While a death is rare, said Christopher Vaughan, a neuropsychologist at the Children's National Medical Center in D.C. who also works in a Towson clinic, lots of high school students are being injured playing sports.

When a concussion is suspected, state public school regulations say, the student must be taken out of the game and not allowed back until cleared by a physician or medical professional.

Bill Rudow, whose son, Michael, was injured in an April 2011 game while playing lacrosse for Friends School in Baltimore, said the best information he got about concussions did not come from a pediatrician, but from a specialist.

Rudow, who is trained as a first responder, said he would have kept his son home from school and not allowed him to exercise, listen to music, watch television or read, if he had more knowledge about the healing process.

"I had no idea that using your brain hurts it. We didn't realize that he should have been resting and doing absolutely nothing those first couple of days," he said.

Michael, injured as a junior, continues to have headaches and has decided to delay his entrance into the University of Pennsylvania for a year to try to heal.

"My junior year was marked by feeling slow, fatigued and generally out of it," said Michael, 18. He missed about a day of school a week, and after resting over the summer, began to feel a little better. But during his senior year he had excruciating headaches whenever he extended himself with homework. He gave up lacrosse.

"Athletes are told to fight through pain," he said. "I didn't go back in to play, but I think that a lot of kids would go back in not knowing."

Michael believes that beginning in elementary school, athletes should be taught how serious concussions are so they will be alert to the symptoms and seek help immediately.

'Stress the mental portion'

One step the state school board is considering is placing limits on practices. Ivy League universities have recently placed limits on contact practices in football, lacrosse and soccer. The NFL and the association for little league football have taken similar steps.

The Baltimore Youth Hockey Club, which was hosting the tournament in which Beth Kennedy was playing, does not have mandatory testing; its coaches, however, must be certified by USA Hockey, which includes a concussion component in its training.

The rules for deciding when athletes must be taken out of play, when they can return and who makes those calls are not consistent throughout youth hockey leagues, said Charles Kaplan, president of the club, a recreational and travel league with 300 players.

"It is an area we probably need to address. We are faced with the same challenges that other programs are," he said.

Kaplan said that his club works with Lifebridge Health to provide a card to all its coaches with a set of questions they are required to ask players to help evaluate them if they suspect they have a concussion. It also offers baseline testing as an option for parents.

In addition, they provide "impact stickers" to put on the helmets of the members of its travel teams; if the seal is broken, indicating an abnormal impact has occurred, the player has to come off the ice.

Howard is one of the counties that is tracking the number of concussions. Mike Williams, Howard County's athletic coordinator, said that when the county started counting concussions in 2007, there were 72 documented cases. This past year there were 275.

"Those concussions were always there, but we didn't have the education and awareness we do now. We are able to better document it," he said.

Last year, Howard football teams began limiting the number of times a week players could have full contact practice. They're also cutting back on drills that put kids at greater risk.

Those limits didn't seem to hurt the teams. "We are winning state championships doing it our way," Williams said. "In football, you can't prevent them all. What you want to do is keep the numbers as minimal as possible."