The Council on Sports Medicine and Fitness policy statement, “Tackling and Youth Football,” asserts that many young athletes will suffer debilitating brain injuries.1 As the council acknowledges, little is known about tackling per se, so that a statement limited to tackling is misleading about the risks of football, where the risk of concussion is greater than for any other sport.2 Furthermore, football participation dwarfs other sports, so this 1 sport contributes ≥60% of sport-related concussions in high school.3 Dompier et al4 estimate that 99 000 youth players experience ≥1 concussion annually. These facts alone should raise questions about our culture’s willingness to tolerate, not to mention encourage, this cause of harm. Add to this the acknowledgment by experts that we are as yet ignorant of the long-term consequences of concussions. Meehan5(p125) notes that “medicine has not figured out how many concussions is too many. And in fact, it is likely no such number exists.”
The evidence supporting the effectiveness of the recommendations is meager. Indeed, there are >40 uses of terms such as “unclear,” “unknown,” “limited,” and “without scientific basis” in the statement, which, though adequately reflecting the state of an uncertain literature, do not support evidence-based recommendations.
It is important for pediatricians to empower parents and their young potential football players. The council’s recommendation that parents “decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling”1(pe1426) undermines the concept of empowerment, because of the absence of information. If parents wanted to make an evidence-based choice, to whom would they turn other than pediatricians?
Perhaps the millions of dollars being devoted to the diagnosis, acute treatment, and long-term management of concussions will help us answer questions such as “Can we end tackling?” and “Can we make tackling safer?” Until those questions are answered through rigorous research, pediatricians should advance primum non nocere, first do no harm, by advocating for the end of youth football.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- ↵Council on Sports Medicine and Fitness. Tackling in youth football. Pediatrics. 2015;136(5). Available at: www.pediatrics.org/cgi/content/full/136/5/e1419
- ↵Institute of Medicine (IOM) and National Research Council. (NRC). Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. Washington, DC: The National Academies Press; 2013
- Meehan WP
- Copyright © 2016 by the American Academy of Pediatrics