Mixed reaction  

"I think that it is a reasonable [policy statement]" about a "complicated" matter, said Stefan Duma, a professor of biomedical engineering and mechanics at Virginia Tech, and author or co-author of a number of the small group of studies  published on injuries in youth football.

" Many people forget the big picture: that most youth head injuries come from riding bicycles, but nobody is talking about getting ride of them." In Duma's view, "It is all about balance, and the fact that there is risk in all sports." He noted that, having studied youth football teams, some involving players as young as seven, "we very rarely see injuries at the lower levels." 

As the guidelines were based on a review of limited research, said Rosemarie Scolaro Moser, a sports neuropsychologist and director of the Sports Concussion Center of New Jersey, "we still have a long way to go toward evidence based decision-making" about the safety of tackle football. But she thought the "spirit" of the guidelines appropriately reinforced the need to "change the culture of youth sport."

While Moser appreciated the way in which the authors weighed the pros and cons of delaying tackling, she thought the AAP "should have been more forceful" in pushing for certified athletic trainers to be at all games and practices. Instead of saying "'efforts should be made', why not just say that if the youth sport is played, then there should be an ATC or other healthcare professional present at all games, period?"  

Moser also liked the fact that the AAP came out in favor of expansion and promotion of non-tackle leagues, "to make them more mainstream, so that kids have a choice."  

Offering his perspective, Andrew Blecher, a primary care sports medicine physician at the Southern California Orthopedic Institute, said in an email that, "The AAP is to be applauded for providing a well-balanced review of the literature regarding the pros and cons of playing tackle football," and for making recommendations which had not, he said, previously been publicly supported by the AAP, "or any medical group, for that matter."

As a result, to that extent Blecher supported the statement "as a step in the right direction."

Passing the buck? 

Having said that, however, Blecher felt, "as a policy statement, [it] falls short."  One can infer from the statement what the AAP's position is, but it not clearly described, he said.

Blecher was particularly critical that the AAP suggested that "participants" be charged with the responsibility of weighing the risks and benefits of playing tackle football. As minors, noted Blecher, youth athletes are by definition not in a position to make such decisions themselves.  

Ultimately, he felt that the AAP should have come out with a firm advice for pediatricians about whether or not to recommend to parents that their kids play tackle football.  Blecher left no doubt on which side of that fence he stood:  "I think the AAP should have recommended that tackle football not be played by athletes under the age of 18 [because they] are unable to consent to the risks associated with a collision sport such as tackle football."

If tackle football is to be played by athletes under the age of 18, said Blecher, the AAP should have, in addition to the recommendations listed above, strongly recommended in favor of:  

1. Training of every coach in head injuries and in understanding the importance of safety first and sport second;
2. The signing by every athlete's parent/guardian of a consent form explaining the risks of tackle football, specifically in regards to head injury;
3. An acknowledgement by coaches, parents and athletes that no equipment (whether helmet or mouth guard) prevents head injury;
4. Greater emphasis on fostering a culture of injury recognition and reporting;and
5. Annual pre-participation physical evaluations (PPE) for every athlete, including a concussion baseline evaluation and screening for high-risk kids (e.g. those with history of multiple concussions, ADD, learning disability, etc. 

To put teeth in the recommendations, Blecher proposed that an organization be created with the power to enforce them, and, if they were not followed, to ban an organization/institution from offering tackle football and allow it to only offer non-tackle football.   

For a pdf of the full AAP policy statement, click here.   

Meehan WP, Landry GL. Council on Sports Medicine and Fitness Pediatrics. Tackling in Youth Football. Pediatrics 2015;136(5). doi: 10.1542/peds.2015-3282 (accessed at http://pediatrics.aappublications.org/content/early/2015/10/20/peds.2015...)

Posted October 25, 2015