Football — especially on the professional level — has come under intense scrutiny in recent years because of the potential effects of repeated concussions suffered by current and former players.
As a result, experts and critics have asked how much violent contact is too much for pre-high school players. Some have even questioned whether tackling — an essential part of the collision sport — should be banned in youth football leagues.
The new AAP policy statement Tackling in Youth Football addresses those concerns and provides guidance to pediatricians and parents based on the information available from relevant studies.
“We’re trying to bring the evidence to the decision-making process as opposed to simply emotion and anecdote,” said William P. Meehan III, M.D., FAAP, a lead author who is director of the Micheli Center for Sports Injury Prevention, Division of Sports Medicine at Boston Children's Hospital.
The policy is available at http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2015-3282 and is published in the November issue of Pediatrics.
There are several recommendations in the policy statement, such as asking that leagues and coaches limit the possibility of repetitive trauma to the head, teach proper tackling techniques and offer more options for children who want to play in non-tackling football leagues.
Examining the research
The policy statement includes insights from several football and sports-related studies.
One of the key study findings was that the incidence of serious injury seems to be greater in football than in other team sports. Ice hockey, however, has a higher risk of catastrophic injury than football, and gymnastics’ risk is just as high.
Studies also indicated that most major injuries in football are caused by tackling, and the worst ones are brought on by head-to-head contact. For example, spear tackling — when a tackler leads with the crown of the helmet — is the lead factor in injuries causing quadriplegia. One key conclusion from studies was that coaches need to teach proper tackling technique in practice at a young age to prevent injuries.Enforcing the rules
The policy statement’s most urgent recommendation is that leagues and referees consistently penalize contacts to the head because the most severe injuries in football are associated with improper or illegal tackling.
“We need people to enforce the rules and teach players to play with proper technique,” said Gregory L. Landry, M.D., FAAP, a lead author and professor of pediatrics at the University of Wisconsin School of Medicine and Public Health.
Although football players are required to wear padded helmets for safety, the helmets sometimes can have the opposite effect when used improperly.
“Helmets are so well made now that players in recent years have learned to use the helmet as a weapon,” Dr. Landry said. “And that’s dangerous.”
In contrast, tackling technique is even more crucial in a sport such as rugby, where players don’t wear helmets.
“We need to get rid of impacts to the head entirely in football,” Dr. Meehan said. “There’s no known benefit to an impact to the head, and it doesn’t need to be part of football. In rugby, head-to-head impacts are rare because it will hurt both players.”
The report authors bring up the possibility that youth leagues might allow only the older players to play full-contact. If that happens, they say the league still should teach proper tackling techniques to younger players.
“People have worried — and I think it’s a reasonable concern — that if you delay initiating contact until the teenage years, by the time they’re a teenager they’re big, fast and coordinated and can deliver a powerful impact,” Dr. Meehan said. “Is that really the first time you want to introduce tackling, in a high-risk situation?”
One way to achieve a middle ground might be to limit full-contact practice time.
“Coaches are taking a critical look at limiting the contacts the kids have in practice,” Dr. Landry said. “Teach them technique, give them some chance to practice, but limit that contact time.”
The emotional tug-of-war about whether football is safe enough is a scene that plays out in pediatricians’ offices every year. The authors want this policy statement and its recommendations to offer guidance during those discussions with parents and kids.
“I hope this report reassures pediatricians in terms of allowing a child to play tackle football if he/she wants to do that,” Dr. Landry said.
Recommendations and conclusions
- Ensure the rules of the game are enforced. A significant number of concussions and catastrophic injuries occur due to improper and illegal contact, such as spear tackling.
- Removing tackling from football likely would result in fewer overall injuries and concussions but lead to a fundamental change in the way the game is played.
- Football leagues and organizations should consider expanding nontackling leagues for young athletes.
- Coaches and officials should make efforts to reduce the number of impacts to the head that occur in football. More research is needed in this area.
- When regulations call for delaying tackling until a certain age, they must be accompanied by coaches offering instruction in proper tackling technique and other skills necessary to evade tackles and absorb being tackled.
- Players should be encouraged to strengthen their cervical musculature to help reduce the risk of concussion, although definitive evidence is lacking.
- Teams should strive to have athletic trainers on the sidelines during organized football games and practices.
