• Won’t somebody think of the children? Unless it’s football, of course.

    Full disclosure: my son Noah played tackle football for a few years, and it was some of the most exciting kids’ sports we watched. I’ve been conflicted about the ongoing discussion about whether kids should be allowed to play tackle football. On the one hand, Noah and his teammates were so small that they didn’t hit each other with much force. And they loved playing. On the other, concussions are bad. Luckily, he “retired”, and I wasn’t forced to make a decision.

    But I like to think I’m consistent in weighing risks and benefits. Others, however, advocate a “protect the children at all costs” approach.

    In an NEJM Perspective piece this week, Kathleen Bachynski calls the AAP to task for its inconsistency with football:

    At least 11 U.S. high-school athletes died playing football during the fall 2015 season. Their deaths attracted widespread media attention and provided fodder for ongoing debates over the safety of youth tackle football. In October 2015, the American Academy of Pediatrics (AAP) issued its first policy statement directly addressing tackling in football. The organization’s Council on Sports Medicine and Fitness conducted a review of the literature on tackling and football-related injuries and evaluated the potential effects of limiting or delaying tackling on injury risk. It found that concussions and catastrophic injuries are particularly associated with tackling and that eliminating tackling from football would probably reduce the incidence of concussions, severe injuries, catastrophic injuries, and overall injuries.

    But rather than recommend that tackling be eliminated in youth football, the AAP committee primarily proposed enhancing adult supervision of the sport. It recommended that officials enforce the rules of the game, that coaches teach young players proper tackling techniques, that physical therapists and other specialists help players strengthen their neck muscles to prevent concussions, and that games and practices be supervised by certified athletic trainers. There is no systematic evidence that tackling techniques believed to be safer, such as the “heads-up” approach promoted by USA Football (amateur football’s national governing body), reduce the incidence of concussions in young athletes. Consequently, the AAP statement acknowledged the need for further study of these approaches. The policy statement also encouraged the expansion of nontackling leagues as another option for young players.

    The AAP committee shied away from endorsing the elimination of tackling in youth football, because doing so would fundamentally change the way the game is played. Yet evidence indicates that tackle football in its current form is inconsistent with the AAP mission “to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults.” Repetitive brain trauma can have serious short- and long-term consequences, including cognitive and attention deficits, headaches, mood disorders, sleep disturbances, and behavioral problems. To significantly reduce the incidence of brain trauma in young people, I believe that physicians should consider endorsing strategies that alter the way football is played.

    I’d post the whole thing, but you should probably go over to the NEJM to read it. I’m still not sure where I stand on all of this, but I think her piece is well worth your time. I also think the AAP (and other groups) might need to think about being more consistent in their recommendations.

    @aaronecarroll

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