With a racing heart but steady nerves, he crouches in his stance 3 yards behind the quarterback. The play is set in motion, and he takes the handoff. He sprints through a hole in the line and into the open field. He is running free, until a shadow out of the corner of his eye emerges.

The classic sound of crashing shoulder pads can be heard across the field as the safety tackles him with a crushing blow. The hit, led by the shoulder and without helmet-to-helmet contact, was perfectly legal. Yet the runner doesn’t get up. Coaches run on to the field to check on him and find him confused and dizzy, his head aching. He has a concussion. He is 8 years old.

This scene will play out across the country time and time again as kids, some as young as 5, are putting on their uniforms, lacing up their cleats and hitting the gridiron.

Concern about concussions has grown in recent years, prompting some parents to hold their child out of tackle football. They worry their child might develop chronic traumatic encephalopathy (CTE), the progressive brain disease diagnosed in some of their football heroes. The attention being given to concussions is important. These are serious injuries that should be prevented when possible and identified and managed appropriately when they do happen.

Unfortunately, concussions aren’t the only brain trauma in football that we should worry about, and CTE isn’t the only potential consequence. By focusing on concussions and CTE, we are ignoring a critical part of the story. We should be just as concerned about the routine hits that happen on every play, and we should do everything we can to eliminate these hits from youth football.

These repetitive subconcussive hits, or hits that don’t cause concussion symptoms, can damage the brain, even over the course of just one youth football season. Kids may be smaller, but they experience hits with the same magnitude of force to the brain as high school and college athletes. They can also experience hundreds of impacts each season. Parents and coaches need to understand that you don’t actually have to hit your head to impact the brain. A blow to the body can transmit forces that cause a concussion or subconcussive damage, too.

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Repetitive brain trauma can have an even greater impact on a child’s brain than an adult’s, because the young brain is rapidly developing. Studies of former football players have found that those who started playing the game at a young age had significantly more difficulties with brain function, depressive symptoms and differences in brain structure compared to those who started playing at an older age. These difficulties may not become apparent until they are much older. Repetitive brain trauma in youth could be disrupting normal brain development processes, leading to these lasting consequences.

To be clear, no evidence shows a single concussion will lead to CTE. Nor does simply playing football as a child increase the risk for getting CTE. But repeated brain trauma is associated with the development of the disease, and research from the Boston University CTE Center suggests the greater the number of hits, the greater the risk of getting CTE. Starting at a young age likely means a greater total number of lifetime hits. Findings from one CTE Center study suggests that, if a person does develop CTE, their symptoms of the disease could begin to show years earlier if they began playing tackle football at a young age, and therefore experiencing repetitive brain trauma.

Efforts have been made to reduce overall hits in practice, and that is critically important. But it may not be enough. If a person who used to smoke two packs of cigarettes a day cut down to one pack, that is better. But is it ever OK for a person to inhale smoke? Likewise, is it OK for a child to experience any repetitive hits to the head?

Even with recent rule changes, children are still hitting their heads repeatedly in the sport. We don’t know if there is a safe number of hits or a threshold above which the risk of altering brain development or other long-term consequences is increased. Simply reducing the number of hits may not be enough to protect a child’s growing brain.

Of course, we aren’t wrapping our kids in bubble wrap, and we will never prevent every hit or concussion. What we can do is remove the hits that are inherent to the game from the youth level. Flag football is a great way for kids to learn about and fall in love with the game, without experiencing repeated brain trauma. Yes, concussions can still happen in flag football. Kids can still experience head impacts if they run into another player or fall to the ground. But the hits aren’t an inherent part of every play.

Football has a strong culture steeped in traditions of heroism and grit. But you don’t have to hit your head repeatedly to learn toughness, teamwork, determination or accountability. We need to ensure kids can reap all of the benefits without sustaining needless damage to their brain. Much more research is needed, but are you willing to risk your child’s brain function for youth tackle football?

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Stamm is a clinical assistant professor in the Department of Kinesiology at UW-Madison and a certified athletic trainer. Her research has focused on the long-term consequences of repeated brain trauma in youth sports, and she is writing a book on this topic: stamm3@wisc.edu and @JulieStammPhD.