Lawrence Robbins, M.D.
Children should just play flag or touch football until at least age 12. The evidence is compelling that early exposure to tackle football may permanently harm the brain. Intuitively, it’s just not a terrific idea for a child to use his head as a battering ram.
Children are not simply “miniature adults.” They have an underdeveloped and fragile nervous system. The “white matter” of the brain is critical for a number of functions, including protecting the brain. This white matter slowly develops until the early twenties. In children aged 6 thru 12, it is unable to help shield the brain from trauma. These ages are critical for development of our nervous system connections; any blow to the head may lead to poor outcomes down the road.
The brain is similar to Jell-O, surrounded and cushioned by fluid. When the head suddenly stops, the brain continues through the fluid, banging into the unforgiving rigid skull. A cascade of chemical events ensues in the brain, leading to changes that are detrimental for a developing nervous system.
Too much emphasis has been placed, in the media and by physicians, on concussions. The more serious problem is multiple “sub-concussive” blows, which add up over time. Many coaches claim that they had not witnessed any concussions during the past year. That may or may not be true, but the childrens’ brains still were being damaged.
Children’s heads are oversized for their body, similar to a bobblehead. When the head is struck, neck and shoulder muscles cushion the blow. In younger kids, these muscles are small and weak. There is little to prevent the brain from smashing against the skull after a forceful blow.
The younger the child, the greater chance for producing neurologic, emotional, and behavioral problems down the road. There are a number of credible studies proving that it is dangerous to start playing tackle prior to a certain age.
A Virginia Tech study assessed 7 and 8 year olds over 2 seasons. They wired the helmets with sensors. The young players averaged 100+ hits per season, mostly in practice. Many of these blows exceeded 40 g-forces, and some reached 80 to 100g-forces. 40 g-forces denotes a similar impact to being punched in the face; even 18g-forces might be equivalent to being hit hard by a pillow. 80 to 100g-forces will produce serious brain damage.
Virginia Tech also did a 2017 study on children playing tackle. Eight percent of the hits were of high magnitude, over 40g-forces. The backs and receivers were at increased risk, with 60% of high impact hits being in the open field. In high school and college, the linebackers and linemen sustain more of the hits than do the “skill” players.
A Wake Forest study of 8 to 12-year-olds revealed problems with the white matter of the brain, even after the football season had concluded. Even without any concussion, the white matter was disrupted in these children. The white matter of the brain is vital for memory, attention, and for regulating behavioral and emotional stability.
A North Carolina study of 8 to 13 year olds assessed kids who had not suffered from obvious concussions. It is the cumulative effect of milder “sub-concussive” blows that causes the most damage. In this helmet sensor study, a good number of high impact hits were recorded. Preseason and postseason MRI scans were performed. As the “sub-concussive” hits to a child’s brain increased, an increase in white matter disruption and damage was observed. For some children, this damage is permanent.
A Canadian study assessed adults 30 years after they finished playing their sport. If they had sustained even 1 moderate to severe concussion in teenage years, they often experienced worsening memory and balance problems over time.
A large Boston University study of 12 and under football players was undertaken. They concluded that there was an increased risk for behavioral and cognitive problems over time. The behavioral problems were doubled among kids who began playing prior to age 12, and the risk for depression tripled.
One study indicated that football players younger than twelve have 3 to 4 times the overall injury rate than the older children. In Canada, similar findings have been made among hockey players, where one group began checking at age 11, and another group waited until age 13. It was found to be significantly safer to delay the intense physical contact. The children can easily “catch up” in technique when they begin at an older age. Most football coaches agree that it does not take years for young players to learn proper technique.
A 2015 study(in the Journal of Neurology) correlated the age of first exposure to tackling with an increased risk of cognitive impairment as an older adult. They assessed 42 players at ages 40 to 69. This was accomplished with objective neuropsychiatric tests of memory and attention. The conclusion was that starting to tackle earlier than age 12 is the major risk. Players who began at later ages fared significantly better on the tests.
A 2017 study (in Translational Psychiatry) evaluated the age of first football exposure with long-term outcomes. The study included 214 adults who had played tackle football. All of the players had continued on to play high school, college, or in the NFL. The conclusion was that if players began prior to age 12, in later years they were at great risk for: depression, cognitive impairment, behavioral problems, and “poor executive function.” The key point was that it did not seem to matter as much if they only played high school ball, or continued to college or the NFL; the major risk was the age they began playing football. The early (less than 12) exposure was the major risk factor.
A Purdue study assessed high school players using advanced imaging techniques. As the season droned on, the players’ brains deteriorated. Certain parts of the brain did not function as well, and other parts of the brain “took over.” On intelligence testing, the kids degenerated over the football season. The brain changes seen over the football season will most likely be permanent for some of the youngsters.
A recent study by Tagge (in Brain) assessed teen athletes who had suffered from closed head injuries. Even at these young ages, evidence for chronic traumatic encephalopathy(CTE) was discovered.
A study by Mentenegro (in Neurotrauma) looked at the cumulative effect of hits to the brain in high school and college players. As the number of hits increased, they observed more late life cognitive impairment, poor executive function, depression (and suicide), apathy, and behavioral problems (including attention deficit disorder).
Early blows to the brain increase risk for chronic neurologic diseases. These include headaches, multiple sclerosis, dementia, Parkinson’s, and amyotrophic lateral sclerosis (ALS). CTE, while somewhat rare, is also a concern.
The evidence is abundant: tackle football is not good for childrens’ brains and bodies. The problem is not simply the risk for neurologic, emotional, and behavioral problems. Cognitively, it is probable that many young kids suffer some loss of IQ points from repeated head blows. Even if the IQ goes from 108 to 104, they will be at a disadvantage for the ensuing 70 years. It is not worth the risk.
There have been efforts to make the game safer. The “Heads Up” program had promise, but did not achieve its goals. Improved helmets prevent fractures, but are inadequate to protect the brain from internal injury. The fancy, expensive helmets impart a false sense of security. Hitting is part of tackle football. As much as we tweak safety rules, kids will still injure their brains. Children are not as coordinated at young ages, and they often are out of control.
We can make the game somewhat safer by: limiting hitting in practice, adopting better helmets, teaching improved techniques, and not allowing full tackling. These measures are mildly helpful, but inadequate. They fool us into thinking that the kids are “safe.” Even sensors in the helmets, to tell us when the child has received a moderate or severe blow to the head, are misguided. Do we really need sensors to inform us that our child has sustained a major brain injury?
When a 45 lb player takes a blow from a 65 lb. young man, his neck muscles simply cannot provide any cushion. A 9-year-old smaller player is at great risk going against a 10-year-old stronger one.
Parents should not be left to decide whether their kids can play. Most parents are on board with delaying tackle football, but many others ignore the evidence. Even when their child has suffered multiple concussions, they often allow the child to continue. Parents may say “My son gets so much out of football; it would devastate him if we forced him to quit”. The innocent child is the one whose brain is being permanently damaged. He is too immature to understand the long-term risks. The stakes are too high to leave it up to parents, who may be ill-informed, or have their own agenda.
At youth football games, we do not always have qualified trainers and coaches. Even at the college or NFL level, with independent neurology observers, concussions are missed. Most coaches are very well-meaning, but some do not buy into the dangers of head trauma. They will dutifully complete a brief training program, but remain unconvinced. After all, most youth coaches are amateur volunteers.
Decades after the long-forgotten football games of yesteryear, many men suffer with various orthopedic and neurologic injuries from football. Is it really worth it?
Flag and touch football are fun and engaging. While I understand the value of the experience and social benefits of tackle football, I still maintain that there are ways to impart these lessons without endangering children. Kids can also learn from playing safer sports.
If we delay tackle football, these young men will think with more clarity and have less emotional and behavioral problems. They will have a significantly reduced chance of suffering from chronic neurologic conditions.
We recently submitted a bill to the Illinois House Legislature, banning tackle football under age 12. The writing is on the wall: eventually tackle will disappear under a certain age. Anything beats damaging their nervous system for life.