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My 15-year-old was joking the other day about what he’ll do when he’s finally out from under my thumb:
“First thing I’m gonna do once I turn 18? Join a football team. Then the army!”
I laughed, equally relieved that he understands these activities are forbidden and has shown no interest in pursuing them. I understand that my view comes from a place of privilege. We don’t need a member of our family to become a professional athlete to lift us out of poverty, and I’m fairly confident that we can find a way to fund my child’s college education without a football scholarship (or one from the military, for that matter.)
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Football isn’t part of our lives, and I view it from an outsider’s perspective, in the same light that I see bullfighting: a cultural tradition that, while troubling, holds deep meaning for many people — meaning that inspires them to play the sport.
For football fans and players’ families, however, the calculus is a lot more complicated.
Concerns about the long-term impacts of repeated blows to the head that players sustain were front and center again last week after Miami Dolphins’ Tua Tagovailoa collided with a player for the Buffalo Bills. Tagovailoa hit his head against the back of the turf, and the Dolphins quickly confirmed that the blow had caused a concussion — Tagovailoa’s career fourth.
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Al Diaz, Miami Herald via Getty Images Miami Dolphins quarterback Tua Tagovailoa (1) sits on the field as he is attended to after an injury during the game against the Buffalo Bills in the second half at Hard Rock Stadium on Thursday, Sept. 12, 2024, in Miami Gardens, Florida.
How common is CTE in younger athletes?
There is ample evidence that this kind of repeated head trauma can lead to Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease mainly seen in football and hockey players, wrestlers and combat veterans. Symptoms often don’t appear for years after the injuries occur, and a diagnosis can only be made posthumously via brain autopsy.
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Experts believe that CTE symptoms often emerge in two waves. The first, in a person’s 20s or 30s, includes mental health and behavioral symptoms. The second, in a person’s 60s, includes memory and cognitive issues that may progress to dementia.
There are currently no treatments available for suspected cases of CTE, although therapy or medication can be used to treat some symptoms.
A study published in 2023 found that CTE was correlated not with the number of concussions a player sustained but with the cumulative force of all the head impacts that they endured. Impacts that do not lead to concussion can still cause damage that won’t be apparent for years. The length of a player’s career and specific position in the game impact their odds of developing CTE.
Boston University’s CTE Center has diagnosed CTE in the brains of more than 320 former (deceased) NFL players, leading to a billion-dollar settlement with former players and changes to NFL protocol around head injuries (although there are still plenty of critics, like those who were alarmed by Tagovailoa showing up for practice just days after his most recent concussion).
Unfortunately, CTE is not limited to players at the professional level. Boston University’s CTE center also examined the brains of 152 former athletes, mostly high school or college players, who died before the age of 30. Their families donated their brains to the center seeking answers, often in the wake of a suicide. Of these athletes, 41% were found to have CTE. In comparison, studies from community brain banks show that the rate of CTE in the general population is less than 1%. Forty-eight of the 63 players found to have CTE played football. Other sports represented in the sample were hockey, soccer, rugby and wrestling. The sample also included the first American female athlete with CTE, an anonymous former soccer player who died at age 28.
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A multimedia report published last year by The New York Times featured interviews with the parents of five of the young players whose brains were included in the study. All died by suicide.
The parents of Wyatt Bramwell, age 18, shared a video message he made for his friends and family in which he describes the past four years of his life as “a living hell.” He said, “The voices and demons in my head just started to take over.” Moments after he finished recording, Bramwell shot himself in the chest. In his video, he instructed his father to donate his brain so that his parents might have “closure.”
While united in their grief, the parents of these young athletes, some of them former players or coaches themselves, are torn over whether, given a chance to re-do the past, they would’ve forbidden their sons from playing football. One mother said her heart breaks every time she drives by a field of padded up young players. A father says that if he ever has a grandson, “He will not play.” When asked, Bramwell’s father gazes past the camera and, after a pause, slowly begins to shake his head. But his wife says she would have let her son play: “He loved it. I wouldn’t have wanted to take that away from him.”
What do parents need to know about head trauma?
Concussions, also known as mild traumatic brain injuries, are “very common in
children and youth, especially those involved in contact sports,” Dr. Linda Papa, director of clinical research and emergency medicine physician at Orlando Health, Inc, told HuffPost.
There are a wide variety of symptoms that a child with a concussion may exhibit. Papa said that these can include:
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feeling “foggy,” confused or dazed
slowed thinking
repeating words/phrases
headache
dizziness
balance problems
nausea or vomiting
vision problems
sensitivity to light or noise
trouble paying attention or difficulty concentrating
memory problems
irritability
getting easily upset/frustrated
nervousness or anxiety
sadness or depression
acting without thinking
problems with sleeping
If there is a chance a child may have sustained a concussion, they “should be removed from play immediately and should be medically evaluated as soon as possible,” Papa said.
The doctor will examine your child and use an algorithm to determine whether they need a CT scan to look for bleeding or bruising in their brain, or if they need to be under observation. CT scans expose patients to radiation, more so than X-rays, so doctors want to minimize unnecessary scans.
Even if your child has a clear scan and is sent home, that doesn’t mean they don’t have a concussion, and they will need to follow up with their pediatrician and perhaps a specialist.
“They will have to stop playing their sport until they recuperate, and their symptoms resolve,” Papa said. She recommends that children return gradually to their activities, and added that “many sports have specific return-to-play protocols.”
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There is a risk of incomplete recovery, or a child sustaining another blow to the head before their previous injury resolves. This is known as “second impact syndrome” can cause brain bleeding or swelling and even death, but, fortunately, is rare.
More research is needed to understand how CTE develops, Papa said. What we don’t have is a way to measure how each individual injury impacts a player’s risk of developing CTE later in life. We can’t tell parents, for example, to remove their child from a sport after a certain amount of cumulative force to the head. Doctors, parents and coaches use guidelines and protective gear to keep kids as safe as possible, but without certainty.
How are families making this decision about athletics?
Parents like me, whose kids are happier playing Dungeons & Dragons, get off easy on this one. We can say we forbid football, but the dilemma remains hypothetical for us.
Parents whose kids really want to play are in a much more difficult position. Participating in sports benefits kids’ physical and mental health. It “can teach children respect, sportsmanship, discipline, teamwork, and helps develop their confidence,” Papa said. These are not small matters. Neither is family and community tradition.
freemixer via Getty Images Parents with kids who want to play football grapple with safety concerns.
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When HuffPost asked parents in our Facebook community about their choices, some said they drew a hard line and said no, often encouraging their kids to pursue other, less-risky (although not risk-free) sports. Almost all of the parents who said they let their kids play mentioned that head trauma was a serious concern. A few said that a serious injury might cause them to reconsider. Some had gone back and forth over the decision already.
“I’m allowing my son who is sixteen to play football. It’s his dream. I am worried about concussions and had the baseline testing done. His father and I said no for years but eventually relented. I’ve seen that a lot in my town — parents who said no finally allowing their sons to play football in late high school,” Jessica Breen said.
David Armstrong of Minnesota explained his family’s process: “My nephew got a TBI [traumatic brain injury] from football in pre-season practice his freshman year of college and had to relearn to walk — so we had an absolute ban until this year when my high school freshman begged me to let him play. After a long talk with my sister, some internet research, and a long talk with the coach, we let him play, but he is aware that we will reconsider if there is an injury.”
Susan Barkin Weitz of Illinois said she was reluctant to allow her son to play tackle football. “It has been his dream since he was little. Last year — his freshman year of high school — he told us he wanted to try out for the team,” she said.
“Honestly, I was hoping he would suck or would hate it. Turns out, neither one happened. He absolutely loves it, he starts, and he plays both defense and offense. He is actually really good. I support him, and go to all the games. I am a nervous wreck while watching though,” she said.
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Other families see the media coverage of CTE in former players, including the heart-wrenching Times piece, and determine that the risks, for them, are too high.
“Our 9th grade son wanted to play football,” Jeanne Hughes of California told HuffPost. While each of her three children played other sports, she felt she had to say no this time. “It was hard for me not to let my son make his own choice, as I like to allow my kids to make their own decisions as often as possible, but in this case I felt the risk/reward ratio was clear.”
Amber Spackman Jones of Utah said, “No football for our kiddos because of the concussion and injury risk. A high school peer of mine suffered multiple concussions playing football — I don’t want that for my kids.”
Parents whose kids did play were eager to take every possible precaution.
“My son is 15 and has played tackle football for 10 years,” Julie Cooper of North Carolina told HuffPost. “Yes, I’m concerned, and we take all appropriate precautions. He is very much aware of the risks, but has always wanted to play,” Cooper said.
Meg St-Esprit of Pittsburgh was also hesitant about letting her 10-year-old son play and had him start with flag football. “We wanted to make sure he was really interested. He really showed an affinity for it,” she said, and after doing some research, she decided to allow him to play tackle. But she remains vigilant.
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“The first set of gear he was given really seemed to not fit him well,” she said. “It would have been easy to say, ‘Oh, whatever. They know what they’re doing’ but we had them go and refit him and size it up and make sure.”
She’s also considering having her son use a Guardian cap, which adds an extra layer of foam over the helmet. Although these are new, there isn’t yet sufficient research to prove they are effective in preventing injury.
St-Esprit mentioned that her son’s coaches have rules to promote players’ safety and that it’s helpful when she can show her son how bigger players have to follow precautions, too, as in a recent college game they were watching where a player was made to sit out for concussion protocol when his helmet popped off.
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“It was good to show our son on TV. It’s not just you,” she said, “we’re worried about everyone’s brains.”