UW Pediatrician and Medical Student Challenge the American Academy of Pediatrics Policy Statement on Youth Tackle Football

The current American Academy of Pediatrics (AAP) policy statement on youth tackle football is not sufficient for parents or players to adequately comprehend the relevant information, particularly involving the risks in playing the sport, according to a recent perspective article from the University of Wisconsin School of Medicine and Public Health. 

The article, recently published in the journal Pediatrics, was authored by Alec Lerner, a third-year medical student and former University of Wisconsin football player, and Norman Fost, MD (Department of Pediatrics Professor Emeritus).  

The paper outlines nine problems with the AAP’s statement and presents a draft model consent form as part of a way to facilitate a broader discussion about what information would be sufficient to elicit meaningful informed consent from parents and participants in youth football. 

“Consent is not ethically meaningful if it is not informed,” said Fost. “It’s important for the AAP to reconcile the differences between their Tackling in Youth Football policy and the opinions of pediatricians and parents.”

A 2017 survey of AAP pediatrician members showed that 77% would not allow their children to play tackle football and 81% support age limits on tackling. These numbers are consistent with a more-recent survey which indicated that 61% to 85% of parents support age restrictions for tackling.

The AAP Council on Sports Medicine and Fitness 2015 policy statement is up for scheduled review in 2020. Lerner and Fost hope their article leads to a revision of the AAP’s policy, particularly its reliance on informed consent as justification for participation. They lay out the following concerns with the current policy:

  • Absence of suggested content or standards for information in the consent process
  • Absence of standards for assuring adequate comprehension of the relevant information
  • Inadequate information and evidence
  • Failure to distinguish first-person from surrogate consent
  • The language of “concussion” obscures the seriousness of brain damage
  • Risk minimization in the consent process
  • The AAP’s football policy is inconsistent with AAP policy on other sports
  • Inadequate explanation of the recreational benefits of tackle football compared to other sports with lower risks
  • Failure to provide guidance to pediatricians on whether and how to counsel parents and children about youth participation in tackle football, as well as guidance and materials to help them obtain meaningful consent

“We acknowledge that there is no ‘right’ answer to the question of what the best consent form or process is,” said Fost.  “We offer a sample consent form to move the discussion along and we encourage the AAP and others to propose alternate approaches.”

The publication of their article comes at a time when growing evidence and awareness of the unusual risks associated with tackle football are shifting public opinion and youth participation in tackle football is declining.