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Recently, the American Academy of Pediatrics has come under fire for being too easy on kids' football. Football is dangerous, but is this simply an overreaction in the name of keeping any child from being injured ever? Aaron has opinions.

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Let's start with a disclosure.  My son Noah played tackle football for a few years and it was some of the most exciting kids' sports we watched.  I've been conflicted about the ongoing discussion about whether kids should be allowed to play tackle football.  I have avoided talking about it until now.  This is Healthcare Triage News.


On the one hand, Noah and his teammates were so small that they didn't hit each other with much force and they loved playing.  On the other, concussions are bad.  Luckily he "retired" and I wasn't forced to make a decision, but I like to think I'm consistent in weighing risks and benefits.  Others, however, advocate a "protect the children at all costs!" approach.

In a New England Journal of Medicine perspective article last week, (?~0:44) called the AAP to task for its inconsistency with football.  She noted that at least 11 US high school athletes died playing football in 2015.  That was news to me.  In October of last year, the American Academy of Pediatrics issued its first policy statement covering tackling in football.

Their review found that tackling was associated with concussions and injuries, and that eliminating tackling would likely lower rates of concussions, severe injuries, catastrophic injuries, and overall injuries, but the AAP didn't recommend that.  They instead focused on enhancing adult supervision of football.  They recommended a focus on proper tackling techniques that physical therapists and exercises strengthen neck muscles and that practices and games be supervised by trainers.

Unfortunately, while these things sound good, theyr'e not proven to work.  The American Academy of Pediatrics acknowledged this and called for further research and they also encouraged non-tackling leagues as an option for kids.  What they didn't do, however, was call for the end of tackling.

What I didn't know and what (?~1:44) pointed out, was that the AAP has been much more anti-football in the past.  In the 1950s, they argued that football and other contact sports contained too great a risk of orthopedic injuries.  In 1957, the AAP committee on school health issued a policy statement saying that body contact sports, especially football and boxing, have no place in programs for children.  

In November of last year, the US Soccer Federation released a new policy which prohibited kids 10 years of age or younger from heading the ball, and they called for a reduction of heading in practices for kids 11 to 13 years of age.  It is possible to use new and emerging evidence to change your policy and we covered some of that evidence in soccer in Healthcare Triage News last year.  

Many people make an argument that these risks are still small overall.  They also argue that the benefits from team sports like football can outweigh the potential harms.  Those arguments have been part of AAP history as well.  In fact, they said, and I quote, "Participants in football must decide whether the personal health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling.

The problem here is that kids can't make those decisions for themselves.  At the end of the day, we're making it for them.  They can't understand the long-term risks.  They barely have abstract thought, but I have to admit, I don't know what the right answer is here.  There are arguments on both sides  and it's complicated to weigh the risks and the benefits.  My problem here, and I think (?~3:09)'s too, is that many advocacy groups often take an approach that we must do anything to save just one life, no matter what the cost.

They lack nuance.  They're (?~3:20) screaming, "Won't somebody please think of the children!" Unless of course, it's football.

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