1. Beal, Judy A. DNSc, RN, FNAP, FAAN

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According to the Centers for Disease Control and Prevention (2011), pediatric providers working in emergency rooms treat more than 200,000 children ages 5 to 18 for sports-related head injuries each year; most of which are not diagnosed as concussions. Approximately 3 million youth are playing tackle football today in the United States (USA Football, 2017). Although the effects of football-related injury have been studied mostly at the college and professional levels, researchers are beginning to examine the impact of concussive and subconcussive injury in younger children. Concerns have recently been raised in social and mainstream media. In a recent episode on one of the sports cable networks, researchers shared alarming findings from their study of the brains of young tackle football players (Montenigro et al., 2017). They concluded that each year of playing football significantly increases risk of chronic traumatic encephalopathy (CTE) based on evidence of CTE found in the brains of 87% to 91% of deceased former National Football League (NFL) players. In a more recent publication this research team reported that among 202 deceased NFL players whose brains were donated for research, 177 were found to have CTE ranging from mild to severe ranges and the majority having had reported behavioral or mood symptoms, cognitive changes, and signs of dementia prior to death (Mez et al., 2017). Chronic traumatic encephalopathy is a degenerative brain disease caused by repeated blows to the head that can lead to dementia, depression, and even death. In the past 3 years, 47 children have died playing football in the United States (Gibbs, 2016). Others found results similar to Montenigro et al. with 21 out of 66 brains with clear evidence of CTE in males who played contact football when young (Bieniek et al., 2015).


The majority of this emerging research has been focused on concussive injuries in contact sports. Researchers studied 25 tackle football players between the ages of 8 and 13 years to explore the effects of high impact on rapidly changing and growing young brains (Bahrami et al., 2016). Little is understood about this phenomenon. In this well-controlled study, each boy was fitted with a special helmet designed with sensors that measured frequency and severity of impacts to the head (Head Impact Telemetry System). Games and practices were videotaped and analyzed for frequency and severity of impact. Pre- and postseason magnetic resonance imaging of brains were compared with alarming results. Findings revealed a significant relationship between head impact exposure and changes in white matter, with no definitive diagnosis of concussion.


No one is indicating that tackle football should not be played, despite worrisome findings of this early research. Some researchers have recommended that until we understand more fully the impact as related to age, playing tackle football should be limited to children over the age of 14. The NFL has reduced full-contact practice to once a week (Gibbs, 2016).


In 2015, the American Academy of Pediatrics issued a position statement that strongly encouraged football leagues to limit tackling. Pediatric nurses can have a major role in advocacy, by advising parents to select leagues that follow these no-tackle guidelines, and in assisting them in making decisions around the risks and benefits of high-impact sports on future brain health of their children.




American Academy of Pediatrics. (2015). Tackling in youth football (Policy Statement). Pediatrics, 136(5), e1419-e1430. doi:10.1542/peds.2015-3282


Bahrami N., Sharma D., Rosenthal S., Davenport E. M., Urban J. E., Wagner B., ..., Maldjian J. A. (2016). Subconcussive head impact exposure and white matter tract changes over a single season of youth football. Radiology, 281(3), 919-926. [Context Link]


Bieniek K. F., Ross O. A., Cormier K. A., Walton R. L., Soto-Ortolaza A., Johnston A. E., ..., Dickson D. W. (2015). Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank. Acta Neuropathologica, 130(6), 877-889. doi:10.1007/s00401-015-1502-4 [Context Link]


Centers for Disease Control and Prevention. (2011). Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged <=19 years-United States, 2001-2009. Morbidity and Mortality Weekly Report, 60(39), 1337-1342. [Context Link]


Gibbs L. (2016). Concussion expert says extent of brain damage in youth football players took my breath away. Retrieved from Accessed July 1, 2017. [Context Link]


Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez V, Huber BR, Alosco ML, Solomon TM.... (2017). Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. Journal of the American Medical Association, 318(4), 360-370. doi: 10.1001/jama.2017.8334 [Context Link]


Montenigro P. H., Alosco M. L., Martin B. M., Daneshvar D. H., Mez J., Chaisson C. E., ..., Tripodis Y. (2017). Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. Journal of Neurotrauma, 34(2), 328-340. doi:10.1089/neu.2016.4413 [Context Link]


USA Football. (2017). Heads Up Football: Safety in Action. Retrieved 9/1/17 from [Context Link]