A year ago, I argued that if we want to limit the number of kids suffering concussions from playing youth football, then adults should not allow them to play tackle until age 14. Until then, children should be playing flag football.
I lobbied hard for this idea. I called for changes to lessen head trauma in other sports, too. My proposals include eliminating heading in soccer until age 14, mandating helmets in girls lacrosse and field hockey and requiring chin straps for helmets in youth baseball and softball.
Although doctors generally approve, they’ve had to tiptoe around the issue with young patients and their parents. Recently, I was speaking with a pediatrician who explained that each year several dozen of the children in his practice play in a local tackle football league. He knew the approximate number because the players required medical clearance to participate—a league policy. The pediatrician was ambivalent about signing off, to put it mildly. As he explained, he believed that his patients would be better off playing volleyball, basketball, or badminton—almost any sport other than tackle football. Yet if he refused to sign the forms, these patients might find another physician. “You want to do what’s best for your patients,” he told me later. “You also want to have patients.”
Medical researchers haven’t just been conflicted about my ideas - some have opposed them. This is a thoughtful group of people, without a doubt. Their work in labs and on papers published in academic journals help us to understand the effects of head trauma on kids. So their opinions matter greatly.
These scientists are skeptical because there are no longitudinal studies on the effects of tackle football or other collision sports such as lacrosse or ice hockey on the brains of young athletes. In a sense, their doubts are understandable. Research science is, by necessity, driven by data and that’s the sort of reasoning that scientists bring to the problem. They want to see the numbers, and research on young athletes is relatively scarce. As a researcher myself, with more than 375 papers published in peer-reviewed journals, I want to see them, too.
Therefore, the next step in making sports safer for kids is obvious. What is urgently needed is the most ambitious, comprehensive study ever done on kids, sports and head trauma. I am talking about an unprecedented effort that, if properly designed, would give us the answer to the biggest questions.
We know little about how our children are affected by the head-banging that occurs routinely in many sports, although a recent study showed the forces their brains are subjected to are similar to high school and college players. (There also are studies suggesting that children are more susceptible to brain injury and recover more slowly than adults). Among the unknowns: How many blows can a child’s brain absorb before cognitive deficits occur? How long does it take for a child’s brain to recover fully from a hit to the head? Are children playing football at greater risk than those playing other collision sports such as lacrosse and hockey? What about soccer? Are children who start playing tackle football at age five (yes, there are organized leagues for kids that young) at greater risk of injury than veteran players of, well, seven and eight? There are at least a hundred more equally important subjects that we know surprisingly little about.
The study that’s urgently needed would be different from previous research in the following ways:
It would be long-term. Typically, research involving kids and sports is more snapshot than motion picture. It captures a brief moment in time based on data gathered from athletes over a few weeks or in the best case, a season. The shortcomings of a limited time frame are hard to overstate. It tells us little about the effects of these injuries on children the next season and the next, and almost nothing about the cumulative effects of these injuries. It’s not only how this exposure affects athletes as athletes that we’re talking and worrying about. Is exposure of this sort jeopardizing the thinking potential of these children now and years from now? The answers are critical.
I propose a study that follows youth athletes for ten years, from their first days on the field until age 15. It would include youth athletes in many sports. Although our primary concern is with children playing collision sports such as football, ice hockey and boys’ lacrosse, where banging into your opponent is an expected part of the game, this study would include swimmers, soccer strikers, volleyball setters and field hockey goalies. Let’s learn what we can about the relative exposure of these athletes and, of course, whether there is a discernible difference in the effects of head trauma between girls and boys. At least one thousand young athletes would be recruited for the study.
Such a study would be expensive, costing perhaps $10 million. (2012 the National Football League donated $30 million to the National Institutes of Health to study head trauma and degenerative brain disease in adults. Last month, the NFL settled a massive head-trauma lawsuit with more than four thousand former players costing an estimated $800 million.) But think about what will be learned and how it might change the futures of millions of youth athletes for generations to come. Then tell me whether it’s too much.
Robert C. Cantu, a clinical professor in the department of neurosurgery and a co-director of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine, is a co-author with Mark Hyman of Concussions and Our Kids, published last month in paperback. The views expressed are solely his own.