during the time period when reported concussions increased, participation in organized team sports decreased. The researchers estimated that about 385 000 children aged 7 to 17 participated in the top 5 organized teams posts in 1997, with the number falling to just over 330 000 participants by 2007. McCrea does not have hard data, but hespeculatedthat theincreasingnumber ofconcussionsduringa timeofapparent declining participation in sports may be the result of how those children remaining inasport trainandcompete.“Participationinsportshasbecomeayear-around commitment;youusedtoplayfootball for 2monthsandthenmoveontobasketball andthenmaybetrackandfield,”McCrea said.“Somaybeparticipationisdown,but for those playing, say football, the number of exposures seems to be certainly higher than seen a decade ago.” In August, the American Academy of Pediatrics issued its first clinical report offering guidance in the treatment and management of sportsrelated concussion in children and adolescents (Halstead ME, Walter KD; the Council on Sports Medicine and Fitness. Pediatrics. 2010;126[3]:597615). Mark E. Halstead, MD, a coauthor of the clinical report and assistant professor of orthopedics and pediatrics at Washington University in St Louis, said their guidance lays out parameters to be used in assessing when an athlete can return to competition following a concussion. “Rather then telling a player to sit out for a set period of time, we gradually increase the athlete’s activities over a 5-day period to make sure the athlete does not demonstrate symptoms,” Halstead said. Deciding when an athlete is well enoughtoreturntocompetitionremains a bit of a mystery, McCrea said, because there is little rigorous evidence to show what works best. He said the decision to return is especially difficult to make for thosewhohavehadrepeatedconcussions andthatsuchadeterminationisprobably best made by the treating physician. “No adult signs his or her own returnto-work slip after they have had a stroke, but return-to-play for concussion for decades has been managed by the injured athlete or nonmedical professionals” such as parents, coaches, or trainers, McCrea said. “But there has been some positive movement in creating policy requiring medical clearance before one can return to an activity.”