In at least three states, the high school football season got off to a tragic and troubling start last week: Alabama, West Virginia and California.

On Friday, 16-year-old high school quarterback Caden Tellier was tackled in the third quarter of the John T. Morgan Academy’s home opener in Selma, Alabama. School officials announced Saturday that Tellier died from complications of a critical brain injury.

In West Virginia, 13-year-old middle school student Cohen Craddock was hospitalized Friday after suffering a head injury that caused brain swelling during a team practice. Doctors said he died at the hospital Saturday.

Two Xavier Prep players suffered serious head injuries during a football game Friday night at Coachella Valley High School in California. One was flown by helicopter to a Moreno Valley hospital and the other was pushed away on a stretcher. Both Xavier Prep players are expected to recover from their injuries.

Football deaths are a rare event, according to data from the National Center for Catastrophic Sport Injury Research. But researchers warn that tackle football and a cluster of blows to the head at a young age can significantly increase the risk of long-term cognitive damage.

Here’s a look at some of the data:

In 2023, there were 16 deaths among college, high school, middle school, and youth league football players in the United States, according to the National Center for Catastrophic Sport Injury Research. Of those 16 deaths, three were due to traumatic brain injuries that occurred during games. In 2022, there were three football-related deaths due to traumatic brain injuries among high school players.

What is a traumatic brain injury (TBI)?

“A TBI can be caused by a violent impact, blow, or jolt to the head or body, or by an object penetrating the brain. Not all blows or jolts to the head result in a TBI,” according to the National Institute of Neurological Disorders and Stroke.

There are two types of TBI. One is a closed brain injury, which occurs when nothing penetrates the skull or brain. It is usually caused by a rapid forward or backward motion that causes the brain to move within the skull. According to Johns Hopkins Medicine, “this results in bruising and tearing of the brain tissue and blood vessels.”

The other is a penetrating brain injury, which occurs when the skull fractures, such as when a bullet pierces the brain.

A degenerative brain disease called chronic traumatic encephalopathy (CTE) can result from repeated traumatic brain injuries.

A Boston University study of CTE in National Football League players found that about 92% of 376 former NFL players whose brains were examined postmortem suffered from CTE.

The disease is also associated with other contact and collision sports such as boxing, football, ice hockey and rugby. CTE is linked to a variety of cognitive problems, including memory loss, depression, early-onset dementia and suicidality.

Read more: Will Guardian Caps solve football’s concussion problem? The NFL is trying.

While the NFL study made headlines, it was discovered that college and high school players are also affected by CTE.

Further research from Boston University School of Medicine has shown that repeated blows to the head, even if they do not result in a concussion, can cause CTE. For every year that a player experiences repeated head collisions, his risk of developing CTE increases by 30%. Every 2.6 years, the risk of developing CTE doubles, according to Boston University researchers.

So if a child starts playing football at age 5, they are ten times more likely to develop CTE than children who start at age 14.

This data has led many families to weigh the risks and benefits associated with exercise – and to consider alternatives.

The alternatives

“A collision or contact sport does not mean that that collision or contact has to involve the head,” Dr. Allen Sills, chief medical officer for the National Football League, told CNN in 2023. “You can play a sport where there is contact between or among players, but we should try to keep the head out of that contact whenever possible.”

The NFL recently implemented changes to its kickoff rules for the 2024-25 season. Players will have the option to wear Guardian Caps to reduce concussions and minimize head contact. In 2018, the NFL banned players from lowering their heads to make forceful contact with their helmet.

In college football, the National Collegiate Athletic Association (NCAA) has similar rules. The 2023 NCAA rulebook states that if a player makes “forcible contact with the helmet, forearm, hand, fist, elbow or shoulder to the head or neck area of ​​a defenseless opponent,” that player should be penalized.

And youth football leagues have made some changes to reduce the risk of head injuries, such as limiting practice time for contact drills. Although no state has banned tackle football for youth outright, efforts have been made to do so, such as when California considered a bill to ban tackle football for children under 12.

The Centers for Disease Control and Prevention also offers suggestions for minimizing head injuries in football, such as reducing the number of physical contact drills to reduce head impacts in football. The agency also offers flag football as an alternative to tackle football for young players after a CDC study found that tackle athletes ages 6 to 14 suffered 15 times more head impacts during a practice or game than flag football players, a sport with little physical contact.

The CDC study found that young tackle football players suffered an average of 378 head impacts per player over the course of a single season, compared to eight head impacts for flag football athletes.

The American Academy of Pediatrics (AAP) addressed concerns raised by experts that if tackling was introduced at a later age, such as 14, athletes would be less prepared and would suffer serious injuries.

“If policies are introduced to delay tackling until a certain age, they must be accompanied by coaches who provide instruction in correct tackling technique and the skills necessary to avoid and absorb tackles,” the AAP said in a policy statement on tackling in youth football.