I was a practicing pediatrician for several years before I finally became a parent myself. During this time period I was called upon to dole out all manner of advice, which I truly believed to have been helpful. However, upon having a small person of my own to raise, I was immediately seized by a desire to call a great many parents and apologize for how worthless I almost certainly was.
It turns out that “this sounded sage during that conference I once attended” and “this helped preserve my sanity during a tense moment with my child” are not necessarily the same thing. As a result of bashing my own expectations against the resilient rocks of my older child’s will, I have learned to temper my recommendations with a healthy dose of flexibility. What works for one family falls totally flat with another. Outside of a few hard and fast rules (vaccinate your kids!), I try to avoid a doctrinal approach to patient care.
With regard to my own kids, I also learned (or, perhaps more accurately, am learning) to eschew absolutes. We have a rough idea of where we’d like to arrive as parents, and find ourselves meandering toward it rather that making the beeline I’d once thought possible. Nowhere does the saying about the perfect being the enemy of the good hold more true than with regard to parenting, and as I am unmistakeably imperfect as a parent I am left to simply Do My Best.
Thus, I have issued very few parental edicts. In fact, I can only think of two things that are completely non-negotiable as far as my kids are concerned. (Maybe I’ll think of more as time goes by.) One is that my kids are never, ever to drink unpasteurized milk. That’s probably the kind of thing that wouldn’t even occur to most parents to have an opinion about, but I do and it is written in stone, chiseled there over the course of my medical training.
The other is that my son is never to play tackle football.
How this diktat goes over when he becomes a teenager remains to be seen. I hope against hope that it’s as close to a non-issue as possible, but there’s no way of knowing how the Critter will respond if he wants to play football and I say no. Because I will, without question, say no. I see far too many kids every year with concussions, and the potential for serious or catastrophic injury is simply too great to be justified for the sake of a game. Though I see lots of patients who have been hurt playing other sports, football surpasses them all. (Hockey is a close second.) He can play soccer, he can run cross-country, he can find some other sport if he has an athletic yen. No football.
All of this sprang to mind the other day reading an article about Pop Warner football in Slate. Writes Stephan Fatsis (who argues that young kids shouldn’t be playing at all):
Last week, I took part in a roundtable discussion in Washington on the future of youth football. Robert Cantu, the CTE (chronic traumatic encephalopathy) researcher and NFL adviser, was there. So were Chris Nowinski, the Harvard defensive tackle turned pro wrestler turned brain-injury activist; neurosurgeon Julian Bailes, who has advised the NFL Players Association, the NCAA, and Pop Warner football; and DeMaurice Smith, the head of the NFLPA. An NFL executive attended, as did various youth-football organizations. There was an ex-Jet/Jaguar/Redskin, a plaintiffs’ lawyer, a school board member, the head of a sporting goods trade group, academics, and a bunch of journalists like me.
I know that Matt Chaney, who wrote for the roundtable this week about the tackling technique that won’t make football safer, is on board with the idea that tackle football is simply too dangerous for the brains of children, and that a distinction needs to be made between what adult men choose to do professionally and what kids are permitted or often pushed to do by parents and other adults. In his new book, Concussions and Our Kids, co-written with journalist Mark Hyman, Cantu proposes barring tackle football before age 14, or the start of high school. The cutoff is arbitrary, Cantu said at the Washington panel. The more important consideration is an individual child’s physical development: If he’s skeletally immature, if he hasn’t developed axillary hair, he shouldn’t play tackle football.
The third and most critical component of the youth-football defense wouldn’t be out of place at a debate over climate change: The science just doesn’t exist to justify banning youth football at any age level. Over and over, Hallenbeck cited the lack of “evidence-based” data. And while Cantu and others agreed that more research is needed, there’s already data that shows the effect of tackle football on undeveloped brains, like a study released this year by researchers at Virginia Tech and Wake Forest that found that 7-year-old players absorb impacts on par with those in college football. [emphasis mine]
Given my unapologetic opposition to my own child playing tackle football at any age, it is probably unsurprising that I don’t think preadolescent children should be playing it. I think it is an utterly terrible idea, and if parents asked for my opinion outright then I would happily tell them so.
But often they don’t ask, and I find out their kids are playing tackle football as I take a routine history and inquire about exercise or extracurricular activities. And I don’t tell these parents that I think their kids should quit. Ought I?
The first reason why I don’t is indicated by the highlighted phrase above. There really isn’t a clear body of evidence that indicates when tackle football is “safe” to begin. As far as I can find, the American Academy of Pediatrics has taken no stance on the question, nor has any equivalent academic or medical body. (I would be delighted to learn otherwise in comments, if anyone knows differently.) While my clinical experience argues that football is too dangerous for small players and there is emerging evidence to support this impression, it is not as solid as I need it to be.
Why? Because football is woven deep into the fabric of our popular culture, and these kids love their sport. Telling them to stop playing is not a neutral action, but would (assuming they even take my advice) have a quality of life cost attached. Furthermore, I have a finite treasury of credibility to spend on any given patient, and I have to be judicious with it. How much should I pay out to prevent some unspecified number of theoretical injuries based mainly on my own inchoate hunches?
I do the next best thing, which is to go over in detail the signs and symptoms of concussion with every patient who plays football. For those below a certain developmental threshold, I advise parents that the effects of concussion are even more poorly understood, so they need to be especially careful and conservative if they have even the slightest concern. For parents who evince ambivalence about whether their kids should be playing in the first place, I more freely share my concerns and say that my advice would be against it. But I don’t try to sway people when they don’t seem interested.
I wonder, though, if I am failing in my ethical duties by not pressing harder. At what point does “I just think it’s a bad idea” gain enough weight that I should put the heft of my professional recommendation behind it? What if I am simply wrong, and new evidence indicates that younger players are at no increased risk compared to their older counterparts?
With my own child, the clarity of my convictions is enough. My own best guess is sufficient justification for making all manner of parenting decisions as I see fit. But my profession demands a different standard, and for now it seems best to me to keep my qualms to myself.