Posts by: CAPP

Football is no game for boys to play: Matt Chaney’s Take on Bob Costa’s Remarks

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On a rare break from his sabbatical from football, Matt Chaney added his incredible historical insight and commented on Bob Costa’s stance on youth football:

Great comments and position by Bob Costas, regarding juveniles and brain risk and outcome of tackle football. America’s child protection structure is faulty, even ridiculous without the prohibition of collision football, at least in the public sector. The institutions of medicine, education and law have head in sand–for at least 110 years, since JAMA editors declared ‘that football is no game for boys to play,’ backed by a significant group of medical professionals, football insiders, educators and more authorities of the period [see 1907 JAMA below/attached].
1907.12.21 JAMA editorial ‘FB Mortality Among Boys’

The 3rd revision of USA Football’s Rebuttal to the NYTimes

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Here is the third reversion in two days of the USA Football’s Response to the July 27 NYTimes article with my comments in red.

USA Football third revision of their statement on New York Times article about Heads Up Football

7/28/2016

By Scott Hallenbeck Now Scott adds his name and photo to this mess. Run, Scott, Run.

USA Football developed Heads Up Football in 2012 with no research, just a marketing plan to improve the safety of the sport and deal with the growing concussion concern. We deliver education, resources and best practices without evidence and a marketing plan to recruit to youth organizations and high schools and their coaches, players and parents.

In our continuing effort to improve player safety and to try to defend the program we had been selling for two years, USA Football commissioned the Datalys Center for Sports Injury Research and Prevention paid for to conduct an independent study to review the effectiveness of Heads Up Football since we had already been marketing it for two years for children age five and up. The New York Times story published July 27 has raised issues (blew the whistle we lied in congress) with how the research conducted by Datalys was reported – No, how USA Football used the study that Datalys conducted and clearly lists the limitations on page 7 of the report. We have acknowledged our error in using (marketing to parents and children) preliminary data since Feb after the study was peer reviewed and published (was not published until July). In early July, we informed our partners and constituents of this issue and have since set a policy that when USA Football commissions research, we will share it only once it has been peer reviewed and published. (But in a bad move for us, we had already summited and presented the false data in congress under oath on May 13).

USA Football stands behind the efficacy of Heads Up Football because we have nothing else to offer to make football safer. We are proud that nearly 70 percent of youth football organizations and a growing number of high schools have  joined us (been hoodwinked into) in working toward a better, safer game (which there is evidence in the study that HeadsUp alone cannot provide).

***

Allow me to reinforce (repeat) the facts that demonstrate the impact and value of Heads Up Football.

FACT: We believe in this program – THIS IS NOT A FACT, it is a desperate belief we are clinging to despite the facts

Heads Up Football is an important football safety program, and it is having a positive effect on youth organizations and high school programs nationwide.

FACT: USA Football is changing behavior for the better – NOT A FACT 

Through the program, coaches learn not only how to teach proper fundamentals and techniques but how to communicate with players and parents in order to foster a positive football experience (Coaches learn to talk to kids?).

Before Heads Up Football, there was no national focus on teaching and training football coaches, parents and players on concussion recognition and response, heat preparedness and hydration, equipment fitting, sudden cardiac arrest, Heads Up Tackling and Heads Up Blocking. (This only should be under the category of crimes that until 2013 NONE OF THESE ISSUES were addresses by USA Football). This has led to hundreds of thousands of coaches being trained in the highest standards in the sport, resulting in a safer and more positive environment for the players.

FACT: Heads Up Football is more than tackling – (important to point out since it doesn’t reduce head injuries)

This program delivers the sport’s highest standards (sad this is the best we can do) on all-player football fundamentals and mechanics (with the decades old ploy of setting up “proper way to play” to then be able blame kids for their injuries if they get hurt because they didn’t use proper technique) alongside important health and safety components.

Through a (we don’t have money to train everyone) train-the-trainer model, Heads Up Football is (marketing) changing behavior by unifying the football community under consistent terminology and techniques.

Launched nationwide in 2013 (with no scientific evidence), Heads Up Football originally included the core elements of:

In (marketing to) working with youth and high school football organizations, alongside input from our Medical Advisory Committee and Football Advisory Committee, the program has since added Heads Up Blockingand sudden cardiac arrest protocols as part of the only nationally accredited youth coaching certification program available in the sport.

FACT: Heads Up Football is more than a course

Heads Up Football is a multi-pronged approach (to hide the fact it doesn’t help concussions) that works hand-in-hand with other USA Football resources to (confuse the issue) create a positive learning environment in which millions of young athletes can learn the sport more safely. These resources are available to all youth leagues, and USA Football strongly recommends their implementation by all coaches to further advance safety.

  • National Practice Guidelines for Youth Tackle Football. Released (finally) in February 2015, these guidelines include a limit of 30 minutes per day (per day NOT A LIMIT FOR THE WEEK) for drills operated at full-contact speed defined by USA Football’s Levels of Contact.
  • Levels of Contact. USA Football is the first national organization in the sport to formally define full contact within practice sessions, breaking drills down into non- or light-contact levels (Air, Bags, Control) and full contact (Thud, Live).
  • Practice Planner. Youth football coaches can organize their drills quickly and easily while assigning a level of contact and time for each drill.

FACT: Heads Up Football is being embraced (hugged?!? without scientific evidenced)

More than 6,300 youth organizations and 1,100 high schools signed up for Heads Up Football in 2015, improving the quality of the sport for their athletes (because they fell for our marketing).

Since Heads Up Football’s inception (in 2012 without scientific evidence or any testing), USA Football has trained thousands of Player Safety Coaches, selected by their leagues to serve as the conduit for the program, along with certifying hundreds of thousands of coaches. Player Safety Coaches are responsible (for the safety of millions of children playing tackle football):

  • Completing USA Football’s Level 1 online coaching education course
  • Attending a one-day clinic led by a USA Football-trained Master Trainer (one day for all of those safety issues)
  • Overseeing his or her organization’s implementation of Heads Up Football
  • Ensuring that all coaches are certified
  • Holding in-person clinics for head coaches
  • Attending practices and games to serve as a reference point for coaches and parents while ensuring that Heads Up Football elements are being taught

FACT: Heads Up Football continues to evolve (because it is our marketing plan)

USA Football works alongside experts in medicine and sport to constantly evaluate and improve what it offers through Heads Up Football.

As we have added elements and other materials to help coaches do their job better, we will continue to seek and recognize information that adds to the value and benefit of the sport and the children who enjoy playing it.

FACT: Research is showing Heads Up Football works (NO, THIS STUDY DOES NOT SHOW THAT AND IF YOU READ THE STUDY, YOU CAN SEE THAT)

Heads Up Football reduces injury rates (NOT CONCUSSIONS) during practices by 63 percent, as shown by a peer-reviewed and published study in The Orthopaedic Journal of Sports Medicine (OJSM) in July 2015 (linked). (BECAUSE THEY USED POP WARNER CONTACT LIMITS NOT HEADSUP AND YOU LIED TO CONGRESS ON THIS POINT)

There also is additional independent research that underscores Heads Up Football’s efficacy in reducing concussions at the high school level:

  • Fairfax County (Va.) Public Schools, the 10th-largest school district in the country, has (You fail to inform parents that Fairfax Schools implemented reduced contact practice guidelines in 2013) employed Heads Up Football since 2013. In this time, the district has reported a 43.3 percent decline in concussions among its 3,000 football-playing student-athletes within its 25 high school programs, all of which are enrolled in Heads Up Football. Overall football injuries have declined 23.9 percent.
  • High schools within the South Bend (Ind.) Community School Corporation (SBCSC), with approximately 1,000 football-playing student-athletes reported concussions from football to decline by 40 percent from 2014 to 2015, the first year the school system implemented Heads Up Football district-wide.

FACT: People believe in Heads Up Football – THIS MAYBE A FACT BUT IT IS BECAUSE OF YOUR MARKETING NOT SCIENCE

A number of constituents have provided statements of support of Heads Up Football and its effectiveness.

Bill Curran, the director of student activities and athletics for Fairfax County (Va.) Public Schools  (Fairfax Schools implemented reduced contact practice guidelines in 2013), has made the following statement:

“In our three seasons within USA Football’s Heads Up Football program, our independent data clearly show that our student-athletes are benefitting from it. We are seeing significant returns. Since adopting the program in 2013, total injuries spanning practices and games among our football-playing student-athletes have decreased 23.9 percent and concussions have decreased 43.3 percent. I have 25 high school football coaches who will tell you Heads Up Football works.”

***

Dr. Michael Koester, (Stay tuned after I contact him) chairperson of the Oregon Schools Activities Association’s Sports Medicine Advisory Committee, states:

“Heads Up Football is the logical next step forward as sports medicine experts continue to work with coaches to implement innovative ways to minimize the risk of football injuries. The Oregon School Activities Association’s endorsement of the program – and requiring our football-playing schools to adopt Heads Up Football – is an important opportunity for high school coaches statewide to set an example for youth leagues in their communities. As a team physician and the parent of a high school football player, I stand behind Heads Up Football as a leading intervention for safer play.”

***

Jon Butler, (JON IS IN THE SAME SINKING BOAT AS SCOTT) executive director of Pop Warner Little Scholars, Inc., is also standing behind Heads Up Football stating:

“As we continue to make football safer and better for young people, Pop Warner places value on changes that make a difference. That’s why we have done things like reduce contact to twenty-five percent of practice time, eliminate kickoffs for our youngest divisions and require that any player who suffers a suspected head injury receive medical clearance from a concussion specialist before returning to play. Giving our coaches the tools they need to teach the game the right way enhances those efforts. It’s why we made USA Football’s Heads Up Football training mandatory for all Pop Warner coaches. Because we’re confident that a well-educated coach is critical to a safer football experience.”

USA Football’s Claims on HeadsUp Study must be reviewed by Congress

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The July 27 New York Times article on Monday did not catch anyone by surprise who had read the original study. Please take the time to read the highlighted sections of this study available right here —->USA Football Report.

And rather than admit they misrepresented the findings, USA Football’s statement this morning in response to the NYTimes article just repeated they stand behind this study.

Please write your representatives in DC to act now.

We must ask congress to determine if USA Football knowingly lied in the May 13, 2016, congressional hearing using data they knew was false from an earlier report.

If so, parents must hear the truth about this recycled, manipulated, fantasy-based safety program directed at hiding the truth about the dangers of tackle football for children.

The timeline is clear.

Feb 2015 – Datalys gives US Football the initial “positive results” of a study based on ONE 2014 fall season. Marketing materials are pumped out to the public.

July 2015 – The formal study is published with a far different story showing a reduction in concussions only when HeadsUp is combined with Pop Warner PW contact limit rules. There was no control group to show PW alone. To be fair to Kerr, the list of “Limitations” on page 7 tell the story that this initial incomplete study must be followed up by further research which was never done.

10 months pass –  NFL/USA Football does not change the marketing marketing of the discrepancies from the peer-reviewed study, even when this study is to be used the keystone of the NFL/USA Football’s written testimony, oral presentation and the accompanying slide deck.

On May 13, 2016, ANDREW GREGORY, M.D., Medical Advisory Committee Member of USA Football and Associate Professor at Vanderbilt University Medical, gives official congressional testimony under oath based on the Feb not July data.

 

Please ask your representative to act on this for the sake of so many children – boys and girls – who are being exposed to brain injury at the hands of the NFL!!

Source Document:

USA Football Report

Comprehensive Coach Education and Practice Contact Restriction Guidelines Result in Lower Injury Rates in Youth American Football

Zachary Y. Kerr,* PhD, MPH, Susan Yeargin,† PhD, ATC,
Tamara C. Valovich McLeod,‡ PhD, ATC, FNATA, Vincent C. Nittoli,§ MS, ATC, James Mensch,† PhD, ATC, Thomas Dodge,|| PhD, ATC, Ross Hayden,* MA, and Thomas P. Dompier,*{ PhD, ATC

Investigation performed at Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA

Why isn’t football modified for U12 players like other sports?

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Current policies on Contact or Heading for US Lacrosse, USA Hockey and US Soccer  

Why doesn’t youth football have “youth brain injury sensitive” rules such as graduated contact or no heading rules for the U12 group like soccer, lacrosse and hockey have enacted?
Why is football is the only one to not modify their sport for their youngest players?

Official US Lacrosse Policy

US Lacrosse polices are written with to try to eliminate violent collisions at all ages.

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Note: No take-out checks/excessive body checks at any age
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Rules limited body checks for U15 and U13 – rules based on peripheral vision may not be fully developed in many boys before 15

No body checking U11 and U9

 IMG_0165

USA Hockey

 Body checking in 12 and under prohibited
IMG_0169 IMG_0168

 

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Official US Soccer Statement on Headings

US SOCCER

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Why did AAP reverse its policy against Youth Tackle Football?

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WHY DID THE AMERICAN ACADEMY OF PEDIATRICS CHANGE THEIR VERY CLEAR OFFICIAL 1950’S POLICY AGAINST TACKLE FOOTBALL FOR KIDS UNDER 13 TO ITS CURRENT 2015 POLICY SUPPORTING YOUTH TACKLE?

In the 1950’s, the American Academy of Pediatrics had a clear policy concerned youth contact sports such as tackle football, boxing, and hockey. The AAP policy stated that these high risk sports had “no place in programs” for kids 12 & under —  and this in a time when sporting activities for kids included Lawn Jarts, backyard pool diving boards and free-fall trampolines — activities which today would completely freak out the current generation of parents. 

Over the last 65 years, a new law banned the Jart, insurance rates ended backyard diving boards and the firm policy of the AAP lead to adding nets to trampolines. Also in this same time frame, AAP’s revised their policies (which are in effect for five years at a time) towards these three contact sports for youth with three completely different approaches. Any statement issued by AAP over the last 65 years as held to opposition to youth boxing, while it’s policy from hockey changed from opposed to a youth game to approving the sport with limiting checking for players 15 years of age and younger. 

But the one sport were there has been a completely reversal of policy — the one complete outlier in AAP’s policy in youth contact sports – is youth tackle football.

When the AAP felt youth tackle football had “no place in programs for kids” in the 50’s; now in 2015,this is a game so sacred to our society that while, modifying “would likely lead to a decrease in the incidence of overall injuries, severe injuries, catastrophic injuries, and concussions” the AAP cannot recommend limiting tackle for young children as “the removal of tackling from football would lead to a fundamental change in the way the game is played.”

And unlike the cases of boxing and hockey where the AAP had taken a clear stand to inform parents of the risks, in the case of football, children and their parents must decide the health risk of football injuries themselves against the benefits of the game if tackle is conducted in the “proper way.” 
“Removing tackling from football altogether would likely lead to a decrease in the incidence of overall injuries, severe injuries, catastrophic injuries, and concussions. The American Academy of Pediatrics recognizes, however, that the removal of tackling from football would lead to a fundamental change in the way the game is played. Participants in football must decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling”. 2015 AAP Report
 
 

AAP Policy towards Youth Boxing

The AAP has had a very clear policy in its opposition to youth boxing in effect for 20 of the last 65 years with 2015 policy in place for the next five years until 2020.
1953  AAP policy spoke at conference —  “opposed to boxing”
1957 expires 1962  Statement of Policy by the AAP — “boxing has no place”
1968 expires 1973  Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by AAP —  “Boxing has no place in programs for children”
 
Gap of 24 years
 
1997 expires 2002  January 1997 “Vigorously oppose boxing as a sport for any child, adolescent, or young adult” + educate patient + suggest alternative sports
2011 expires 2015  September 2011  Revised – the three recommendations above plus “appropriate medical care is provided for children and adolescents who choose to participate in boxing, ideally including medical coverage at events, preparticipation medical examinations, and regular neurocognitive testing and ophthalmologic examinations.”
2015 expires 2020  June 2015 Reaffirms 2011 Policy

TIMELINE OF AAP POLICY and Contact Sports

AAP Policy towards Youth Hockey

The AAP has also had a clear policy in its opposition to youth hockey in effect for 15 years from 1953 to 1968, then it modified this policy only if a “school or community only could provide exemplary supervision medical and educational.” And for the last 16 years, 2000 to 2017, AAP policy has firmly recommended limiting checking in hockey players 15 years of age and younger.
 
1953  AAP Policy at conference —  “opposed to hockey”
1957 expires 1962  Statement of Policy by the AAP — 
1968 expires 1973  Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by AAP —  Hockey along with other sports – “ Unless a school or community can provide exemplary supervision medical and educational it should not undertake a program of competitive sports, especially collision sports, at the pre-adolescent level.”
 
Gap of 27 years
 
2000 expires 2005 Pediatrics. 2000 The American Academy of Pediatrics recommends limiting checking in hockey players 15 years of age and younger as a means to reduce injuries
2014 expires 2019   However, because of ongoing concerns that a high number and proportion of boys’ ice hockey injuries are attributable to body checking, the AAP has elected to reassess its 2000 recommendation that “body checking should not be allowed in youth hockey for children age 15 years or younger.” — In the continued interest of promoting boys’ youth ice hockey as a safe, lifelong recreational pursuit, the AAP recommends: Expansion of nonchecking programs for boys aged 15 years and older. Pediatricians should advocate for development of these programs in their communities and encourage their patients to participate in them.
 

AAP Policy towards Youth Football

Over the last 65 years, the AAP was clear on opposing youth tackle football, modified its opposition and then after a gap of 43 of no officially policy, completely flip-flopped its football to letting parents decide the risks. This new policy is now in place for the next five years until 2020.
1953  Quote at conference —  “opposed to football”
1957 expires 1962  Statement of Policy by the AAP — “football has no place”
1968 expires 1973 Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by AAP —  Football along with other sports – “ Unless a school or community can provide exemplary supervision medical and educational it should not undertake a program of competitive sports, especially collision sports, at the pre-adolescent level.”
 
Gap of 43 years
 
2015-2020 2015 AAP Statement on Tackle Football – Children and parents left to decide the risks vs benefits if played properly.     

How the AAP Policy on Contact Youth Sports evolved based Source Documents from AAP website and in public record

The first reference to the AAP and youth football, boxing and hockey was found in a newspaper article from 1953, with a quote from a doctor representing the AAP at two-day conference at the National Education Association: (Sources are all listed at the end of this post):
Strongly opposed to tackle football, boxing and ice hockey and other contact sports was Dr. George Maksim, representing the American Academy of Pediatrics. “Children under 13 aren’t mature enough for such sports,” Dr. Maksi said, “and the risk of permanent bone and joint injuries is just too great.”
In the 1957’s Statement of Policy by the AAP, the AAP’s position on youth tackle football and boxing was also very clear:
1957-page-2-e1458913280547.jpeg
1957-Page-3-e1458913239850.jpeg

In 1968-1973, a Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by American Academy of Pediatrics which held to the probation for boxing. There was an allowence for contact sports including football and hockey but with several caveats, a discussion of risk and a number of high standards to be met. 

Boxing has no place in programs for children of this age because its goal is injury and the educational benefits attributed to it can be realized through other sports. Sports with varying degrees of collision risk include baseball, basketball, football, hockey, soccer, softball, and wrestling. The hazards of such competition are debatable. The risks are usually associated with the conditions under which practice and play are conducted and the quality of supervision affecting the participants. Unless a school or community can provide exemplary supervision, medical and educational, it should not undertake a program of competitive sports, especially collision sports, at the pre-adolescent level.
From this point on there would be a 24 year gap in policy towards boxing, 27 year gap towards hockey and a 43 year gap before a policy towards football would be announced.
 

AAP BOXING POLICY

 
In the official 1997 Statement, the AAP was still “vigorously opposed” boxing for youth; and officially, states in Pediatrics January 1997, VOLUME 99 / ISSUE 1, a policy would stay in effect until 2002:
The American Academy of Pediatrics recommended that pediatricians:
  1. Vigorously oppose boxing as a sport for any child, adolescent, or young adult
  2. Educate “at risk” patients about the medical risks of boxing and provide information that supports the Academy’s opposition to the sport; and
  3. Encourage young athletes to participate in sports in which intentional head injury is not the primary objective.
The 2011 AAP Policy (2011-2015) was revised to keep the three recommendations from 1997, above plus “appropriate medical care is provided for children and adolescents who choose to participate in boxing, ideally including medical coverage at events, preparticipation medical examinations, and regular neurocognitive testing and ophthalmologic examinations.”
In 2015, the AAP did not let their policy on boxing lapse, and with the 2015 AAP Policy, they reaffirmed their 2011 Policy.
 

AAP HOCKEY POLICY

 
After a gap of 27 years, in 2000, The American Academy of Pediatrics recommended in Pediatrics limiting checking in hockey players 15 years of age and younger as a means to reduce injuries. This policy would expire in 2005.
 
In 2014, AAP Policy (2014-2019) because of ongoing concerns that a high number and proportion of boys’ ice hockey injuries are attributable to body checking, the AAP has elected to reassess its 2000 recommendation that 
 
“body checking should not be allowed in youth hockey for children age 15 years or younger.” — In the continued interest of promoting boys’ youth ice hockey as a safe, lifelong recreational pursuit, the AAP recommends: Expansion of nonchecking programs for boys aged 15 years and older. Pediatricians should advocate for development of these programs in their communities and encourage their patients to participate in them.
 

AAP TRAMPOLINE POLICY

 

On a side note, in 1999, the AAP’s issued a stern policy on Youth and Trampolines for parents, parks and schools after a high number of injuries and six deaths over a 9 year period. 

83,400 trampoline-related injuries occurred in 1996 in the United States… supports the American Academy of Pediatrics’ reaffirmation of its recommendation that trampolines should never be used in the home environment, in routine physical education classes, or in outdoor playgrounds… Since 1990, the CPSC has received reports of six deaths involving trampolines. Victims ranged in age from 3 years through 21 years, although the 21-year-old died 6 years after being injured on a trampoline…Catastrophic cervical spine injuries are rare. However, head and neck injuries constitute a notable number of the more serious injuries requiring hospitalization…

AAP RECOMMENDATIONS

Despite all currently available measures to prevent injury, the potential for serious injury while using a trampoline remains.The need for supervision and trained personnel at all times makes home use extremely unwise.

  1. The trampoline should not be used at home, inside or outside. During anticipatory guidance, pediatricians should advise parents never to purchase a home trampoline or allow children to use home trampolines.
  2. The trampoline should not be part of routine physical education classes in schools.
  3. The trampoline has no place in outdoor playgrounds and should never be regarded as play equipment.

 

AAP YOUTH TACKLE FOOTBALL POLICY

 
While there are a number of studies and discussion listed in the AAP over the years on youth tackle football, there is not any official AAP policy towards tackle football from and the librarian at the AAP was not able to locate any additional policies. AAP policies expire after five years and so after 1973, the 1968 Policy Statement on Competitive Athletics for Children of Elementary School Age would no longer be in effect.
 
After what seems to be a gap of 43 years, in 2105, with the NFL lawsuit and scientific evidence pointing to brain injury in pro players, the AAP’s response to the controversy around youth tackle football was the publication of an official statement, several blog posts and a video:

The findings of the report can be summarized in this quote from the report itself:

 
“Removing tackling from football altogether would likely lead to a decrease in the incidence of overall injuries, severe injuries, catastrophic injuries, and concussions. The American Academy of Pediatrics recognizes, however, that the removal of tackling from football would lead to a fundamental change in the way the game is played. Participants in football must decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling.” 2015 AAP Report
 
The AAP clearly leaves everyone else on the hook to decide. Are children left to decide for themselves? Parents? Coaches? And further more the AAP implies there is a “proper” way to tackle… How do we know? What independent research has been done? 
In the comment section under AAP statement in Dec 2015, was a single comment – a reply from by Lewis H. Margolis, Associate Professor of Maternal and Child Health, University of North Carolina, Gillings School of Global Public Health, in which he asks of pediatricans, “Whatever Happened to First Do No Harm?” 
 
In his post, Marigolis points out the irony in an official report by the AAP, that parents, not doctors, are asked to weigh the risks for their children to play tackle based on the uncertain, flimsy data which is stated is unclear, even to top medical experts.
 
Marigolis points out how in the hemming and hawing of the report he counted: 
… over 40 uses of terms like “unclear,” “unknown,” “limited,” and “without scientific basis” in the statement, which, while adequately reflecting the state of an uncertain literature, do not support evidence-based recommendations.
The key problem with the AAP report is the concept of:
Advising parents to “decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling” undermines the concept of empowerment, because of the absence of information.
Then he cuts to the chase to pose the question: 
Until those [safety] questions are answered through rigorous research, pediatricians should advance primum non nocere, “first do no harm,” by advocating for the end of youth football.
  • 30 November 2015  — Whatever Happened to First Do No Harm?
    • Lewis H. Margolis, Associate Professor of Maternal and Child HealthUniversity of North Carolina, Gillings School of Global Public Health

    The Council on Sports Medicine and Fitness policy statement, Tackling and Youth Football, assures 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 Further, football participation dwarfs other sports, so this one sport contributes 60% or more of sport-related concussions in high school.3 Dompier et al. estimate that 99,000 youth players experience at least one concussion annually.4 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 acknowledgement by experts that we are as yet ignorant of the long-term consequences of concussions. Meehan notes that “medicine has not figured out how many concussions is too many. And in fact, it is likely no such number exists.”5(p.125)

    The evidence supporting the effectiveness of the recommendations is meager. Indeed, there are over 40 uses of terms like “unclear,” “unknown,” “limited,” and “without scientific basis” in the statement, which, while 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. Advising parents to “decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling”1(p.e1426) 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? And yet, the Council advises that “participants in football must decide whether the potential risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling.”1(p.e1426)

    Perhaps the millions of dollars being devoted to the diagnosis, acute treatment, and long-term management of concussions will help us answer questions like “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.

    1. COUNCIL ON SPORTS MEDICINE AND FITNESS. Tackling in youth football. Pediatrics. 2015;136(5):e1419-30. doi: 10.1542/peds.2015-3282 [doi].
    2. 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.
    3. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among united states high school and collegiate athletes. J Athl Train. 2007;42(4):495-503.
    4. Dompier TP, Kerr ZY, Marshall SW, et al. Incidence of concussion during practice and games in youth, high school, and collegiate American football players. JAMA Pediatr. 2015;169:659-665.
    5. Meehan WP. Kids, sports, and concussions. Santa Barbara, CA: Praeger; 2011.

The 2015 AAP report leaves so many questions unanswered, and one must look at the conclusions and wonder how is a parent to know the risks for their children if the doctors cannot take a stand as they clearly did with boxing and football and even trampolines. Should youth sports organizations who operate without any government oversight calculate risks and do their own research? And in the end, do parents, players, sports organizations, the AAP or the government have responsibly to make the call?

  • Who is responsible to collect the data on injury rates for youth sports or any activities for children ?
  • Who is responsible to inform parents of risks in sports without any alternative motive?
  • Who is responsible to determine safety claims like the new “safe tackle football” proposed by HeadsUp Tackling is a scientifically valid or just a recycling PR concept tried in past decades?
Doctors, parents, kids? The AAP clearly avoids their responsibility they felt so clearly with other contact sports.

CONCLUSION

This is America, and within the law, parents have the freedom to chose what sports their children play and decide what risks they take. But how is a parent to know the risk of injury in any particular sport for their child? 

Parents have always looked towards their pediatricians for health information about their children, and the AAP is the source of policy for these doctors. Over the last 65 years, the American Academy of Pediatrics been clear on its position against boxing, has had modified position to support hockey with no checking U15, but completely reversed it’s policy against to supporting tackle football without a modification for younger children. 

Now with NFL research determined to be flawed, what guarantee is there that injury risk in tackle football for youth been honestly portrayed for parents? The same parents who have been left by the AAP to make those life-changing decisions for their children. 

Source documents

Boxing

AAP Policy in Reference to Boxing
1953 – a quote from a doctor representing the AAP at two-day conference at the National Education Association:
Strongly opposed to tackle football, boxing and ice hockey and other contact sports was Dr. George Maksim, representing the American Academy of Pediatrics. “Children under 13 aren’t mature enough for such sports,” Dr. Maksi said, “and the risk of permanent bone and joint injuries is just too great.”
 
 1957 –  Statement of Policy by the AAP, the AAP’s position on Youth Tackle Football was also very clear:
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1968 –  a Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by American Academy of Pediatrics:

Boxing has no place in programs for children of this age because its goal is injury and the educational benefits attributed to it can be realized through other sports. Sports with varying degrees of collision risk include baseball, basketball, football, hockey, soccer, softball, and wrestling. The hazards of such competition are debatable. The risks are usually associated with the conditions under which practice and play are conducted and the quality of supervision affecting the participants. Unless a school or community can provide exemplary supervision medical and educational it should not undertake a program of competitive sports, especially collision sports, at the pre-adolescent level.
 
1997

This Policy Is A Revision Of The Policy In

Pediatrics
January 1997, VOLUME 99 / ISSUE 1

Participation in Boxing by Children, Adolescents, and Young Adults

Committee on Sports Medicine and Fitness

The overall risk of injury in amateur boxing is actually lower than in some other collision sports such as football, rugby, and ice hockey. However, as opponents of boxing have emphasized, boxing is the only sport where direct blows to the head are rewarded and the ultimate victory may be to render the opponent senseless. Participants in boxing are at risk for dementia pugilistica, a chronic encephalopathy caused by the cumulative effects of multiple subconcussive blows to the head. Numerous studies of professional boxers document this hazard and its potentially devastating consequences on long-term health.2,4-

RECOMMENDATIONS

The American Academy of Pediatrics recommends that pediatricians:

  1. Vigorously oppose boxing as a sport for any child, adolescent, or young adult;

  2. Educate “at risk” patients about the medical risks of boxing and provide information that supports the Academy’s opposition to the sport; and

  3. Encourage young athletes to participate in sports in which intentional head injury is not the primary objective.

2011

This Policy Is A Reaffirmation Of The Policy Posted

Pediatrics
September 2011, VOLUME 128 / ISSUE 3
From the American Academy of Pediatrics

Policy Statement

Boxing Participation by Children and Adolescents

AMERICAN ACADEMY OF PEDIATRICS, COUNCIL ON SPORTS MEDI

Abstract

Thousands of boys and girls younger than 19 years participate in boxing in North America. Although boxing provides benefits for participants, including exercise, self-discipline, and self-confidence, the sport of boxing encourages and rewards deliberate blows to the head and face. Participants in boxing are at risk of head, face, and neck injuries, including chronic and even fatal neurologic injuries. Concussions are one of the most common injuries that occur with boxing. Because of the risk of head and facial injuries, the American Academy of Pediatrics and the Canadian Paediatric Society oppose boxing as a sport for children and adolescents. These organizations recommend that physicians vigorously oppose boxing in youth and encourage patients to participate in alternative sports in which intentional head blows are not central to the sport.

INTRODUCTION

Amateur or Olympic-style boxing is a collision sport that is won on the basis of the number of clean punches landed successfully on an opponent’s head and body (Appendix).1,2 A match is won outright if an opponent is knocked out. Participants in boxing are at risk of serious neurologic and facial injuries.3,–,7 Despite these potential dangers, thousands of boys and girls participate in boxing in North America. In 2008, more than 18 000 youths younger than 19 years were registered with USA Boxing (Lynette Smith, USA Boxing, written communication, August 2009).

The societal debate regarding boxing has raged for decades. Many authors and medical organizations have called for boxing to be banned (Table 1), citing medical, ethical, legal, and moral arguments.8,–,13 Others state that participants should be allowed to make autonomous decisions about participation and that the role of the medical profession should be restricted to the provision of injury care, advice, and information only.14

TABLE 1

Position Statements on Boxing

Organization Position
American Medical Association9(2007) Recommends that until boxing is banned, head blows should be prohibited
American Academy of Pediatrics8(1997) Opposes boxing as a sport for any child, adolescent, or young adult
Australian Medical Association10(2007) Opposes all forms of boxing; recommends the prohibition of all forms of boxing for people younger than 18 y
British Medical Association11(2007) Opposes amateur and professional boxing; calls for complete ban on boxing; recommends banning boxing for those younger than 16 y