The invisible brain injury risk in youth sport that every parent is missing
Every weekend millions of children pull on their boots, grab their kit bags and play the sports they love. As parents, we cheer them on from the sidelines; proud, hopeful, and a little anxious when the collisions and head impacts inevitably occur. Sport gives our children confidence, friendships and a sense of belonging that screens and classrooms cannot match.
But a growing body of neuroscience shows that many parents, coaches and players, despite their best intentions, are dangerously misinformed about the extent of brain injury risks associated with head impacts in youth sport.
A survey developed by the UK National Innovation Centre for Ageing in partnership with Voice at Newcastle University asked parents, players and coaches what they knew about brain injury in sport and protective equipment. What it revealed should be a wake-up call for everyone in youth sport [1].
Sub-concussive brain injury in youth sport is being widely misunderstood
Most parents recognise the signs and symptoms of concussion. Far fewer understand sub-concussions; frequent small-force head impacts that cause no visible signs or symptoms of concussion, yet these still cause damage to the brain.
Sub-concussive brain injury is now understood to be a key driver of long-term neurodegenerative consequences, and related to the risk and severity of Chronic Traumatic Encephalopathy (CTE) [3]; a progressive neurodegenerative disease associated with memory loss, behavioural change and early-onset dementia in patients in their 20s/30s/40s. Crucially, CTE does not develop from one big hit. It develops from the cumulative damage of sub-concussive impacts, and often begins in childhood sports.
This cumulative sub-concussive exposure model is well established in neuropathology. Post-mortem studies show that the severity of CTE correlates more strongly with total head impact exposure over time rather than with the number of diagnosed concussions [4].
Concerningly in the UK National Innovation Centre/ Newcastle University survey, only four percent of respondents correctly identified sub-concussive impacts as most associated with CTE [5].
As Dr Emer MacSweeney, consultant neuroradiologist and CEO of Re:Cognition Health, explains, CTE is primarily driven by repeated symptomless smaller-force sub-concussive head impacts that contribute to accumulated damage over time, rather than concussive injuries [6].
Brain injury risk starts in childhood
While awareness of concussion recognition and management has improved, the actions of schools, clubs and governing bodies continue to focus almost exclusively on identifying visible concussion and return to play. This approach fails to address the far greater risk posed by the frequent sub-concussive impacts during training and play and their cumulative damage to the brain adversely affecting memory, the ability to focus, learn and think as well as behaviour.
The survey revealed a significant blind spot: parents consistently ranked children less at risk of brain injury than adult players. This could not be further from the truth.
We now know that a child’s brain is more vulnerable. Research also shows that earlier exposure to repetitive head impacts is associated with worse cognitive outcomes later in life. A landmark study of former athletes found that age of first exposure to contact sport was associated with later-life cognitive impairment, independent of their concussion history [7].
Even a decade ago, the Wake Forest Report [8] using special MRI imaging techniques demonstrated that 8-13 year olds who experienced a higher cumulative number of sub-concussive head impacts had more structural changes in their brain after one season, despite having no diagnosed or recorded concussions.
The frightening truth is that the foundations of neurodegenerative disease and CTE are laid early, with symptoms only emerging decades later. Given sub-concussive brain injury is cumulative and that no one can predict which child may have a genetic or metabolic vulnerability, play sport into adulthood or at an elite level, then every child is at risk of a massive lifetime exposure of sub-concussions.
Girls’ sport faces greater brain injury risks, with even less awareness
The knowledge gap extends to girls’ and women’s sport. Few respondents were aware that female athletes sustain concussions at higher rates and often take longer to recover than males. This sex-based difference in brain injury risk is well documented [9].
As participation in girls’ football, rugby and AFL accelerates, this lack of awareness risks creating a generation of female athletes who are under-protected and under-informed about their own brain health.
Head protection is not the same as brain protection
There exists science and innovation to reduce brain injury risk in sport. Yet a persistent misconception remains: that traditional and conventional head protection, including rugby scrum caps and headguards provide meaningful brain protection.
Most head protection is designed to reduce cuts, abrasions and superficial injury, not brain injury. World Rugby explicitly states that their approved headgear is not intended to prevent concussion or other forms of traumatic brain injury [10].
Brain injury in concussion and sub-concussions is driven primarily by rotational forces [11]. This causes the brain to rotate within the skull with the tearing of tiny blood vessels and brain cells, resulting, over time, in the breakdown of the blood-brain barrier and the creation of damaging neuro-inflammation. Reducing linear force to the brain alone is not sufficient.
Protecting young brains protects participation in sport
Brain protection is not about wrapping children in cotton wool or discouraging sport. On the contrary, sport is vital for physical, social and mental health. But the protections must evolve with neuroscience.
Protecting the brain is not the opposite of participation; it is the foundation of it. Children cannot be expected to understand brain injury risk or make informed decisions alone. That responsibility sits with parents, coaches, schools and those who govern sport.
There is no conflict of interest in protecting young brains. We all want children to have the best chance to reach their full potential, on and off the sporting pitches. That means demanding better brain health education, offering evidence-led brain protection, and updating safety standards that reflect what science now clearly shows about the damage of rotational forces and sub-concussive brain injury in youth sport.
- Rezon Halos® Survey 2025.
- McKee et al., Brain, 2013
- Daneshvar et al., Brain Pathology, 2015
- Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males, Daneshvar, D.H., Nair, E.S., Baucom, Z.H. et al, 2023.
- Rezon Halos® Survey 2025.
- What a world-leading neuroradiologist wants you to know about CTE – Dr Emer MacSweeney. Re:Cognition Health
- Stamm et al., Neurology, 2015
- Subconcussive Head Impact Exposure and White Matter Tract Changes over a Single Season of Youth Football – PMC
- Covassin et al., Journal of Athletic Training, 2013
- World Rugby Law 4 – Headgear Trial
- Why Most Traumatic Brain Injuries are Not Caused by Linear Acceleration but Skull Fractures are. Kleiven S. 2013
Author: Alex Reily
