By Dr. Christian Turner, Novant Health Pediatric Sports Medicine

This year’s World Cup has been tremendous thus far, and although the U.S. didn’t qualify, there has been plenty of excitement from soccer fans all over the country.

I know because in addition to being a pediatric sports medicine physician , I’m also one of those thrilled American soccer fans. Certainly, there are going to be kids everywhere, including the Carolinas, working hard on their soccer skills this summer.

There’s one skill, however, younger players are now waiting a bit longer to perfect than they used to: heading the ball.

It’s actually been more than two years since U.S. Soccer, the sports’ governing body, rolled out its latest guidelines for headers at the youth level. U.S. Soccer published their recommendations in 2016 as part of its "Recognize to Recover" campaign centered on injury prevention and management.

The portion of that program that received the most national attention, naturally, was the recommendation that children 10 and under should not head the ball at all in practice or games, and that children 11 to 13 be limited to no more than 30 minutes of practice heading the ball (and no more than 20 total headers per week).

The guidelines are not requirements for all of youth soccer, as U.S. Soccer does not have quite that much oversight. However, the group strongly recommends that all leagues implement the rules, as well as incorporate the advice allowing substitution for a player being evaluated for a head injury does not count against the total number of substitutions in games.

  As a physician, I support many of the 2016 guidelines based on what we currently know, although I do believe for older youth ages allowed head the ball in games, practicing headers in controlled practice environments (rather than during the chaos of games) is useful for safety.

The World Cup has sparked news stories that capitalize on the broader public focus on soccer, such as a recent story in the New York Times headlined “Heading the Soccer Ball May Be Bad for Young Brains.” Before we make too much of it quite yet, context is important.

The study the Times study referenced, on examining past the headline, included just 30 children and was conducted over a brief span of time. It looked simply at how 9 to 11-year-olds performed on a computer-based cognitive test before and after playing three soccer games.

However, since the study has not apparently been published in full, the details are still sparse. While the headline of the Times story specifically references headers, there was no mention in the study abstract of what type of contact constituted an “impact.”

It’s unclear if these contacts in the study were from headers, player-to-player contact or contact from players falling on the ground. The intentions of the investigation are certainly useful: attempting to see if young players who have collisions but no diagnosed concussion suffer negative cognitive effects.

Unfortunately, the information from this particular study is not sufficient yet to make a conclusion in that regard. Certainly, more data could potentially strengthen the recommendation to have young children avoid collisions, including headers.

The goal of reducing concussions in youth sports is a worthwhile challenge. It takes effort to read deeper into the coverage of scientific data, especially when the headline doesn’t tell the whole story.

Parents and coaches alike need to do their best to stay informed of significant new information as well as the rules.

While concussion safety is important, I often stress that it doesn’t stop at headers. Most concussions in soccer do not occur as a result of heading the ball. A large study published in JAMA Pediatrics in 2015 looked at concussion in high school soccer players from 2005 to 2014 and found that contact with another player was the most common concussion mechanism for both boys (68.8 percent) and girls (51.3 percent).

Removing headers from the game would seemingly help decrease the rate of concussion, but perhaps might not be as effective as limiting player-to-player contact.

For now, let’s continue engaging in safety research and these discussions, and let’s also enjoy the games — both the ones on television and the ones on our youth soccer fields.

Novant Health Pediatric Sports Medicine is ready to provide the care you need.