damage, I asked Dr. Lauren Smith, interim health commissioner of the state Department of Public Health, whether she had any advice for parents worried about the risks of football and other contact sports.

Smith was instrumental in getting a concussion law passed in the state two years ago that required high school coaches to become more educated about the dangers of concussions and approval from a physician before teenagers with concussions can be sent back to practices and games.

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Here are edited excerpts from our interview.

Do you agree with the recommendation made by study co-author Dr. Robert Cantu that kids under 14 shouldn’t play contact football to protect their developing brains?

Dr. Cantu, as a neurosurgeon, has the special vantage point to see how things can go terribly wrong from brain injuries. I know that he comes at this from that perspective, but I don’t have data that would help me decide when would be the right time for kids to start playing tackle football. I do know there’s strong evidence that if a young person sustains a concussion, there needs to be thorough and appropriate management of that head injury to avoid future problems.

Do you think high school football coaches should be limiting contact practices?

Our state regulations don’t speak to the content of practices other than that coaches shouldn’t teach athletes dangerous techniques. However, I think the latest data from the research field -- that concussions are sustained in practices not just games -- makes me want to think more carefully about it.

What advice do you have for parents who may be reluctant to let their children play football?

I don’t have an easy answer for them. Parents have to weigh a lot of options when they’re looking at potential risks from sports -- and football isn’t the only sport that carries significant risks. When parents do decide to let their child participate on a sports team, they should know who is supervising the activity. And they should be checking in with their child regularly to see how the team is going and whether many players have been injured. Parents should also be aware of the signs and symptoms of a concussion.

High school football player Nathan Stiles appears to have taken all of the precautions after his concussion, but he sadly died of a brain bleed. Any way to explain?

I don’t know what happened with this young man, and we don’t want any family to have to go through that tragedy. His case might have just been extremely unusual, an outlier. But I also wonder whether he had a graduated return to play.

Our state regulations require athletes to return slowly to practices and games after they’re free of concussion symptoms and have a doctor’s approval to return to the sport. Players start with a little bit of activity to see whether any of their concussion symptoms recur. If at any stage they get symptoms -- headaches, fatigue, nausea -- they must stop and go back to rest for a few days before trying mild activity again.

Reporter’s note: Nathan Stiles returned to his first game three weeks after his initial concussion, and his father, Ron, didn’t mention in his interview whether his son had graduated practices during the week beforehand; that’s what Mass. now requires. Ron did say that everything went fine in that first game back. Nathan collapsed and died of a brain bleed after his second game, four weeks after his initial concussion.

Is there any evidence that this technique will prevent or lower the risk of a dangerous second impact?

I’m not certain if that’s been proven, but a consensus panel of neurology specialists -- which included Dr. Cantu -- recommended that players return gradually to full activity, so that’s what we based our regulations on.

It does, though, make sense that it would help. If you break your leg and get your cast off, you’re not suddenly going to be running hundred meter hurdles. The brain also needs time to go through a healing process before getting back up to full metabolic function.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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