Viewpoint: Should your child play football or hockey?

Body: 

Organized sports are great for kids in so many ways, but there is a downside to consider: injury. Football and hockey are examples of collision sports with frequent athlete impacts generating significant force magnified by increasing size and speed as kids get older. Injuries are common — most are minor, a few are catastrophic and an unknown number are hidden and may not be apparent for years.

A concussion is a traumatic brain injury caused by impact to the head or body that causes sudden movement of the brain inside the protective skull leading to damaged brain cells and chemical changes in the brain. Concussions can happen in accidents, falls and all sports.

However the rate of concussions in collision sports is high and potentially dangerous head and body impacts are a part of every play in football. We lack tools to accurately diagnose concussions, although several blood tests for molecules from damaged brain cells are being developed and are promising in early small studies.

Self-reporting of concussion symptoms is unreliable for many reasons. Failure to protect the brain from further impacts while it is healing can lead to severe brain swelling and even death. This is one reason the decision to return to play after a concussion is so difficult.

We don't know exactly how a developing brain responds to injury, especially the repetitive blows that may cause some cellular damage and processing problems without causing traditional concussion symptoms. Brain maturation is not complete until the mid-twenties.

A just released study of adolescent hockey players showed brain changes persist on high tech brain images for months, long after concussion symptoms resolved and they were cleared to return to play.

We continue to learn that professional football players have a startlingly high rate of chronic brain damage, also known as CTE. This damage has also been seen in non-professional players, and sometimes players without definite concussion histories.

Helmets and protective equipment are important, but may give a false sense of security. Modern helmets decrease other injuries, but do not appear to decrease concussions because they can't protect against large rotational forces that cause the most damage to brain cells.

There are other ways to decrease the risks of collision sports but we are fighting against entrenched interests when we want rule changes and strict enforcement of those rules. Youth football safe tackling programs have had mixed results.

Responding appropriately to an injury is also extremely important. Parents, coaches, players, athletic trainers and health care providers need to work together to identify and manage injured players safely without focusing on "the big game." However, this all happens after the injury has occurred and only minimizes additional damage if play is resumed too soon.

I stand with many physicians who think the risks of youth collision sports are far greater than the benefits based on current information. I urge parents of children already struggling with learning problems, emotional control or attention problems to seek out noncollision physical activity and team participation. Many sports can help kids develop fitness, discipline, cooperation, humility, fraternity, analytical ability and leadership with much lower risk. I encourage all families to develop new traditions and bonding activities that do not involve collision sports.

Schools and colleges should make the tough decision to not sponsor collision sport teams. Educational institutions which are focused on healthy brain development and growth should not be promoting or supporting sports that have a high risk of brain injury (temporary or long lasting). Removing sports as a focus of school spirit, school experience and alumni fundraising would involve a major cultural and economic shift for most institutions. The cultural meme of the high school "jock" peaking in high school and struggling in life afterward may in fact represent disability caused by the sport.

My position is not popular and may be thought to be extreme. Science and the data on brain injury and brain development don't care about popularity. Parents and educators, neither should you.