When Should Children Start Wearing Head Protection in Youth Sport?

Brain injury risk starts when sport starts

Children do not need to be playing elite sport, academy sport or full-contact competition before brain protection becomes relevant. The risk starts earlier than that.

Brain injury risk starts when children begin participating in sports where head impacts can happen. And this is not limited to high-impact contact sports. Risk exists across football, rugby, hockey, netball, basketball, lacrosse, cricket, martial arts, gymnastics, curling, climbing, combat sports, Gaelic games, AFL, flag-football and many others.

That does not mean every child will suffer a brain injury. But it means the exposure pathway begins as soon as sport begins.

Children fall. Children collide. Children jump, turn, compete, challenge, slip, mistime tackles, clash heads, hit the ground, hit equipment, and experience head impacts on the sporting field.

A child can experience repeated head impacts without being removed from play, without a medical assessment and without anyone recording a concussion. These lower-force, asymptomatic impacts are sub-concussions.

A sub-concussive impact does not produce the clinical signs and symptoms required for a concussion diagnosis. But repeated sub-concussive exposure has been associated with measurable brain changes in young players ^{[2, 3]}.

Why are sub-concussions and rotational forces the key concerns?

Concussion is not the only brain injury concern in youth sport. The larger concern is repeated sub-concussive exposure.

Sub-concussions are head impacts that do not produce symptoms. They do not stop play. They do not get reported. They do not appear in injury statistics. But they still transmit forces to the brain.

The most important biomechanical concern is rotational force.

When the head is struck or moved at an angle, the brain rotates inside the skull. That motion creates shear strain within brain tissue, tearing axons, damaging blood vessels and disrupting neural communication pathways ^[1].

Repeated sub-concussive head impacts are an accepted part of youth sport. Protecting the brain in youth sport means reducing the transmission of these rotational forces when head impacts inevitably occur.

Why every child should be treated as at risk

Every child should be treated as at risk because adults do not know the child’s future exposure profile.

At the start of youth sport, parents, coaches and clubs do not know three important things:

1. Who has genetic risk factors

Some children carry genetic factors that influence how their brain responds to injury or repeated trauma. Parents and coaches cannot know this.

2. Who has metabolic risk factors

Some children have metabolic or biological vulnerabilities that influence recovery, inflammation or response to repeated brain stress. Parents and coaches cannot know this.

3. Who will keep playing for years

A five-year-old trying sport for fun may become a teenager playing several times a week. A child who starts with school sport may continue into university, adult amateur sport or an elite pathway. No one knows who will accumulate a high lifetime dose of head-impact exposure.

That uncertainty matters.

The risk begins before adults know which child is more vulnerable, which child will keep playing, and which child will accumulate years of sub-concussive impacts ^[4].

Every child therefore has the possibility of accumulating a substantial lifetime dose of concussive and sub-concussive head-impact exposure. The best mitigation to this cumulative risk is to reduce the transmission of rotational force and the accumulated damage of sub-concussions across a sporting lifetime. Doing so requires head-worn brain protection.

Are children safer because they are lighter and slower?

No. This is one of the most common and dangerous myths in youth sport.

Children’s brains are still developing and are more vulnerable to injury. Additionally, a child’s neck strength, coordination, balance, anticipation and technique are still developing too. They will also be at greater risk from the poor technique of other players, exposing them to unexpected and unanticipated risk.

The Rezon Brain Protection Survey found that respondents incorrectly believed children are at lower risk of brain injury in sport than adult players ^[5]. That misconception matters.

If adults underestimate the risk, they delay protection. They assume that brain protection is only needed when sport becomes faster, harder, full-contact, or more visibly dangerous.

But childhood is a critical stage of brain development. A child’s lighter body does not make repeated head impacts irrelevant. A slower collision does not make rotational force harmless. A game that looks playful from the touchline can still involve falls, clashes, collisions and repeated sub-concussive exposure.

The risk should not be dismissed because children are young. It should be taken more seriously because they are young.

What are the risks of repeated head impacts?

Sport is valuable. It builds confidence, strength, friendships, discipline and joy. But it carries brain injury risk, also.

The point is not to discourage youth sport. The point is to stop adults underplaying a real brain injury risk recognised by neuroscience.

Repeated sub-concussive head impacts create long-term brain health concerns, with risk including chronic traumatic encephalopathy, or CTE. CTE is a neurodegenerative disease and form of early-onset dementia that is strongly associated with repetitive head-impact exposure ^{[6, 7]}.

The strongest lesson from former athletes who have sadly passed, or who are currently suffering the consequences of long-term brain injury, is that recognition that brain injury exposure starts long before professional sport. Shane Christie’s story matters because he did not start playing rugby as a professional. He started as a child. He began playing rugby aged five, long before his later career and diagnosis became part of the public brain-injury conversation ^[8].

That is the point for parents. Lifetime exposure does not begin when the world starts watching. It begins when the child starts playing.

The consequences of neurodegenerative disease are severe. CTE and other neurodegenerative conditions affect mood, behaviour, cognition, impulse control and emotional regulation ^{[7, 9]}. Suicide can be one tragic consequence of neurodegenerative disease and the mood and behavioural changes associated with it.

The answer is not to stop children from playing sport. It is to take brain health seriously and start protecting a child’s brain from the moment they set foot onto a sports field.