Advising Parents on Neurological Risks of Youth Football

By Hannah Stuart
Tuesday, November 1, 2016

With research yielding sometimes discordant findings regarding long-term medical risks of football, physicians are looking for answers for parents concerned about youth participation.

Parental focus on contact sports — particularly football — has grown as information about the effects of repeated blows to the head has become more widely publicized. Many parents of the approximately 3 million American youths who play tackle football have questions for pediatricians about the safety of the sport and potential health consequences for their children.

Risk Versus Benefit

While there are no universally agreed-upon answers to those questions, physicians can provide parents and young athletes guidelines to minimize concussion risk.

The American Academy of Pediatrics recommends that skilled athletic trainers be on the sidelines, that individual players assess the benefits of playing against the risk of injury and that tackling rules be vigorously enforced.

Yet those guidelines cannot fully address the complex matrix of factors that can increase or reduce risk for concussion.

“Pediatricians should not emphasize concussions. It misleads parents. Pediatricians should emphasize that ... exposing [the] head and brain to repeated blows is dangerous and can damage your child’s brain.”
— Bennet omalu, MD

“If you had concussions in the past, you have higher risk for future concussions,” says Christopher Giza, MD, Director of the UCLA Steve Tisch Brain Sport Program and a Professor of Pediatrics and Neurosurgery at Mattel Children’s Hospital UCLA. “If you wait and make sure [your] brain recovers, then you can reduce that risk, but there’s also a risk of people who just tend to play more aggressively.”

Dr. Giza recommends programs that teach heads-up tackling as one means to reduce players’ likelihood of injury. Pediatricians should also urge parents to look for coaches who will teach children better spatial and visual awareness, which can reduce the risk of blindside hits that cause more brain movement. And, he adds, parents should avoid coaches who have a win-at-all-costs mentality. Instead, they should choose someone whose priority is the safe enjoyment of the sport and who has undergone training in dealing with head injuries.

“[W]hat sport to participate in and at what level is an individual decision of risk versus benefit,” Dr. Giza says. “Most of the time, I would say pediatricians and other doctors should really be looking at the individual risk and benefit for each child.”

Prepping Parents

While awareness of concussion has risen among parents of young athletes, there is still a lack of understanding of what a concussion involves, says Julie M. Stamm, PhD, LAT, ATC, Associate Lecturer in the Department of Kinesiology at the University of Wisconsin-Madison.

Stamm recommends physicians explain to parents and children what concussion symptoms look like. This enables children to know what to report and parents to know what to look for — for example, if a child is complaining of dizziness or seems overly fatigued. Greater understanding of subtle symptoms that only parents might notice because they spend more time with their children can aid identification of concussions, she adds.

Avoiding Football Altogether

Bennet Omalu, MD, Chief Medical Examiner for San Joaquin County, California, Associate Clinical Professor of Pathology at UC Davis, and the forensic pathologist who discovered chronic traumatic encephalopathy, is unequivocal in his view that no child should play contact football. He believes his work and that of others demonstrate that the risk for long-term brain damage is simply too high.

“Any child who plays [high-impact contact sports] stands a significant risk of suffering permanent brain damage,” Dr. Omalu says. “You can never reduce risk to 0 percent — that’s why my position is [that] children can play other sports that are not high-impact contact sports.”

He encourages athletic participation in sports in which risk of blows to the head is lower. He does not include in that category sports such as football, ice hockey or rugby.

“Pediatricians should tell parents, ‘Look, in whatever activity your [child] is engaged, whereby his or her head is exposed to repeated blows, there is a risk of permanent brain damage,’” Dr. Omalu says. “Do we know what that risk is? We can’t quantify it, but there is a risk, and the brain is what defines who your son or daughter is. You don’t want to undermine that.”