Parents have a right to expect that, when they entrust their children to a sports program — whether it be Pee Wee hockey, youth lacrosse, Olympic development soccer, or high school football — that it will take reasonable precautions to protect them against harm. In other words, parents have a right to expect that the entire team to whom they entrust their children's safety — including the national governing body for the child's sport, the state association, the athletic or club director, the athletic trainer (if there is one), and especially the coaches - are part of the youth sports safety solution, not part of the problem.

That they will witness their child suffering a serious injury, such as a concussion playing sports is a parent's worst nightmare. Like the vast majority of parents, the possibility of injury was always in the back of my mind when I watched my children play sports.

But because the signs and symptoms of concussions are not obvious as a broken leg or a sprained ankle and are often very subtle, because most don't involve a loss of consciousness, and because self-reporting by athletes is critical to the detection and treatment of concussions, the only way parents can sit in the stands without worrying sick about what might happen if their son or daughter suffers a concussion is if they know the program, and especially the coach, takes concussions very seriously and that every member of the team is using the same playbook.

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Here are the eleven things every parent of a youth athlete has a right to expect when it comes to concussion education and management — a list I call the Parent's Concussion "Bill of Rights":

1. A concussion education and safety meeting is held for parents and athletes before every season.

The meeting should include presentations by:

• A medical doctor familiar with the grading and evaluation of concussions and return to play guidelines who can educate parents on the important role they play in their child's recovery from a suspected concussion, especially in terms of checking for signs of deteriorating mental status requiring immediate hospitalization, ensuring that their child gets the cognitive rest required, and monitoring for continuing signs or symptoms of post-concussion syndrome that must clear completely before an athlete should be allowed to return to play;

• Former athletes who can share personal stories about the consequences of continuing to play with concussion symptoms — or after a series of concussions — and to tell them about their reoccurring headaches, their depression, and their memory problems;

• Parents of concussed athletes who can emphasize how critical it is that, in making the all-important return-to-play decision, parents consider not the here and now, but the future: if I let her play now, what will her life be like in ten, twenty, thirty years? Will she know who her husband is? Will she know who her children are? Or will she be suffering from chronic, major depression, or Alzheimer's?

• The coach, who needs to do three things: (1) actively encourage athletes to self-report post-concussion symptoms and inform the coaching staff or athletic trainer about teammates with symptoms if they fail to report them to the staff; (2) let athletes know that if they self-report their symptoms, they will not jeopardize their position as a starter or on the team, but (3) if they don't report symptoms — their own or a fellow player's — if they lie about them when asked, if they try to fudge their answers on baseline neuropsychological tests, if they say they are symptom-free so that they can be cleared to play in the next game, they will be subject to progressive discipline (game suspensions up to and season disqualification) for violating team rules.

2. The program has adopted and enforces conservative philosophy for grading and managing concussions:

• Players who experience concussion signs or symptoms should be prohibited from returning to the same game or practice. Such a rule is the one best supported by the available science, the one recommended by consensus of concussion experts at the 2nd International Conference on Concussion in Sport held in Prague in 2004, the one that best protects the still-developing and vulnerable brains of young, and the easiest to apply consistently.

  If parents know about the rule in advance; if the reason for the rule is explained before the season begins, they will see it as putting their child's safety first, which is exactly as it should be in youth sports. The alleged lack of scientific studies, the amount of clinical judgment involved in concussion management, and the lack of a consensus, either about grading the severity of concussions or in return to play guidelines, while complicating efforts to educate parents on concussions, should not be used as an excuse to do nothing.

  Conservative management of youth concussions is also necessary 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.

• The rules need to be followed consistently during the season, regardless of the athlete or circumstances surrounding the injury (i.e, no double standard — one for regular players, another, more lenient, standard for the "stars.").

3. The athletic department has a certified athletic trainer (ATC) on staff. Adding to the challenges sports programs face in evaluating and managing concussions, and the anxiety level of parents of children playing contact sports, is the fact that many high school programs don't employ athletic trainers who have received training in recognizing the often subtle signs of concussion. Only 42 percent of U.S. high schools, according to the National Athletic Trainers' Association, have access to an ATC. In some states, the number is much lower (Over three-quarters of Nebraska high schools, for instance, are without ATCs). An ATC is so important that she should be the next hire after the head coach.

Because physicians are present at relatively few youth sports contests and never at practices, an ATC is essential for a number of reasons:

• The ATC often sees the athlete on a daily basis, and thus has the opportunity to establish a trusting relationship. This trust is a vital part of the process of evaluating and managing a concussion.

• Athletes may be more comfortable reporting symptoms to an ATC, who they see on a regular basis, than to a physician they do not see regularly, or to their coach.

• An ATC may also be better able to identify subtle signs that an athlete has suffered a concussion because he or she knows the athlete's usual behavior and demeanor.

• An ATC is also in best position to perform daily follow-up examinations that allow the ATC and team physician to determine when the athlete is symptom-free and determine when he or she may return to play.

4. Every child in a contact sport undergoes pre-season baseline and post-injury neuropsychological testing. With several recent studies demonstrating the value of neuropsychological testing in evaluating the cognitive effects of and recovery from sport-related concussions, such testing has become, according to the 2004 Prague consensus statement, a "cornerstone" of concussion evaluation, at least for "complex", Grade 2 or 3, or moderate to severe concussions

5. Parents or guardians receive written notice of injuries and must give written consent before their child is allowed to return to play. In the case of concussions, parents should be provided (a) information on post-concussion signs and symptoms and signs of deteriorating mental status to watch out for in the first 24 to 48 hours after concussion, (b) follow-up care, including the need for cognitive rest (i.e. no homework, no school), and (c) return-to-play guidelines, such as is provided on the Sport Concussion Assessment Tool developed by the authors of the Prague consensus statement. Implementing such a rule will, by itself, prompt all of the stakeholders to take every injury to an athlete with the appropriate degree of seriousness.

6. Their child is provided with a safe helmet. Most football helmets currently in use do little if anything to protect brains from the forces that cause concussions, a fact that most parents and athletes don't know. An estimated half of all football helmets in use at the high school level have either been improperly reconditioned, have foam padding that has degraded over time, or fit poorly. Because only about one in five helmets is new, programs need to make sure that used helmets are properly reconditioned every one to three years.

   Fortunately, technological advances in helmet design while they are not going to make concussions in football a thing of the past, hold out at least the promise of being able to significantly reduce the number of concussions.

   Parents need to know about these new helmets. They need to know that their child's football program thinks enough about their safety that it will find the money to buy them; that if it can't find the money, they will have the option of buying them on their own at the least possible cost (such as through Internet "power buys") or getting together with other parents to raise the money necessary to buy every player an advanced helmet.

7. An ambulance and paramedics are present at all high school football games, and, if they are not, procedures in place on how to properly contact EMS. For a reason, we need look no further than the tragic story of Will Benson, a 17-year old football player from Austin, Texas, who paramedics were unable to reach for nearly 30 minutes because the person who called 911 didn't tell the dispatcher exactly where he was, causing paramedics to waste valuable time trying to find the trainer's room where Will lay unconscious after collapsing during a game in September 2002.

8. Coaches and officials are required by law to be trained in basic safety and emergency procedures. Laws should be enacted in every state modeled on "Will's Bill," the 2007 Texas law named after Will Benson, which requires that every high school coach and official be trained in basic safety and emergency procedures. Every coach needs to be certified in CPR the use of an AED (which should be available at all games and practices), and first aid, with special attention paid to hydration, cardiac and concussion awareness.

9. Sports officials are given the right to send any athlete who they reasonably suspect has suffered a concussion during play to the sideline for further evaluation. Officials are often in the best position to detect the subtle signs of concussions in athletes during a game.

10. High school athletic programs require that each athlete undergo a comprehensive pre-participation physical examination (PPE). The PPE should include the taking of a structured concussion history, including specific questions about previous symptoms of concussion (not just the perceived number of concussions) and previous head, face or neck injuries, as well as questions about symptoms currently being experienced, if any. If a school can't afford to foot the bill for such PPE's, parents need to get them on their own or, better yet, alternative ways should be explored to provide PPEs to all athletes, either through parent fundraising or by asking local medical groups to donate the exams as a community service.

11. The national governing body for their child's sport has taken steps to address concussions, both in terms of education and prevention.

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