"It used to be you sucked it up, put dirt on it and went back in the game," Gus Pasquale says, looking back on his small-college football career.

He now coaches his son in a Wellington, Fla., football league and, like other parents, is better-informed about youth sports injuries, he said.

"As a parent, I'm thinking about the next six years, not the next six minutes," he said. "So I'll err on the side of safety."

As youth sports seasons start for the fall, the weighing game for parents and coaches starts as well: When players get injured, do you send them to the emergency room, say "suck it up" or suggest something in between?

Youth sports account for almost 4 million emergency room visits a year, according to the American Academy of Orthopaedic Surgeons.

Doctors, naturally, remind us that there'll always be another game to play, that long-term health supersedes the immediate satisfaction of continuing to play.

On the other hand is an equally compelling message: learning to handle sports (read: life) when things don't go 100 percent your way. Battling through. That, plus no one wants to unnecessarily spend a day in the emergency room. Or fork over yet another co-pay.

All within the context of a game for kids.

As Pasquale put it: "I've never seen Urban Meyer come from the University of Florida or Bobby Bowden come from Florida State to give a 12-year-old a scholarship."

Not tiny adults

In youth sports, coaches often are unpaid volunteers, usually parents, and few have extensive medical training, said Stephen Swirsky, a pediatric sports medicine specialist at Miami Children's Hospital. So, while it's important for parents to respect the time their coaches are putting in, it's equally important they don't merely hand off medical evaluations of their child to the coach.

"Kids aren't miniature adults," said Dr. Randolph Cohen of Joe DiMaggio Children's Hospital in Hollywood, Fla. "They are at risk for a whole set of injuries that adults don't get."

For example, children have growth plates at the end of their bones, which are prone to injury and require diagnosis and treatment to prevent future problems, he said.

Cohen and others helped prepare youth football coaches at a symposium this summer. Although he doesn't expect coaches to become medical trainers, Cohen does advise them on what to do in case of injuries -- and that includes straying from the "suck it up" mentality that most coaches had drilled into them when they were players.

Dr. Maria Torres, director of the emergency department at West Boca Medical Center in Boca Raton, Fla., said strains and sprains often take longer to heal, and sometimes are worse than a fracture.

"Inexperienced coaches may blow them off or not take it seriously," she said.

Her rule of thumb for general injuries: "If there's still pain after 24 hours, you need to consult with a doctor, whether it's a trip to the E.R. or their own private physician."

Know the child

Gillian Fairclough, whose son, Justin Besley, 13, plays goalie for a Sunrise, Fla., soccer team, compares the situation to the times parents get calls from school when their child is in the clinic.

"Do you send them back to class or not?" she said. "You can second- and third-guess yourself. But generally, I get comfort from talking to a doctor. It's worth it."

The coaches, meanwhile, decide daily: Are the players hurt or do they just need a push?

"It comes down to knowing the kid," said Hector Kinder, who coaches in the Delray Rocks, Fla., football program. "Sometimes a kid will lie on the ground longer because he's embarrassed he made a bad play. But there are some kids that hate to come out, and if they're complaining, you know they're really hurt."

Daniel Peruyero, who coaches youth football in Miramar, agrees.

"There are always kids that moan, and it's only during certain parts of practice," he said.

So sometimes he'll pull a player off to the side, away from the drill.

"If I see him bouncing around, joking, then I know he's not injured," Peruyero said.