Charlie Mahoney for The New York Times
Brian Lilja is a patient at the Boston Children's Hospital youth sports concussion clinic. His mother, Jennifer, said his injuries caused a "scary" personality change.
BOSTON — The drumbeat of alarming stories linking concussions among football players and other athletes to brain disease has led to a new and mushrooming American phenomenon: the specialized youth sports concussion clinic, which one day may be as common as a mall at the edge of town.
Charlie Mahoney for The New York Times
Isabelle Kindle, center, a hockey player at Wellesley High School in Massachusetts, recently returned to the ice after two concussions. There is no standard recommended recovery time for young athletes who have had a concussion. Doctors may consider genetic, biomedical or anatomical characteristics in addition to the severity of the injury.
In the last three years, dozens of youth concussion clinics have opened in nearly 35 states — outpatient centers often connected to large hospitals that are now filled with young athletes complaining of headaches, amnesia, dizziness or problems concentrating. The proliferation of clinics, however, comes at a time when there is still no agreed-upon, established formula for treating the injuries.
"It is inexact, a science in its infancy," said Dr. Michael O'Brien of the sports concussion clinic at Boston Children's Hospital. "We know much more than we once did, but there are lots of layers we still need to figure out."
Deep concern among parents about the effects of concussions is colliding with the imprecise understanding of the injury. To families whose anxiety has been stoked by reports of former N.F.L. players with degenerative brain disease, the new facilities are seen as the most expert care available. That has parents parading to the clinic waiting rooms.
The trend is playing out vividly in Boston, where the phone hardly stops ringing at the youth sports concussion clinic at Massachusetts General Hospital.
"Parents call saying, 'I saw a scary report about concussions on Oprah or on the 'Doctors' show or Katie Couric's show,' " Dr. Barbara Semakula said, describing a typical day at the clinic. "Their child just hurt his head, and they've already leapt to the worst possible scenarios. It's a little bit of a frenzy out there."
About three miles away, at Boston Children's Hospital, patient visits per month to its sports concussion clinic have increased more than fifteenfold in the last five years, to 400 from 25. The clinic, which once consisted of two consultation rooms, now employs nine doctors at four locations and operates six days a week.
"It used to be a completely different scene, with a child's father walking in reluctantly to tell us, 'He's fine; this concussion stuff is nonsense,' " said Dr. William Meehan, a clinic co-founder. "It's totally the opposite now. A kid has one concussion, and the parents are very worried about how he'll be functioning at 50 years old."
Doctors nationwide say the new focus on the dangers of concussions is long overdue. Concerned parents are properly seeking better care, which has saved and improved lives. But a confluence of outside forces has also spawned a mania of sorts that has turned the once-ignored concussion into the paramount medical fear of young athletes across the country.
Most prominent have been news media reports about scores of relatively young former professional athletes reporting serious cognitive problems and other later-life illnesses. Several ex-N.F.L. players who have committed suicide, most notably Junior Seau, a former San Diego Chargers and New England Patriots star, have been found posthumously to have had a degenerative brain disease linked to repeated head trauma.
State legislatures have commanded the attention of families as well, with 43 states passing laws requiring school-age athletes who have sustained a concussion to have written authorization from a medical professional, often one trained in concussion management, before they can return to their sport.
The two Boston clinics, one started in 2007 and the other in 2011, are typical examples of the concussion clinic phenomenon, busy centers of a new branch of American health care and windows into the crux of a mounting youth sports fixation.
"We are really in the trenches of a new medical experience," said Richard Ginsburg, the director of psychological services at Massachusetts General Hospital's youth sports concussion clinic. "First of all, there's some hysteria, so a big part of our job is to educate people that 90 percent of concussions are resolved in a month, if not sooner. As for the other 10 percent of patients, they need somewhere to go.
"So we see them. We see it all."
Uncertainty Among Doctors
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