Face masks and the brain


The current epidemic of football-related concussions and the association of repeated concussions with CTE is a serious problem that must be addressed and resolved.

editors’ note

This article’s views do not necessarily reflect those of Contemporary Pediatrics, the editors, or the Editorial Advisory Board.


On March 16, 2016, the New York Times reported that the National Football League (NFL) finally has acknowledged a direct relationship between football-related concussions and degenerative brain disorders such as chronic traumatic encephalopathy (CTE).1 Previously, the NFL had disputed this connection. The fact is that the overwhelming weight of evidence clearly has established the link between traumatic brain injuries and CTE.

The current epidemic of football-related concussions and the association of repeated concussions with CTE is a serious problem that must be addressed and resolved. As pediatricians, we are leading advocates for the health and welfare of children, and therefore we must take action.

More: Care of the student athlete

The question to be asked is whether children should or should not participate in football. Currently, football is a sport that promotes and encourages the use of a hard helmet as a lethal weapon to tackle any opponent. Before I give my answer, a bit of history is in order.

Until the 1950s, football on all levels was played with leather helmets and without face masks or mouth guards. During World War II, I was a US Navy pharmacist’s mate stationed in Annapolis, Maryland, assigned to the Navy football team. My job was to help the trainers and physicians handle injuries occurring during practice and during Saturday games. Monday mornings were pretty busy-taping sprains, cleaning and dressing lacerations, and applying hot and cold compresses. Broken noses were not uncommon as were broken or loosened teeth, but there were no concussions.

To address the facial injuries, face masks became routine in the 1950s along with mouth guards. Helmets were changed from leather to hard plastic in order to help prevent skull fractures. The result of these changes in equipment has been fewer facial injuries but more concussions and CTE.

Football will remain a hard-hitting contact sport, and it will continue to be a wonderful, enriching activity for many children, from Pop Warner through college. However in order to allow our kids to participate, changes must be made, and, in my opinion, the sooner the better.

No more face masks

The solution to the escalating problem of repeated concussions [attributed] to violent head-to-head contact is simple: Let’s go back to the good old days of softer, spongier helmets and no face masks. Yes, there may be more broken noses, but they can always be fixed. Not so with a traumatized brain. We may not fully eliminate CTE, but we surely will have a lot fewer ex-football players with dementia, depression, suicide, and CTE. Without a face mask, a child or even a 300-pound lineman will think twice before smashing his unprotected face and head into another player’s head. Mouth guards should remain.

The no-face-mask rule should be put into effect at all levels of competition, [beginning] in elementary school. Children must be taught to tackle correctly from the start, to never tackle around the neck or head. Only then will we begin to make inroads into the epidemic of concussions and traumatic brain injuries accumulating during the football life of the player.

It is my sincere hope that the American Academy of Pediatrics will officially endorse my recommendation to remove face masks during all football-related activities and return to a softer, spongier helmet. As a pediatrician with a continued interest in the preservation of intelligence quotient points and brain function, this recommendation is long overdue.



1. Belson K, Schwarz A. Game may never be the same as N.F.L. shifts on concussions. New York Times. March 16, 2016:A1. http://www.nytimes.com/2016/03/16/sports/nfl-concussions-cte-football-jeff-miller.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news&_r=0. Accessed March 16. 2016.

Dr Eden, clinical professor of pediatrics, Weill Cornell Medical Center, New York, New York, has been a practicing pediatrician for over 40 years. He has written numerous books on childcare and publications on iron deficiency in children. He also is past chairman of the Committee on Nutrition, New York District II, Chapter 2, of the American Academy of Pediatrics.

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