WHY

I LET MY SON PLAY FOOTBALL

Donald Haas, MD, MPH
How can you let your son play tackle football? As a physician, I hear this question often, and for good
reason. It seems the media is filled with one study after another focusing youth sports injuries,
particularly head injuries. Football takes the brunt of the scrutiny. I read and hear these reports like
every other loving parent. I also follow the medical literature on this topic. So my decision to allow my
son to play is, if nothing else, thoughtful.
Without question, playing football comes with the risk of incurring injuries, including concussions. In
fact, football lags only behind womens soccer in terms of relative concussion risk among competitive
youth sports1 . The crucial question, however, is what is the absolute risk of concussion, rather than the
relative risk. Absolute risk refers how often an event occurs per exposure. Relative risk is a ratio
comparing one outcome to another. For example, a drug company may advertise that their new
product can lower your heart attack risk by 50% compared to standard treatment (relative risk). Thats a
striking improvement, but it needs to be interpreted in the context of the absolute risk. If your baseline
risk of suffering a heart attack is only 1%, taking a drug to lower your heart attack risk to 0.5% may not
be worthwhile. On the other hand, if your absolute risk of a heart attack is 60%, cutting that risk to 30%
with the drug would be a wise decision. Its the absolute risk that needs to be understood, more so than
the relative risk.
Most of what is reported in the media regarding concussions and football describes the relative risk for
example, high school football players are more than twice as likely as high school wrestlers to sustain a
concussion2. However, the relevant question, in my view, is what is the absolute risk for a concussion in
playing football? Available data suggests that for both high school and youth football (ages 8-12) there
are about 0.7-1.7 concussions per 1000 athletic events, where an athletic event is defined as a practice
or game 1,2,3. The actual occurrence rate of concussions in youth and high school football is
considerably lower than the relative risk suggests.
I am also asked, Even if the absolute risk is low, why play a sport where there is even a small increase in
concussion risk? My answer is admittedly subjective and debatable, but I think there are few, if any,
team sports like football arguably the ultimate team sport. In football, every player matters on nearly
every play. Twenty-two opponents line up to compete individually and the sum outcome of these
unique contests determines the success or failure of a play. An entire team (coaches included) prepares
for a week, focused on implementing a complex game plan that requires all team members to execute
effectively. Also, football offers an opportunity to excel even for kids not blessed with great hand-eye
coordination or speed. Strength, along with agility and quickness (which are different from speed), can
always be improved upon and these are the core elements needed to play on the line. Football fosters
toughness and perseverancenot just physically, but mentally. It takes courage to line up against
someone a foot away from you and compete for four quarters. Former players speak of the
brotherhood of football, and I think it is an accurate description.

Playing football was an overwhelmingly positive influence on my life, and I hope my son will have the
same experience. There are risks, but I know I cannot protect my son from everything in life. I also let
him ride a bike, climb trees, swim in the ocean, and ski I dont think that makes me a bad parent. I
credit youth football programs (which seem to be ahead of other youth sports) for their efforts to
educate coaches, parents, and players regarding concussions (the WW-P Wildcats program provides
preseason neurocognitive testing in effort to diagnose concussions more effectively). I will continue to
follow this topic closely in the scientific literature, rather than the media. I will be the first to prohibit
my son from football if the risks are unacceptable. At this point, the data, in my view, does not support
keeping him from a game that has been a positive influence on boys and young men for decades.

(1) Giza CC, et al. Summary of evidence-based guideline update: Evaluation and management of
concussion in sports: Report of the Guideline Development Subcommittee of the American
Academy of Neurology. Neurology 2013;80:2250-2257.
(2) Harmon KG, et al. American Medical Society for Sports Medicine position statement: concussion
in sport. British Journal of Sports Medicine 2013; 47:15-26.
(3) Kontos AP, et al. Incidence of sports-related concussion among youth football players aged 8-12
years. Journal of Pediatrics 2013; 163:717-720.