By Francis M. Smith
The sport of American football has come under scrutiny in recent years at all levels of play, from the schoolyard to the Super Bowl, for the heightened risk of head injury that its players experience. Traumatic brain injuries (TBI), the more medically-accurate term for concussions, can have lasting effects on a sufferer’s physical, cognitive and emotional health, especially as repeated injuries accumulate over time. This year, the largest youth football organization in the US is implementing policies that it hopes will make the game less dangerous for participants in its youngest leagues.
Pop Warner has introduced rules changes effective for the 2019 season and governing three age groups of players: “Tiny Mite,” with participants aged 5 to 7, “Mitey Mite” for 7- to 9-year-olds, and “Junior Pee Wee,” for ages 8 to 10. The policy change in question will eliminate the three-point stance, with one hand touching the ground, normally used when players line up for the ball snap. Instead, players in the affected age groups will either stand upright or squat with their hands resting on their legs. The three-point stance is being banned in these age divisions because the position lowers the heads of the players while jutting them forward, exposing the children to a heightened risk of head injury. The organization states that it intends to ban the three-point stance at all age divisions of play, but has offered no timeline for introducing this rules change at other levels. However, Pop Warner remains the first national football organization to ban the stance during play.
This is not the first rules change that Pop Warner has introduced to protect its young participants from head injury. In 2016, kickoff was removed from the game in the youngest three divisions, replaced by simply placing the ball at the 35 yard line after scoring or at the beginning of a half. The 2019 season will see this rules change introduced to the “Pee Wee” division for ages 9 to 11. Kickoff generally sees players running and tackling in a particularly fast and aggressive manner, and thus puts players at greater risk of head injury, prompting its elimination by Pop Warner.
While traumatic brain injuries (TBI) can be devastating for patients of any age, children are particularly vulnerable to this kind of injury, as their brains are still developing. According to the Centers for Disease Control and Prevention (CDC), brain injury is the leading cause of death and disability among US children and teens. In some cases, the lasting damage caused by a TBI doesn’t make itself obvious until the child is older and confronted with complex cognitive and emotional tasks, which the injury has damaged his or her ability to master. Many of the ways in which a TBI affects the brain interfere with judgement, reasoning, and managing emotions – areas in which a deficit is obvious in an adult, but which children are not yet expected to have mastered. The reasonable expectation of childish behavior in children can mask the full extent of the damage caused by a TBI.
The symptoms of a TBI can vary depending on the type of injury and the part of the brain that is affected, as can the severity and duration of those symptoms – though this can be improved with early diagnosis and treatment. Symptoms may affect the child’s physical, cognitive, or emotional health, and often include a combination of several of these. Common physical symptoms include impairment of vision, hearing, or speech; trouble with balance or motor coordination; headaches; and fatigue. Examples of cognitive symptoms include difficulty concentrating and maintaining attention, short-term memory problems, difficulty with reading and writing, and impaired judgment and ability to plan. Emotional symptoms resulting from a TBI may include mood swings, anxiety, depression, difficulty regulating emotional responses, lack of motivation, and uncharacteristic self-centeredness. Unfortunately, many of these cognitive and emotional symptoms are easily misattributed to some other issue, like ADHD or a behavior problem. Correctly diagnosing a TBI is key to helping a child overcome or manage these symptoms.
Correctly diagnosing a TBI is particularly crucial to ensure that an injured child does not return to high-risk activities such as sports until the symptoms of their concussion injury have fully resolved. If a second blow to the head is sustained while the patient is still suffering TBI symptoms, anywhere from minutes to weeks after the initial head injury, a deadly complication known as second-impact syndrome (SIS) may result, causing rapid swelling of the brain. Even a minor injury to the head, or an indirect blow that causes the brain to feel the force of acceleration, is enough to trigger SIS in a patient suffering an unresolved TBI. It's imperative that coaches and parents learn to recognize the signs of TBI and keep injured kids off the field.