As Dr. Hergenroeder reminded the audience, the policies that really matter are those that influence what happens on the field. From this perspective, the policymakers most relevant to head injuries in youth soccer players are the national sports associations and local organizations such as schools and soccer clubs.

As to federal policies, safety issues in children's sports are often covered by the Consumer Products Safety Commission (CPSC) insofar as sports equipment is involved. In May 2000, the Commission held a workshop to examine the possible use of helmets in youth soccer players, but did not find that the available evidence warranted the mandatory adoption of helmets. The Centers for Disease Control and Prevention (CDC) also monitors childhood injuries and funds research on injury prevention, but has not recommended against heading in youth soccer. Finally, the National Institutes of Health is the major federal supporter of medical research, but currently supports fewer than half a dozen grants related to head injuries in children's sports.

No peer-reviewed studies have been published to support or refute the use of helmets in soccer and no authoritative medical or sports organizations have recommended the use of helmets in soccer.

Different speakers at the workshop viewed the dangers of heading in a variety of ways. Most, but not all, of the studies presented suggested that heading a soccer ball does not cause cognitive deficits. However, without definitive data there can be no conclusive resolution about the dangers of heading. Further, all of the studies reported at the workshop and in the published literature were based on adults or high school age players; none of the available data are based on pre-adolescent children. Several of the studies were not designed to definitively separate the effects of concussions from repetitive heading, an issue raised by several speakers during the workshop. Clarification of the long-term consequences of heading soccer balls awaits the outcome of well-designed prospective studies, such as the 5-year study being led by Dr. Kirkendall and funded by the United States Soccer Foundation.

In the meantime, the American Youth Soccer Organization recommends that children under 10 should not head the ball but continues to support the practice of purposeful heading for older soccer players. No peer-reviewed studies have been published to support or refute the use of helmets in soccer and no authoritative medical or sports organizations have recommended the use of helmets in soccer.

Ironically, while there has been considerable media coverage about the possible dangers of heading, there has been comparatively little public attention to the dangers of concussion. Without exception, every speaker at the workshop concurred about the need for a greater attention to concussions in youth sports. Concussions and especially multiple concussions are both more frequent and more serious than is commonly understood.

Many of the speakers emphasized that the people on the playing field and the sidelines— the players, referees, coaches, and trainers— especially need to become educated about the signs and symptoms of concussion and need clear evidence-based guidelines about how to decide when a player can return to play after sustaining a concussion.