Thursday, April 28, 2011

Speaking out about kids, football, and traumatic brain injury

I attended a Grand Rounds on Chronic Traumatic Encephalopathy (CTE) and the NFL earlier this year given by neuropathologist Dr. Daniel Perl. It was eye-opening for me. Despite all the recent media attention given to cases of NFL players being diagnosed with the disorder post-mortem (usually following untimely deaths due to suicide or bizarre "accidents"), it hadn't really penetrated my consciousness. But to see the actual images of abnormal tau protein staining in these relatively young brains - heaps and tangles similar to Alzheimer's but in slightly different locations - well, it was chilling. Even more chilling was hearing about these findings in younger players, those without years and years of professional-level play. Including those without many (or any reported) concussions. I started thinking about all of the children in the US who play tackle football and wondering: When are these changes happening? Why aren't we talking about this re: children? How many mothers might not realize that their children could be sustaining irreversible injuries that only manifest many years later? This. is. huge.

I debated whether or not to write about the issue. On the one hand, I felt passionately that discussing these issues was a matter of public health. Yet, I also weighed this against the likely backlash from football supporters and the kinds of personal attacks that commonly happen on the comment pages of online media forums.

In the end, I decided that this was too-important of an issue not to write about, stick and stones notwithstanding. My op-ed is in today's USA Today. Would love to hear your thoughts (including dissenting!), mothers in medicine, about this issue. Do you (would you) allow your children to play football? Do you think developing CTE is a reason for concern in kids? What do you think should be done to protect kids who play? Pediatricians, do you discuss this with your patients/parents?


  1. I remember my sister's explanation for letting her son play football. He was a big kid (the football type) and he REALLY wanted to play. She said "No" until she saw one of his soccer games where there were hard hits to the head without helmets...Her conclusion: She would rather have him playing football where there was padding and a helmet, than playing soccer...
    Personally, I don't go along with that reasoning and am VERY glad that my son was on the small side and never really considered football.

  2. It's not just kids who play football who are at risk of TBI and CTE. I regularly discuss helmets and head injuries with my clients who ride and drive horses, especially those whose children ride. Every kid who rides should own and use an appropriate helmet, as should every adult - especially those whose kids watch them ride.

  3. TBI is a big issue in Canada at the moment because of hockey and because the NHL isn't really doing anything worthwhile to help prevent problems. I would agree with the many who are saying they should ban hits to the head as the NFL has done, but they're dragging their heels saying "it's part of the game" - not wearing helmets used to be "part of the game" too but that changed! All while a player who was probably the top player in hockey today, Sidney Crosby, has been out since January with ongoing concussion symptoms/post-concussion syndrome. And recently a former NHL player who passed away in his mid-40's was shown to have CTE changes in his brain as well.

    So, no, I don't want my daughter to play hockey (girls football isn't really an issue around here).

  4. Thank you for writing about this very important issue.

    My naturally very athletic son played football for one short season after which I was certain that he would not play the game any more. It was not because of anything that happened to him personally on the field, but several children during their games did sustain hard hits to the head (helmet or no helmet, it is still damaging) and after looking at the existing and emerging medical literature it is simply too big a risk.

    I know many people, including my husband initially, may not view such a decision kindly. Some may even consider it downright un-American. Some people say it's part of being a kid in America, some say if you worry about every little thing you will end up keeping your kids in an insulated bubble. In my opinion that is wild hyperbole. Not playing football does not equate to living in a bubble - there are plenty of other, safer sports and activities, and while most everything (including waking up in the morning... hello MI!) carries some amount of inherent risk, we can be sensible about which risks we choose to take.

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  6. Christie Critters- there have been some work on the effects of heading in soccer as well - but it's not like it happens to the extent as head hits do in football. The helmets in football, too, are designed to prevent skull fracture and not concussions. I really hope my sons have no interest in playing.

    Outrider- agree that there are many sports that put kids at risk.

    guidemd- can't see how hits to the head are critical in hockey. =) Of note, while the NFL fines hits to the head, players have said that they would rather be fined and get the good hit... The "it's part of the game" argument is difficult for me too.

    white coat dreamer- I know- totally realize that football is sacred in many parts of the country, in many households. In an earlier draft, I even had included a bit about how this did NOT mean I wanted my children walking around in bubbles! But, in my personal opinion - like you- I don't think the current risks the way the game is now, outweigh the benefits. I want them to be involved in sports, though. Just other ones with less likelihood of lasting brain injury.

  7. It is interesting that you would post about this subject. I have a 12 year-old who has harassed me for the past 2 years to play football. Over and over again I said no due to possible injuries, etc. But then he said to me, "Mom, I really want to play. Didn't you break your fingers playing basketball last year? You let me play baseball and what if I get hit in the head with a baseball? You let me swim but what if I hit my head and drown?"
    So, maybe it was a moment of weakness or just tired of being the one in the family on the other side of the issue...I relented and said he could play next year. I will make certain he has the best equipment, and yes I am worried but I was scared to death the first time my daughter drove on a 75 mph highway also or started dating a boy. (Yes, this was very scary.)
    Yes, I may wish I would have stuck to my guns but there comes a time we have to make decisions with our children and not for them. Trust me I have explained the risks, etc. So, we will see what happens but be careful with judging those of us who do allow our kids to play football, soccer, baseball, basketball or any other potentially dangerous sport because you may find yourself in this same position some day.

  8. Laughing Doc, thanks for weighing in and adding your experience with this. Yes, I could absolutely be in the same position years from now and I certainly am not judging those who do allow their kids to play, being fully aware of the risks. But there are many who are not aware of the potential risks - hope they can be aware as they are making this decision and be vigilant about detecting concussions, etc.

    Everything in life has risks, clearly and how we perceive those risks is very individual (and often misaligned with probabilities - there was this great article in NYT(?) on this in recent months.) Then, as you rightly point out, sometimes the decision must be made with our kids. I haven't gotten to that stage yet!

    I think the sport has to change for the better, still. For everyone involved. My friend who played high school and college football has so many stories of sustaining likely concussions during high school play (seeing everything off kilter for hours after a hit) but not feeling it was acceptable to say anything since it wasn't manly. That kind of culture worries me the most.

  9. KC- Trust me I will be on the sidelines watching for any indication of a problem. Maybe it will be a blessing for the whole team to learn about concussions, zingers, etc. I tend to be vocal at times. :)

    It was funny too, I asked my son again after picking up from school about football and the risks and he promptly said, "Well, mom I hope that doesn't happen to me but you promised I could play!" Ahhh...I think it was easier when they were in diapers.

  10. I have spent some time considering this (and cringing at future parenting decisions)

    I think the danger of medical ways of thinking is our tendancy to be reductionistic in our thinking.

    After one shift in an Emergency department in a rural town I decided that I would never let my children do motorcross (riding motorcycles on a dirt track over jumps etc) as in my 10 hour shift I saw far too many young lives potentially at risk, but then there are the other risks...the grey zones.

    How much risk is too much? Is there such a thing as not enough? Is risk taking behaviour an essential part of normal development? I tend to think it probably is.

    When I was growing up the healthiest boys I knew, those who did not take illicit drugs or smoke were healthy because they wanted to be good at football (Australian rules) and not let their team down.

    How can you do a study which weighs the risk up against the benefits, some of which are not even realised?

    I agree that if there is a way of making the safety gear better then you should. My motherly instinct is rocked by your account of images of young brains looking similar to those with alzheimers.

    But the more philosophical part of me wonders what our risk management of childhood is actually achieving, and what it is taking away.

    Thanks, I think...for the thought provoking post...although something tells me I won't be thanking you when my son runs out onto the field for his big match and my heart rate climbs...

    The joys of parenthood.

  11. bekkles- yes, I'm also always feels like our parenting is so difficult at our current stage of life but it never gets better, just different. (the driving part? Not looking forward to that!) And, part of parenting IS dealing with risks - risks that we can't control.

    Thanks for the thoughtful comment, and to all- lots of things to think about.

  12. I read your article (well done!) and some of the comments. This is a polarizing issue, much with a lot of issues to do with parenting and child rearing. I have to say that I'm with you. I would not want my kids to play contact sports. I'd not previously thought too much about soccer, but I guess there are some very serious concerns there too. Much of what we do nowadays IS protecting our kids. e.g. seat belts and car seats. When I was growing up there was no such thing as car seats or wearing seat belts. In fact, we would constantly overload the back seat, be in adults' laps, etc. Now, car seats are law. Is that coddling, or being overprotective? There are lots of other such examples, but I would rather protect my kids than let them get hurt. I don't mean my kids will NEVER play sports, but this is something I will have to really think long and hard about.

  13. I am an orthopedic anesthesiologist and a mother of four sons. In my state, the rules are at least starting to get tighter in terms of head injuries in sports. When a child has a second concussion in a season, they are no longer allowed to play until the next season.

    In addition, my surgeons believe that once a child has torn an ACL or had a shoulder injury, they should be done with sports as these don't heal like broken bones and re-injury is common and life-changing.

    Food for thought.

  14. I need 2007 my son fell off a car and had a TBI! he is fully recovered (so it seems) he did lose his sense of smell! he has been BEGGING to play football all through highschool and wants to revisit the Neuro to see if he can play this year,,,what do ya'll think?


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