Chris G. Koutures, MD, FAAP Pediatric and sports medicine specialist

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Comprehensive blend of general pediatric and sport medicine care with an individualized approach that enhances the health and knowledge of patients and their families



Proud physician:
USA Volleyball Mens/Womens National Teams
CS Fullerton Intercollegiate Athletics
Chapman University Dance Department
Orange Lutheran High School

Co-Author of Acclaimed Textbook

Pediatric Sports Medicine: Essentials for Office Evaluation

Orange County Physician Of Excellence, 2015 and 2016


Filtering by Tag: USSF and youth soccer heading recommendations

Schedule Dr. Koutures to Speak to Your Soccer Club or Team


With more and more kids and teens playing soccer, so comes the risk of injury. Today, players are suffering from head injuries, groin injuries, knee injuries, hamstring pulls and broken bones.

Schedule Dr. Koutures to come speak to your coaching staff or families!

Some common topics he can address include:

To schedule a one hour session with Dr. Koutures for coaches and/or parents, click here or call 714-974-2220

More Dr. Koutures Thoughts on Heading and Helmet Use in Youth Soccer

The United States Soccer Federation decision to not have players under age 12 engage in heading activities and to limit heading exposure in players between age 12 to 13 has fueled many interesting exam room discussions about soccer-related concussions that have led me to develop particular thoughts on the topic, including a very unexpected and somewhat troubling take on the use of of soft helmets.

Many of my ideas have been incorporated in two thoughtful articles written by Lindsey Barton Straus, JD  from Mom'sTEAM.  Highly recommend taking the time to read both, as she very adeptly captures my experience and research with this important topic:

One of the main take-home points that underlies my philosophy and is echoed by several other interviewed authorities emphasized an individualized approach to determining readiness to initiate heading.

While certain categorical age-based decisions are far easier to implement, as we are continually taught in pediatric medicine, the focus should more often be placed on each child's developmental age rather than their chronologic age.

Another maxim in pediatrics- never hesitate to have  a realistic discussion about a difficult topic- in this case, a dialogue between player, coach, family and medical professionals as needed to make the best decision for each athlete.

Having several such realistic discussions about preventing head injuries and making return to play decisions after concussion has also brought a unique, if not cynical insight into a related controversial topic, the use of soft helmets to reduce head injuries in soccer.

From a professional standpoint, I have always been somewhat unconvinced about the true protective value of soft helmets in soccer, and have never mandated that an athlete must wear one in order to continue playing the sport. 

It didn't take long for me to learn that most of my young athletes shared my apprehension about helmet use.

However, their lack of interest wasn't due to their reading of the medical literature, or a more typical adolescent rebellion against parent/coach/medical professional authority. 

Rather, they were afraid to wear them for fear of being a target.

"If I am the only one, or only one of a few that are on the field with a helmet, my opponents will come after me."

After hearing this concern several times over, I must admit that now when asked by a parent about my opinion on helmet use, I reflexively turn to the child and ask them to truthfully tell me their opinion.

Sure enough, I get reminded of the fear of being a target. Definitely makes the parents think a bit differently about helmet use, and given the lack of consistent evidence supporting their use, definitely influences my decision.

This may not be the most scientific way to form a response, and definitely is a sobering reflection on the competitive environment faced by many young players, but it does provide a practical and necessary real-world platform to best address each individual player's needs, concerns, and future expectations.

Curious if others have encountered hesitation to wear soft helmets based on perceived risk of being singled out on the playing field? Does this information change opinion on possible helmet use?






Dr. Koutures Thoughts on US Soccer Youth Heading Recommendations via MomsTEAM

On November 9, 2015, as part of a concussion-based lawsuit settlement agreement, the United States Soccer Federation (USSF) announced a series of recommendations directed at identification, management, and prevention of concussions in youth soccer.

In regards to youth players heading a soccer ball, the following recommendations were released:

  • Under age 11(U11) and younger
    •  U.S. Soccer recommends that players in U11 programs and younger shall not engage in heading, either in practices or in games
  • U12 and U13
    • U.S. Soccer further recommends for players in U12 and U13 programs, that heading training be limited to a maximum of 30 minutes per week with no more that 15-20 headers per player, per week.
  • All coaches should be instructed to teach and emphasize the importance of proper techniques for heading the ball.

As one of the co-authors of the 2010 American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness Policy Statements on Injuries in Youth Soccer, I responded to questions posed by Lindsey Barton Straus, JD of MomsTEAM  about certain aspects of these heading recommendations. Please click on the above link to read her entire article and my embedded comments which represent my opinions and may not be interpreted as official AAP policy.

Be on the lookout for a follow-up article from MomsTEAM that reviews return to play decision-making components of the settlement agreement