The tragic death last week of actress Natasha Richardson after hitting her head during a ski lesson at a resort in Canada has been widely - and my opinion, correctly - viewed as a cautionary tale about the risks of participating in winter sports, the need for participants to wear helmets and to take even the most seemingly minor head injuries seriously.

When I was growing up in the nineteen sixties and seventies, I spent most of my winter weekends and all of my vacations at my father's home in Vermont. From dawn ‘til dusk I was on the slopes at Stratton or Bromley with my six siblings and friends skiing all over the mountain, often using beginners' trails as short cuts to the "Black Diamond" trails cut out of steeply sloped "glades".

Back then, of course, the only skiiers wearing helmets were racers. (By contrast, the National Ski Areas Association reported that in the 2007-08 season, 43 percent of U.S. skiers and snowboarders wore helmets, up from 25 percent in 2002-03, with the number jumping to 70 percent for children under 10.)

Nevertheless, I can only recall one serious accident. It happened when I was about seventeen following a faster friend through the glades. He stopped short and I ended up careening into a tree.

Years later I was skiing with my then thirteen-year-old sons when Spencer took a bad fall snowboarding on an icy slope, hitting his head (again, he wasn't wearing a helmet back in 1996). His triplet brothers noticed right away that he just did not seem right and they quickly located me.

After initially evaluating Spencer (like most boys his age he tried to shake it off), I took him to the ski patrol hut. A few minutes later we were on our way to a local hospital twenty five minutes away. Even though it appeared that he had suffered, at worst, a mild concussion, I wanted him to be at a hospital in case he started exhibiting any symptoms of a more serious head injury. Tests confirmed that Spencer had suffered a concussion and would need to be watched closely. Two hours later Spencer was cleared to leave the hospital.

I can still vividly recall the lecture that the emergency room staff gave Spencer and his brothers. They told them a story about a boy who had been left in a comma from a snowboarding accident. They told my sons that 75% of all accidents on the mountain involve teenagers not wearing helmets and being reckless.

But Natasha was not a teen age boy and she was not being reckless. I am still having a difficult time understanding how she hit her head hard enough to cause bleeding between her skull and her brain unless the snow she fell on was more ice than packed powder. Would natural snow have cushioned her head? Probably. Would a helmet have helped save her life? Probably. Might her life have been saved had she been seen in a hospital emergency room immediately after she fell? Maybe. Did her death bring awareness to people about the high rate of death and catastrophic injuries sustained while skiing-absolutely.

Is the ski industry doing everything it can to help prevent future accidents? I don't think so. And that is the big problem.

Yesterday, I spent some time talking with Daniel Gregorie, M.D. an internist and founder of the California Ski and Snowboard Safety Organization (CSSSO), which promotes and supports safety improvements in California skiing, snowboarding and recreational snow sports. The CSSSO also serves as an independent source for information about the safety of California ski resorts. Dr. Gregorie formed the CSSSO in memory of his daughter, Jessica Gregorie, who died in a tragic snowboarding accident at Alpine Meadows in 2006.

Dan is leading the CSSSO's efforts to spotlight California's lack of uniform ski-and-snowboard-safety protections, to serve as a statewide repository of information on ski-resort-related deaths and injuries, and in lobbying the state's 30 ski resorts to publicly release their safety policies.

As I spoke with Dan I had a flood of my own emotions. What a wonderful person he is for all he is doing to keep our families safe. He is a gift to each of us. But my thoughts for most part were stuck on how Jessica, such a beautiful, athletic and recent Smith College graduate, could have fallen to her death in a ravine Alpine Meadows that should have blocked off from skiers and snowboards. As I listened to Jessica's father I had a difficult time finding words.

My mind was stuck on the dates. Natasha Richardson died one day after what would have been Jessica's twenty eighth birthday. But instead of dwelling on the past Jessica's father was providing tips and advice for other parents.

Dr. Gregorie understands that the ski and snowboard industry, for the most part, "is a rescue culture and not a prevention culture." He is working hard to make snow sports safer in California by supporting a bill (AB 990) that has just been introduced in the California legislature by state assemblyman Dave Jones.

In a future blog I will talk more about my conversation with Dr. Gregorie and the new California ski and snowboard safety bill; but for now I want to share some questions he thinks parents should ask before they hit the slopes  to make snow sports safer:

• Is the resort at which you are planning to ski or snowboard safety conscious? Is it proactive in preventing accidents? What is its safety policy? Does it even have a policy?

• What is the resort's emergency plan? Are paramedics at the mountain or does EMS have to come from off-site? Where's the nearest hospital?

• What do the resort's trail signs look like and are they uniform and easy to understand? Like highway signs, everyone should be able to understand the signs. Unfortunately, there isn't uniformity when it comes to trail signs.

• Is the beginner's slope off-limits to the other skiers and snowboarders? Many times faster, more experienced skiers will take short cuts through these trails resulting in serious accidents.

• Are helmets mandatory? (Remember: helmets are not a panacea -- they provide considerably less protection once a person exceeds 14 miles per hour -- and occasionally can induce complacency. "Sometimes you can put a helmet on a 13-year-old and he thinks he's invulnerable," notes Michael Berry, president of the Colorado-based National Ski Areas Association (NSAA). "The helmet's only part of the issue. Behavior and education about when the helmet can be effective are another part.")

I am not sure if this is being done anywhere, but I have often thought it might be a good idea to issue special bibs to skiers and snowboarders under a certain age to alert others to their presence and, hopefully, cut down on collisions between out of control skiers and snow boarders and reckless behavior.

Dr. Gregorie would also like to see resorts have some type of skills assessment and a type of parental reporting system so people who are skiing to endanger the lives of others would be held accountable and the number of serious accidents curbed.

I am looking forward to working with Dr. Gregorie and will continue to report on his progress. In the meantime, if you are a skier or snowboarder and want more information and/or would like to make a contribution to the California Ski and Snowboard Safety Organization, visit its websites by clicking here or here.

The other day I got an e-mail from a sports mom in Nevada with a link to an article about her daughter’s cross-country coach.  Seems he forfeited the team’s first meet of the season against the defending state champion out of concern for the runners’ long-term health had they run over a hilly 2.75-mile course consisting mostly of pavement in 90 degree heat.

The first time I read the article I thought, “Bravo! Bully for the coach.” The second time I read it some doubt crept in about the coach’s explanation for the forfeit, so I wrote the mom back and asked if was any reason to doubt that the reason offered by the coach was the true reason. Nope, she replied. The reasons he gave were legit. Relieved, I thought to myself, “Finally, a coach not willing to put his team in harm’s way.”

According to the article, South Tahoe High School coach, Dan Wilvers, pulled his girls’ team out of the race because he was convinced that running primarily on pavement (much of the grass portion from previous years had been replaced by asphalt, which is really tough on a runner’s legs).  Wilvers told the Tahoe Daily Tribune, “I was just concerned about the kids' health because we have all of these kids who are always fighting nagging stuff that can really debilitate them throughout the season with the training. Those downhills on the pavement were just not going to be good.”

This country needs more coaches like Wilvers: ones who are child-centered, not adult centered; ones who put safety first. In my book, Home Team Advantage, I extolled the virtues of women coaches.  One of the advantages I cited was the finding by evolutionary biologists that woman have an inborn instinct to protect children from harm, whether their own or others, while men, from the beginning of time, have been more inclined to value competition, winning and risk taking.  Yet here was the rare male coach who had, dare I say it, instincts more typical of a woman.

Wilvers is the type of coach we all want coaching our children: he saw an unacceptably high risk of long-term injury from running down hill on hard pavement in a highly competitive cross-country meet and decided that beating the defending state champion simply wasn’t worth it.

For a list of ten signs of a good youth sports coach, click here.

The sad fact, and what makes it sometimes hard for parents to truly believe that programs are taking concussions seriously, is that many of the sports programs in which their children participate do not follow any set of return-to-play guidelines, and if they do follow guidelines, they are too liberal in terms of same-day return-to-play (RTP). When parents are kept in the dark like that, when they have no clue as to how a program treats concussions, their anxiety level naturally goes up. This happened to me when my son Taylor sustained a soccer concussion and his ATC told him he only needed to sit out one day.

Thus, the third point in the Concussion Bill of Rights for parents is that the athletic director or administrator, coach, athletic trainer (if there is one) and team doctor have, at the very least, agreed upon and adopted a philosophy for evaluating and managing concussions before the start of the season which prohibits players who experience concussion signs or symptoms from returning to the same game or practice, and that they use it consistently during the season, regardless of the athlete or circumstances surrounding the injury. In other words, no double standard when it comes to concussions will be applied - one for regular players, one more liberal standard for the "stars."*

Same Day RTP Debate

Some advocate against any rule that would flat out bar players who experience concussion signs or symptoms from returning to the same game or practice. They view such a rule as not only unworkable but counter-productive. Their fear is that such a strict, unyielding rule is likely to be evaded by the very players it is designed to protect, leading players to simply stop telling sideline medical personnel that they have any symptoms so as to avoid being benched for the remainder of the game. Many parents, either out of ignorance of the risks or out of a desire to see their child achieve athletic success, adhere to this view as well.

Others, including many of the YouthSportsParents audience, believe that the rule that best protects our children, is the easiest to apply and the one best supported by the available science, is the one reflected in the consensus statement of the 3rd International Conference on Concussion in Sport held in Zurich in 2008 (and published in May 2009): a rule that recommends no return to play for concussed athletes in the same game regardless of how quickly the symptoms appear to clear.

If the penalty for not reporting symptoms, for not playing by the rules, is to be suspended or kicked off the team, then players will not, as some fear, try to evade the rule and adoption will not lead players to simply stop telling sideline medical personnel that they have any symptoms so as to avoid being sidelined for the remainder of the game.

Same day return to play should be banned

All of the recent consensus statements recommend such conservative management of concussions in athletes under the age of 18. In the face of such consensus, the only reason I can think of for allowing a youth athlete to return to play in the same game after concussion symptoms clear is because it increases the team's chances of winning.

As I write about at length in my book, Home Team Advantage, and elsewhere on this website, our youth sports culture has become so obsessed with winning that not only has fun taken a back seat, but, more dangerously, so has safety.

Winning at any level of sports simply isn't worth it, at least when it comes to concussions, which are simply in a league of their own apart from other types of injuries.

To the extent our culture teaches that winning is more important for athletes who don't get paid to have their clocks cleaned for a living, it needs to change.

If parents know about the rule banning same-day return to play in advance, if the reason for the rule is explained before the season begins, I think that, by and large, they will see it as putting their child's safety first, which is exactly as it should be in youth sports.

No excuse

The alleged lack of scientific studies and the amount of clinical judgment involved in concussion management, and the lack of unanimity, either about grading the severity of concussions or in return to play guidelines, while it complicates efforts to educate about and manage concussions, should not be used as an excuse to do nothing. Conservative management of youth concussions is also necessary, in my view, in order for a program to fulfill the fundamental duty of care - a duty embodied in the United Nations' Conventions on the Rights of the Child adopted by every country in the world with the notable exception of two (Somalia and the United States) - our sports programs, like the rest of adult society, owe every child.

Thirteen years ago, on their first day of their first year of middle school, my triplet sons each received a thick green booklet packed with school rules and policies, and survival tips for incoming sixth graders .  Parents were provided with a copy of the same booklet.

Printed on the inside of the front cover was a selection of 295 tips from the complete booklet given out to freshman at the high school titled "Advice to incoming freshman from those who have made it." The booklet was written by the high school faculty, staff and twelfth grade students.

Prominently placed at the top of the list of tips was #4: Tryout for at least one sport each year.  Number 5 stated: "If a person says hello or waves to you, respond." Number 11 warned, "Avoid leaving your stuff around; you may never see it again," Number 15 advised to  "Avoid shortcuts on homework." And so on all the way down the list.

Out of all of the handouts my sons received during their school years, I saved a few that I found poignant and important.  The front cover, with its list on the back, recently turned up in an old file folder.  It was stapled to the cover of the booklet which they received three years later on their first day of high school titled: Advice to incoming freshman from those who have made it: 295 tips.

While I am not a sentimental hoarder of piles of old school stuff, I am sentimental and do recall the specific reason for saving the list. It was just about that time when I first began writing a book with the working title, A Parents Survival Guide to Youth Sports.   I knew that the list, and in particular, tip number 4, was powerful and worth incorporating into the book.

Although my literary agent found tremendous interest in the book from the top publishing houses, each wanted me to write a series of books because, as one said, "she has so much great information and wisdom to share." 

At the time my first book was being "shopped around" my love affair with the Internet was growing.  I concluded that no book, as a limited container of content, could compete with the Internet, so I decided instead to launch MomsTeam.com and put the book idea on the shelf.  

When I dusted off the book idea three years ago and began writing  Home Team Advantage the powerful 295 Tips list resurfaced in a crate of sports-related information as I was  researching information for Chapter Fourteen, my favorite chapter: The Controversy Over Cutting. 

From working deep in the trenches with literally tens of thousands of sports parents over the years I view the practice of cutting athletes from middle or high school teams as arguably the most controversial practice in youth sports all the way through high school years. While it is true that it is important for kids to learn the value of overcoming obstacles with hard work and how to grow through failure, the fact is that being cut from a middle school or high school sports team is often one of the most upsetting and traumatic events in a teenager's life.

I believe that the goal of childhood should be to prepare children for adulthood by giving them a chance to develop coping skills and the self-confidence needed to succeed in the adult world in a safe and nurturing environment. 

There are many folks working in the youth sports field who agree with me that cutting isn't necessary to ensure strong athletic programs, that the goals of school-based athletics are educational; that to teach the athletic and - yes, social skills  - teenagers will need to both compete and collaborate as adults, the practice is outmoded and deprives a greater percentage of student athletes who want to keep playing sports every year.

Think about it.  In 1924, when interscholastic sports were in their infancy, the average size of a high school was 128 students. Today, the average size is roughly 1,840 students. Yet, all schools still only have one boys varsity basketball, football and baseball team.  No longer is there a roster spot for every child who wants to play, which was the case in 1924.

With the tryouts for fall sports over and the cuts having been made, it is no wonder that the majority of  e-mail questions I have been getting lately all ask variations on the same theme: How can we eliminate this antiquated practice and adopt sports programs in our middle schools and high schools that give every student wanting to play an opportunity to continue playing? 

I can't tell you how many times a mother or father writes asking what to do now that their child, who has  played soccer all the way through 11^th grade, has been cut from the varsity in his senior year.

It is time we as a nation grasp the importance of belonging to a school team. Not just playing intramural sports, but having a roster spot on the team that competes against other towns. The kids know it.  Even high school boys list the number one reason for playing sports is -To Have FUN!

One of our staff, a mom of freshman high school boy/girl twins , came into work last week with a similar booklet to the one my sons came home with.  One of the tips was  "Participate on a school team."  Except instead of being listed #4, it was now #1.

Like the booklet my sons got, the booklet given to her twins was compiled from hundreds of suggestions by faculty, staff and twelfth grade students.

My question is this: if participating on a school team is always at or near the top of the list of tips for incoming first-year students, why is it that our schools can't seem to find a way to provide interscholastic sports to every child who wants to play? 

It is too late to do anything about the cuts that have been made for this fall season.  But it isn't too late to start thinking about the next sports season, and the one after that. 

By reading this blog and by visiting YouthSportsParents, you have demonstrated a committment to our mission of making youth sports more inclusive.  The YouthSportsParents community represents a powerful group of parents. Let's begin the work!  One of our members has started a forum  on cutting to start the conversation.  I encourage you to join the discussion. 

As controversial a subject as cutting is, we need to talk about it if we are ever to see more kids involved in after school sports.

Oh, and last on the list of tips from 1996 and 2008? Have Fun and Good Luck!

Today's annual meeting of the American Academy of Orthopaedic Surgeons brought some news sports parents need to hear.

The shoe doesn't fit

The first bit of disturbing news came from Swiss researchers. Think your child is wearing the right size shoes when playing sports? Think again. A study by researchers in Switzerland found that a surprising majority of kids ages 5 to 10 are wearing shoes that are too small for their feet, putting them at risk of developing serious foot deformities including bunions. No wonder the shoes were too small considering the study's finding that nine of ten of the shoes kids wear for outdoor activities were smaller than the size marked on the box!

The three lessons parents should take from the study: (1) Measure your children's feet every time you buy them new shoes using a special measuring device to ensure that the length of the shoe exceeds the length of the child's foot by at least 10 millimeters; (2) Consider the actual size of the shoe rather than just the number marked on the inside of the shoe or the box; and (3) Check every month or so to see if a child's shoes still fit, especially when the child is in a growth spurt. (Remember: many children will often outgrow their shoes well before the shoes are worn out).

Link between ACL injury epidemic and early specialization

The second was a presentation by Darren L. Johnson, M.D., orthopaedic surgeon and director of sports medicine at the University of School of Medicine. Dr. Johnson suggested that the alarming increase in the number of younger children and adolescents suffering ACL (anterior cruciate ligament) injuries playing sports, particularly among girls, may be the result of the trend towards early specialization and year-round play in a single sport.

"Not long ago our youth participated in multiple sports, which effectively allowed an athlete to cross train and use multiple muscle groups differently and develop their potential," Dr. Johnson said. "But nowadays kids are picking one sport by the time they are 13 and playing year round on multiple teams, home and travel, which only allows development of the specific muscle group that applies to that specific sport. To play multiple sports is, in the best sense, childlike and fun," says Dr. Johnson. "Specialization at an early age conveys a seriousness of purpose that can lead to burnout, injury or both, which is common in high school athletes."

Dr. Johnson said that while all the effects of the extra wear and tear on a 13-year-old's growing body from playing so many games (often more than college athletes play) aren't yet known, what is known is that "participating without taking time off, playing on multiple teams at one time and at higher competition levels, makes young athletes susceptible to ACL tears at a younger age."

Doomed to pain-filled future?

To add injury to injury, pressure from parents and coaches or placed by the athletes on themselves is leading too many young athletes to come back from an ACL injury - which usually requires surgery and as much as a year of intensive rehabilitation - far too soon.  Returning too soon puts the athlete at a higher risk for another ACL injury.  Between 30 and 40 percent of athletes suffering a single ACL tear never return to their previous level of performance and are at increased risk of long-term degenerative changes in the knee such as arthritis.  The chances of coming back from two ACL injuries are even less.

Indeed, Dr. Johnson, notes, it is not uncommon these days for young athletes to have had two ACLs replaced by the time they enter high school. "Once that happens," Dr. Johnson warns, "it is very unlikely their knees will ever be normal."

The suspected link between an increase in ACL injuries in 12- and 13-year old children and early specialization and year-round play doesn't surprise me. I have been warning parents for years, both on this site and in my book, Home Team Advantage, about the many reasons early specialization is a bad idea for their kids, and that the trend is supported by myths, not facts. It is a trend we must reverse. If we don't, more and more kids will be doomed to a life of chronic knee, elbow or ankle pain. Is that what we want for our kids? I don't think so.