He was a dashing figure until he hit the manhole cover and flew face first into the street, knocking out his two front teeth and causing a concussion that sent him to the hospital for two days.

Today his smile is a little crooked, but he keeps his safety helmet on perfectly straight.

According to the Brain Injury Association, every year in the United States 1.4 million people are treated for traumatic brain injury (TBI) in hospital emergency rooms. About 50,000 people die each year from TBI, and 80,000 experience the onset of long-term disability.

Major causes of TBI are falls (28%), motor vehicle crashes (20%), struck by/against (19%), and assaults (11%). Alert parents need to know how to protect their children from brain injuries, and how to identify a serious injury.

Some Of The Facts

Nearly 200,000 traumatic brain injuries occur on U.S. sports fields each year. An estimated 65 percent of the injuries occur to young people 5 to 18 years old.

Repeated concussions not only impair memory and mental function over the long term, but may trigger "second impact syndrome," a sudden, fatal brain swelling.

There is no such thing as a "modest" concussion. And you don't have to be knocked out to suffer one. More than 90 percent of concussions don't involve loss of consciousness.

Experts agree that nobody who still has symptoms of a brain injury should be allowed to play again until all symptoms have cleared.

After a brain injury, the risk for a second injury is three times greater; after the second injury, the risk for a third injury is eight times greater.

Helmets First

A properly fitted helmet is the most important piece of safety equipment for many activities. For example, medical research shows that 88 percent of cyclists' brain injuries can be prevented by a helmet.

* Different activities require different helmets.
-Bicycle helmets are OK for bicycling, inline skating, skateboarding and roller-skating.
-When around or riding horses, wear an equestrian helmet.
-Use motorcycle helmets on motorcycles, ATVs, snowmobiles and minibikes.
-Snow skiing and snowboarding require special helmets.

* Only buy helmets that meet the certification requirements for a particular activity. For details on helmet selection and fitting, talk to an expert, or contact a national association for the activity or the Consumer Product Safety Commission.

* The child should participate in the selection of the helmet. Do not buy one that a child can "grow into."

* Never buy a used helmet! Do not use a helmet that has been dropped or involved in a collision.

* If parents wear helmets, almost all kids wear them, too. If parents don't wear helmets, the number drops considerably.

In The Event Of A Brain Injury

* After any fall or activity involving contact to the head, see a physician if any of the following symptoms are present: thinking problems; memory loss; dizziness; headache; nausea; sensory changes; balance, sleep or pain problems; changes in personality, mood or behavior; or trouble communicating.

* Ask your child's teacher(s) to call you if they see any symptoms.

* When your child leaves the emergency room or office following a brain injury, the doctor or nurse should give you instructions on caring for your child over the next 24 hours, and describe any important changes to watch for. If you do not get these "Head Sheet" instructions, ask for them.

* The effects of a "mild" brain injury may not be seen immediately. See a doctor who specializes in brain injuries right away if you notice these changes in your child:
-severe headache that does not go away or get better.
-seizures, eyes fluttering, body going stiff, staring into space.
-child forgets everything, amnesia.
-hands shake, tremors, muscles get weak, loss of muscle tone.
-nausea or vomiting that returns.