American football is a game under siege. The President of the United States convenes a summit of major stakeholders “with the object of devising means of eliminating so far as possible the brutal elements of football.”1Severe head injuries are rampant, and 18 football-related deaths occur in a single season.2 Questions are raised as to whether football should be allowed to continue within America’s educational institutions.
Does some of this sound familiar? This describes the situation of American Football back in 1905, where President Theodore Roosevelt tried to “save” the sport. This effort resulted in the formation of the National Collegiate Athletic Association (NCAA) and fundamental changes in the rules of the game. Football was no longer a series of rugby-like scrums with massive player pile-ups. It became a game where the forward pass spread players out across the field, and intermittent play stoppage tried to minimize the kicking and punching that caused many serious injuries.
Fast forward a full century, and American football is once again getting a red flag. Summits have been convened and rules have been changed, yet football is still the sport associated with the highest rates of concussion and musculoskeletal injury. In this month’s Pediatrics Perspectives, Lerner and Fost (10.1542/peds.2019-1985) raise significant concerns about the safety of children and adolescents participating in American tackle football, and explore the role of pediatricians in assuring that athletes and their families are aware of risks assumed when children and adolescents elect to play this sport.
These authors focus on the following statement contained in the AAP’s 2015 clinical report “Tackling in Youth Football:”
“Participants in football must decide whether the potential health risks of injury are outweighed by the recreational benefits associated with proper tackling.”
Lerner and Fost posit that this statement implies the need for a rigorous informed consent process before “allowing” young athletes to participate in tackle football. They propose that the AAP should take a leadership role in the development of education and assessment materials to assure that families and athletes truly understand the intrinsic risks of this sport and give specific recommendations to that end.
This Pediatrics Perspectives is a compelling read that for many may “push the boundaries” of the role pediatricians should play in guiding activity choices for their patients. But, it certainly makes me consider the conversations I routinely have with patients and families. I try to give a balanced assessment of the risks and benefits when clearing athletes for participation in football (or really for any contact/collision sport), but this paper makes me wonder if maybe I am not doing enough. After you read this article, see if you don’t feel the same way.
- “Hears football men.” Washington Post October 10, 1905. https://www.documentcloud.org/documents/1175005-144576144-1.html Accessed October 4, 2019.
- Abbott K. “Score one for Roosevelt.” Smithsonian.com. https://www.smithsonianmag.com/history/score-one-for-roosevelt-83762245/. Accessed October 4, 2019