Youth Football: What are the Real Risks and Rewards?

It’s a fraught, complex question that a growing number of parents are asking themselves: Should I let my child play football? Recent events have certainly given pause to mothers and fathers with a child begging to get on the gridiron. Dr. Bennet Omalu, who discovered chronic traumatic encephalopathy (CTE) brain degeneration in NFL players and was portrayed by Will Smith in 2015’s Concussion, now calls football “the definition of child abuse” with a “100 percent risk exposure.”

And just weeks ago, former New England Patriot Aaron Hernandez, who committed suicide in prison at 27, was found to have had severe CTE. Hernandez had played three seasons at the University of Florida and 44 games in the NFL (including playoffs). Leaving aside whether CTE had anything to do with his violent off-field behavior, it’s logical to wonder: How did so much damage happen to someone so young? And at what level of football did it occur?

It’s easy to read these stories and think, “My child will never put on a helmet.”

Or to think that you played football as a child and teenager and you’re doing OK, so there can’t possibly be that much cause for concern, right?

To sort through the medical and ethical realities of how football affects a growing brain, RealClearLife talked to two experts in the field.

Dr. Uzma Samadani is a neurosurgeon and the endowed chair for Traumatic Brain Injury Research at the Hennepin County Medical Center in Minneapolis. She is the co-author of The Football Decision: An Exploration Into Every Parent’s Decision Whether Or Not To Let A Child Play Contact Sports.

Dr. David Geier is an orthopedic surgeon and the author of That’s Gotta Hurt: The Injuries That Changed Sports Forever, which tracks crucial advances in sports medicine.

With their assistance, we explore some of the dangers of the sport, as well as the benefits—and yes, there are benefits—the variables, the unknowns, and the reason we may soon understand the risks a little better. (It will also address the ethical dilemma this advance could create.)

Let’s begin with the obvious question:

Why play football? At its best, football lets kids get exercise while discovering the rewards of teamwork in a way they actually enjoy. This is an important, not to be overlooked advantage, as Samadani will explain. And it’s worth remembering that the game can offer lifelong rewards even to those who never come close to an NFL payday.

Is non-tackle football OK?. “I don’t really have a problem with flag football or touch football at any age,” Geier says. However…

What about full contact? This is where things get complicated. “Every single child is different, from their genetics to their environment,” explains Samadani. You know what else is different? “Every single brain injury.” Quite simply, there is no precise formula to know exactly when a given child should play tackle football.

Understand that football, like everything in life, involves levels of risk. Geier notes that players face heightened risk if they are playing a position where there are “repetitive subconcussive blows that occur on every play, i.e., the collisions between offensive and defensive linemen.” This is not to suggest quarterbacks, wide receivers, running backs, tight ends, and players in the defensive secondary are free from jeopardy and can’t suffer outright concussions with a bad hit, however. He adds: “I don’t know if there’s really a safe position, except maybe kicker or punter.”

No tackling before 12 years old. Having interviewed “all the researchers at Boston University doing the CTE study,” Geier says it’s generally accepted that “12 would be the absolute bare minimum” age for playing tackle football. He explains that there is “good data that, under 12 [years old], those repetitive blows are harmful to the kid’s brain because the kid’s brain isn’t finished maturing.”

Geier, however, personally recommends no tackle football until age 14, just to be on the safe side since “development is slower or faster for [different] individuals.”

But Samadani reminds us that being a parent means staying vigilant, in case you’ve failed to account for something, to avoid making a horrendous mistake.

The big picture. “The key thing to consider in deciding whether or not to let your child play football is what their risks are if they don’t play,” Samadani says.

What does that mean? Samadani explains: “Many of the kids who play on the offensive and defensive line tend to be the bigger kids. They tend to be the kids with the BMI [Body Mass Index] greater than 26 or so.” (A BMI above 25 is typically considered overweight.) She notes that bigger children often struggle with both speed and cardio, which minimizes their sports options: “Often, they’re limited to things like wrestling and football.”

These children with reduced athletic options stand to benefit from sports the most, according to Samadani. “They’re at unique risk in terms of health,” she say. “They’re at higher risk for hypertension, obesity, diabetes, cardiovascular disease, sedentary lifestyle-associated dementia. One would potentially argue from a public health standpoint that you need to have a sport that is interesting and captures the enthusiasm of that child.”

In addition, Samadani argues that “the most high-risk activity of all is childhood, because children are fooling around with their friends, particularly when they’re adolescents who start drinking and driving.” Thus the question: Are adolescents sometimes at greater risk avoiding football than playing it?

Seeing these potential benefits and believing we’ve yet to find the data to back a specific minimum age for full contact football, Samadani instead urges the teaching of safe tackling from a young age. (With a particular emphasis on avoiding direct head contact.)

This brings us to three tips that are useful for everyone with a child interested in football.

1. There is no substitute for safe, fundamentally sound coaching. Former NFL coach Jon Gruden has mocked youth coaches who obsess over “winning the Super Bowl when you’re in the nine- and 10-year-old level of football.” Quite simply, any coach or instructor more fixated on winning games than teaching proper technique shouldn’t be anywhere near your kids, particularly if they play as pre-teens.

2. Make sure your kids never hide head trauma. Playing through pain has long been a point of pride in football. Unfortunately, it can have terrible long-term consequences for the human brain. “You got to let the athletic trainer know that you got hit, that you have a headache, that you’re nauseated,” emphasizes Geier, noting that kids may conceal symptoms rather than come out of the game. Make sure children understand that this won’t make you proud: it will only make you extremely worried about their future.

3. Don’t rush the recovery. “It may take a big blow [to cause] that first [concussion], but if you’re not recovered, they come on easier and easier and take longer and longer to go away,” explains Geier. Unfortunately, there’s no set minimum time for a recovery. “For one patient it may be three years and for one it may be three hours,” Samadani says.

Samadani does suggest one possible approach to establishing a real recovery from a concussion. It involves passing multiple checkpoints. “The way the NFL does it is probably the right way to do it,” she says. “No symptoms at rest, no symptoms on mild exertion, no symptoms on moderate exertion, and finally no symptoms with full strenuous contact.” Geier also notes the importance of “computer testing and absolute baselines,” to help determine if a player has indeed returned to their pre-concussion state.

And finally, in just the past few weeks, there has been some potential groundbreaking good news.

The Biomarker Breakthrough. There may soon be a big advance in football safety from a neurological standpoint. Researchers believe they have found a CTE biomarker, which would allow the detection of CTE in players while still alive. “Bob Stern [Director of Clinical Research at Boston University’s CTE Center] told me he thinks it’s five to 10 years away,” says Geier, noting that CTE diagnosis might come from “an MRI-like test, maybe it’ll be a blood test.”

In theory, this would let every player—and parent—know how much risk was involved every time they stepped on the field. However, Samadani notes even this positive development has ethical implications. “If you say, ‘This kid can play football and this kid can’t,’ where do you draw the line? Should you not let them dive either, because every time you hit the water there’s a certain amount of cranial impact?”

(Another ethical complication of this testing: at the college and pro level, would schools and teams declining to offer scholarships or draft players based on their concussion scores, effectively denying them opportunities even if they’ve pursued the sport knowing full well the risks?)

This real-time CTE testing remains in the early experimental phase, but even if it does become a reality someday soon, football will still pose hard questions for parents. As Vince Lombardi famously said, “It’s not whether you get knocked down, it’s whether you get up.” Today, young players and their parents must consider if there are times it’s best to stay down or perhaps never go out on the field at all.