The American Academy of Pediatrics tackles the problem of youth football safety with a list of recommendations.

College and professional American football are in the midst of a serious concussion crisis, with former players exhibiting extreme brain injuries after decades of hard hits to the head.

For some players, arthritis and joint trauma are long-term prices paid for the gridiron glories of their youth. And the increasing media attention paid to these physical costs are causing some parents to think twice about letting their kids play the game at all.

But participating in team sports still has major benefits for kids, and any sport comes with risks. Enter the American Academy of Pediatrics (AAP) with a set of recommendations published today to make youth football safer and saner for kids so that they may enjoy the physical and social benefits of playing the game as it’s meant to be played, but without undue risk to their long-term health.

There are approximately 1.1 million high school football players and about 250,000 youth football players ages 5 to 15 years in Pop Warner leagues, the AAP says.

The AAP’s recommendations include the following:

  1. Officials and coaches must enforce the rules of proper tackling, including zero tolerance for illegal, head-first hits.
  2. Players must decide whether the benefits of playing outweigh the risks of possible injury.
  3. Non-tackling leagues should be expanded so athletes can choose to participate without the injury risks associated with tackling.
  4. Skilled athletic trainers should be available on the sidelines, as evidence shows they can reduce the number of injuries for players.

The report is published in the November issue of the journal Pediatrics.

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Dr. Greg Landry, a pediatrician who co-authored the recommendations, said delaying the introduction of tackling until a certain age might lower the risk of injury in the short term, but then lead to higher rates of injury when tackling is introduced when players are stronger and bigger.

“It’s this paradox that makes it so important for leagues to teach proper tackling technique and skills to avoid and absorb tackles, even if no tackling occurs throughout the seasons,” Landry said in a statement.

According to research on football injuries, tackling or being tackled accounted for half of all injuries among high school players. The injury rate for youth football is lower than the rates for high school and college players.

Some people insist that tackling be removed as part of the game, but co-author Dr. William Meehan III, a member of the AAP Council on Sports Medicine and Fitness, said that could “fundamentally change the sport of football.”

The AAP believes that athletes should continue playing, but that coaches and officials should strive to reduce these injuries.

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Youth football is being taught better, played safer, and using the best available science, according to Joe Frollo, a spokesperson for USA Football.

The association oversees a safety program called Heads Up Football.

The American College of Sports Medicine, the National Athletic Trainers Association, the American Medical Society for Sports Medicine, and more than three dozen other organizations support the program.

Frollo told Healthline that educating players and coaches on safer play practices has been shown to change behavior. He cited a 2014 study showing a 76 percent reduction of injuries in youth football leagues that follow the Heads Up Football curriculum.

This included a 34 percent reduction of concussions in practices and a 29 percent reduction of concussions in games.

He believes parents should decide if playing football is right for their children. If a child is interested in playing football, parents should ask the league if it adopts Heads Up Football and other USA Football practices.

“What’s being taught and played today is not your father’s youth football or even the youth football that was played five short years ago,” Frollo added.

Landry agrees.

“Parents should seek well-informed coaches who will teach proper tackling technique, forbid spear tackling, and minimize the number of contact practices,” Landry told Healthline.

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Dr. Patrick Kersey, a sports medicine physician and youth football coach from Indiana, told Healthline that youth football can be played safely even with tackling included if the athletes are coached and taught properly.

“It’s important that people who are teaching our kids are teaching them properly,”he said, adding he favors standardized teaching for coaches.

Kersey said that many parents are fearful to let their children play because they are misinformed. There is a 10- to 12-fold increase of injuries when kids participate in activities such as biking, soccer, riding skateboards, and jumping on trampolines, he said.

“The best way we can address those concerns is to answer them and get as much educational information out there,” he added.

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While injuries occur in every sport, Kersey said there’s a lot of “misinformation and misunderstanding” surrounding football safety.

Many injuries in the NFL don’t have a parallel in the level of play happening in youth football.

“In relatively no way, shape, or form [are NFL injuries] a true comparison,” he said. “The comparison seems to be appropriate when the true physicality is not the same.”

Whether children participate in non-tackling leagues or learn from trained coaches how to tackle safely, Kersey believes that intervention is necessary to prevent injuries.

Proper tackling instruction can be integrated into training as children grow, so they learn how to tackle safely.

“We shouldn’t be throwing kids [into] contact sports and say ‘Hey, go get ‘em,’” Kersey said.