Informed Consent for Youth Tackle Football: Implications of the AAP Policy Statement

* Abbreviations: AAP — : American Academy of Pediatrics CTE — : chronic traumatic encephalopathy mTBI — : mild traumatic brain injury NFL — : National Football League There are 2 to 4 million tackle football players in the United States under the age of 19.1–3 Concerns are growing over the safety of the sport, particularly with regard to short- and long-term effects of brain injury associated with concussions, also known as mild traumatic brain injury (mTBI). Once thought to be a transient and relatively innocuous injury, we now know the symptoms and underlying neuropathophysiology of concussions often last for weeks to months and sometimes longer.4–7 There is increasing evidence that subconcussive trauma can be associated with debilitating neuropathology, including chronic traumatic encephalopathy (CTE).8 Football, with its high incidence of concussion1,9,10 and participation rates, causes the majority of sports-related brain injuries among our nation’s youth.11,12 Per season, individual players experience 100 to 1000 head impacts,3,13 and an estimated 53 000 to 178 000 school-aged players sustain at least 1 concussion.1,7,12 In response to these concerns, the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness published a policy statement in 2015, “Tackling in Youth Football.”3 In this article, we expand on published criticisms14–19 of the AAP policy, particularly its reliance on informed consent as a justification for youth participation in tackle football, summarized in the statement, “Participants in football must decide whether the potential health risks of injury are outweighed by the … Address correspondence to Alec Lerner, attn: Norman Fost, MD, MPH, University of Wisconsin Hospital, 600 Highland Avenue, Room K4/944, Mail Code 9988, Madison, WI 53712. E-mail: aplerner{at}wisc.edu