Facing the concussion risks of youth football

After years of denying the link between football and brain disease, this month the National Football League’s own experts calculated that nearly one third of its players will go on to develop long-term cognitive problems after retirement. The league’s new stance might help shift public perceptions of football’s extraordinary risks to professional players’ brains. From a public health perspective, examining the sport’s impact on millions of youth players is of even greater importance.

Children as young as seven and eight continue to play tackle football across the United States in far greater numbers than NFL stars. Accumulating evidence suggests that the repeated collisions inherent in the youth sport may cause significant harm. The players might be smaller, but the hits are still dangerous. Researchers have found that nine-twelve year olds can experience head impacts of a similar magnitude to those that occur in high school and college football. Furthermore, because children’s brains are still developing and because they have weaker necks than adults, they may be more vulnerable to brain trauma.

Why do parents allow their children to participate in a sport that poses significant risks to developing brains? One reason is that organizers of youth football leagues portray the youth game as much safer than the professional game. The Pop Warner website, for example, states that there is “an absence of catastrophic head and neck injuries and disruptive joint injuries found at higher levels” in their league. Such assertions seem to discount the potential severity of concussions, which are common in youth football and can have major short-term and long-term consequences. Parents may not fully appreciate the risks associated with football head injuries. A recent study of over three hundred football parents found that most did not realize that a concussion is considered a mild traumatic brain injury, or that a direct blow to the head is not necessary for a concussion to occur.  (A two-page fact sheet with danger signs and symptoms of concussions is here.)

Yet even if parents acknowledge that concussions are a significant injury, most people believe that strategies such as improved helmets, return-to-play guidelines, and "safer" tackling techniques can help significantly reduce the risks of concussion. Indeed, the NFL has helped promote this prevailing view, most notably with its "Heads Up Football" partnership with youth leagues, intended to teach proper tackling techniques to children. 

There is no evidence that the “Heads Up Football” program reduces the risk of concussion or of long-term brain damage: As former Denver Broncos tight end Nate Jackson has observed, no matter what tackling technique children use, “you can't remove the head from play in the football field.”

Unfortunately, improved helmet design is not a silver bullet either. Although helmets are very effective in preventing catastrophic head injuries such as skull fractures, they are not designed to prevent concussions. Even the best designed helmet cannot prevent the forces that occur when the head rotates on the neck. Kevin Walter of the American Academy of Pediatrics’ Council on Sports Medicine and Fitness recently stated that currently, “no protective equipment can prevent concussion.”

We need to ask different questions. At what point are the risks of head injuries so high or severe that even fully informed parents should not be permitted to let their children to play? And at what age can players consent to the risk of brain trauma and the elevated risks of neurological diseases later in life?