Dr. Gupta is a private practice pediatrician in a small, rural town. As a primary care physician, he is often asked to evaluate children and teenagers for participation in youth sports programs. This means much of his work is dedicated to high school football, one of the mainstays of youth athletics in the region. Dr. Gupta is often happy to serve in this capacity; he has spent much of his career working to prevent child obesity and believes strongly that community sports and fitness are crucial components of healthy lifestyles.
He is asked to evaluate 15-year-old Jesse in preparation for the boy’s first season on a junior varsity high school football team. Jesse is accompanied by both of his parents. As Dr. Gupta walks into the examination room, he senses that the atmosphere is tense. After a brief history and pre-participation physical exam, he asks Jesse’s mother and father if they have any questions.
The risks of participation in football, particularly the cumulative effects of concussion and chronic traumatic encephalopathy, are not fully clear. Dr. Gupta cannot reliably predict whether or not Jesse will sustain further concussions, whether those concussions will have a significant effect on his future well-being, and whether or not the subconcussive blows he is likely to sustain while participating in high school football will result in long-term consequences. Thus, it is unclear whether the decreased risk of injury associated with prohibiting Jesse from playing football outweighs the benefits to his health and well-being of allowing him to participate.
Introducing physical education and sports into the course is an excellent approach towards creating that habit in the young blood. Having said this, making is compulsory for all can disrupt the purpose. As generally accepted, forcing something to children might make them hate those things the most. Sports and related education can be an optional activity with a merit attached to it. For instance, achievers to get 15 marks bonus in the final mark sheet could be an excellent way to motivate students to take part in physical activities while they are on schools premises. This would not only encourage them but would push them to put in their best at sports also.
Because there is no unusual risk in this case, respect for the family’s autonomy outweighs any potential net benefit, if indeed there is one, to prohibiting Jesse from playing. If there were a clear history of unusual risk or vulnerability (for instance, if Jesse had a history of multiple concussions occurring with decreasing force, injuries that were taking longer and longer to recover, or incomplete recovery) then it would be the responsibility of the physician to step in and insist that Jesse be disqualified from contact sports. In this case, that history doesn’t exist, so, the decision should be left to Jesse and his family. Essentially, this process is similar to informed consent after a discussion of the best medical information available.
We agree with Dr. Gupta’s decision to acknowledge and recognize both the health risks that Jesse’s mother is worried about and the benefits that Jesse’s father wants his son to obtain. His recommendation, that the family further discuss the risks and benefits, including Jesse in the conversation, and come to a conclusion about whether or not they wish Jesse to participate in sports, is sound.
Playing a team sport provides kids with important lessons in personal values, Ross says. "Kids learn that things aren't going to go their way all the time, and that they need to respect their peers as well as referees and sports officials."
"When you play a team sport you learn that it doesn't just come down to the best player," says Ross Morrison, a sports expert with the NSW Department of Education and Communities.
Dr. Gupta’s approach could be augmented, however, by a more complete evaluation of Jesse and a more complete discussion of the available medical literature. He could more thoroughly assess Jesse’s readiness for a collision sport and potential risk of injury. For instance, if Jesse were particularly undersized for his sport or proposed position, if he had physical deficits such as subpar core strength, balance, or neck strength, or if he had already demonstrated a propensity for sustaining concussions with relatively low levels of contact that are expected to occur frequently in football, then Jesse, his family, and Dr. Gupta might feel more strongly about finding a sport with less contact. Furthermore, Dr. Gupta could review the relative incidence of concussion in football versus other team sports. He could discuss the studies that have demonstrated the cumulative effects of concussions sustained during sports. He could discuss the limitations of those studies, including the changes in management of sport-related concussions since the time those included in the studies were playing. He could discuss the evidence of chronic traumatic encephalopathy as well as the limitations of that evidence. By discussing the studies and data that are available while simultaneously acknowledging the existence of clinical uncertainty, Dr. Gupta would promote a more autonomous decision-making process, allowing Jesse and his parents to perform a more informed risk-benefit analysis [4, 48].
Regular exercises not only keep a person fit but also make them confident, energetic and fresh for the rest of the day. It keeps the body flexible and the heart healthy. This would in a way be beneficial during their older years. Besides, team sports teach pupils how to work in a group and achieve a common goal. Furthermore, many sports and games help children develop their cognitive abilities. This is why undoubtedly sports and games should be a part of a complete education in schools.
is an attending physician in the Division of Sports Medicine at Boston Children’s Hospital and an instructor in orthopedics at Harvard Medical School. He is director of the Sports Concussion Clinic and was associate program director for the Primary Care Sports Medicine Fellowship Program at Children’s. Dr. O’Brien is a staff physician at The Micheli Center for Sports Injury Prevention in Waltham, Massachusetts, and part of the medical coverage team for the Boston Marathon, the Boston Ballet, Bay State Games, and various synchronized ice skating and track and field championships.
is director of The Micheli Center for Sports Injury Prevention, director of research for the Brain Injury Center at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. Dr. Meehan serves on the section on emergency medicine for the American Academy of Pediatrics, the advisory board of the Sports Legacy Institute, and the advisory committee for Sports Head Injuries for the Commonwealth of Massachusetts Department of Public Health.