Faceguards -
Are they a “suit of armor” or a piece of equipment that makes sense?
The experts weigh in.
Medical and sports organizations and authorities who endorse the use of batting helmets with faceguards include:
Dr. J. James Rohack, President of the American Medical Association, who wrote to Little League President/CEO Stephen Keener in March 2010:
“While some might say that the number of injuries is small to a mother whose son required rehabilitation, that is one injury too many. The Little League should move quickly and without delay, as the new season is upon us, to require the use of athletic helmets with faceguards ...
I look forward to hearing from you regarding this important preventative measure."
According to Dr. Rohack’s office, he is still waiting for a reply.
Dr. Judith Palfrey, the President of the American Academy of Pediatrics, who wrote to Keener in May 2010:
“The American Academy of Pediatrics would like to encourage you to consider revising your policy to mandate batting helmets with faceguards to protect the children’s heads, teeth and eyes.”
Dr. Andrew G. Iwach, the Secretary of Communications for the American Academy of Ophthalmology, who wrote to Keener and Paul Seiler, Executive Director/CEO of USA Baseball in May 2010:
“We ask you to make the following standards mandatory: On-deck batters, batters and base runners are required to wear a batting helmet with a protective faceguard that meets the American Society of Testing and Measurement (ASTM) Standard F910”;
“We ask you to endorse the standards put before you to ensure all children keep their sight for life while playing baseball.”
Dr. E. Anthony Rankin, the President of the American Academy of Orthopaedic Surgeons, who wrote to Seiler in June 2008:
” As President of the American Academy of Orthopaedic Surgeons, I am compelled to write you regarding the use of batting helmets with faceguards as one of the most important ways of reducing injuries in young baseball players”;
“We are the physicians who see the many unnecessary injuries to our children because using helmets with faceguards is not mandatory in Little League and all of the other baseball organizations which are part of youth baseball”;
“On behalf of my orthopaedic surgeon colleagues nationwide, the American Academy of Orthopaedic Surgeons strongly urges USA BASEBALL to prevent injuries, save lives, and require the use of batting helmets with faceguards.”
Hugh R. Perry, President and CEO of Prevent Blindness America, who wrote to Seiler in June 2008:
“Statistics show that 72 percent of sports related eye injuries happen to those ages 25 and younger, yet only 15 percent of children wear protective eyewear. Little League Baseball only required safety bases after an increase of knee and ankle injuries;
What is the magic number, then, of children with head injuries and loss of vision until protective head and face gear are mandatory?”
The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS):
In 1996, the AAFPRS petitioned the Consumer Product Safety Commission (CPSC) to mandate that all youth batting helmets manufactured from that point on require faceguards. 1
Dr. John A. Bogert, Executive Director, The American Academy of Pediatric Dentistry (AAPD):
Fifteen year ago, the Executive Director of the AAPD, Dr. John A. Bogert, stated that the Academy, “Strongly supports the development of a safety standard that would require use of a faceguard on batting helmets for all children participating in baseball, softball and T-ball." 2
He said face guards “are effective, not expensive, and do not compromise vision or airways” and that "to knowingly put children in danger of serious injury when simple affordable devices exist to prevent that injury is cavalier at best.” 3
The AAPD issued an Oral Health Policy statement in 1999. The AAPD stated that faceguards were a piece of equipment deemed critical for reducing the prevalence of oral and facial injuries as well as other bodily injuries in youth sports.
Their policy also stated that certified faceguards should be mandated for boys and girls age 12 and under participating in organized baseball and softball activities.” 4
Dr. James Linakis, Associate Director of Pediatric Emergency Medicine, Hasbro Children’s Hospital, Providence, RI:
“The recommendations regarding face protection cannot be emphasized strongly enough"… "As a pediatric emergency physician, one of the most common baseball injuries that I see is eye injuries from batted or thrown balls, and dental injuries are also quite common. These injuries have the potential of being serious or even permanently disabling, yet they could be easily prevented." 5
Dr Ronald P. Danis, Director, Eye Injury Registry of Indiana and Professor, Department of Ophthalmology and Visual Sciences, Indiana University Medical School:
Danis and colleagues Kuolung Hu of the Department of Psychiatry at the University of Indiana and Mason Bell, a member of the Board of Directors of Prevent Blindness Indiana conducted a scientific study with children using faceguards. It was published in the Injury Prevention Journal in 2000. 6
Danis and the others concluded, “This study implicates another sport, alongside youth ice hockey, American football, and racquet sports, that engenders a significant risk of oculofacial injury. In spite of its availability and apparent acceptability, however, the requisite safety equipment is rarely employed. To foster this measure, it is necessary to further educate coaches regarding the benefits of protective equipment…In addition, league administrators, parents, and coaches should consider mandating these face guards.” 7
Dr. David Hunter, Professor and Vice Chair, Pediatric Ophthalmology and Strabismus, Harvard Medical School, Boston, MA and Ophthalmologist-in-Chief, Children's Hospital, Boston MA:
“Anyone who works in ophthalmology sees cases of sports-related eye injuries. It’s frustrating because they’re almost all preventable.” 8
"Little League is one place we’d really like to see a change. There are some great helmets available with face shields, but peer pressure keeps them from being used. If shields were required, by law or by the league, peer pressure would no longer be an issue. An interesting footnote to this problem is that when kids wear face shields, their batting improves.” 9
Dr. Stephen Bolduc, member, American Academy of Pediatricians' Committee on Sports Medicine:
"There's no question in my mind this equipment, particularly the face mask, will reduce injuries.”10
Dr. Karen DeSafey Liller, Professor, University of South Florida College of Public Health:
“Studies of protective eyewear indicate that polycarbonate lenses provide excellent protection for batters from the risk of being hit in the eye by a pitched ball” 11
“Faceguards are strongly recommended for batters. Two independent studies have indicated that faceguards reduce the risk of facial injury by 23%-35%.”12
Other medical organizations that endorse the use of faceguards on batting helmets include:
The American Academy of Family Physicians
The American Academy of Orthodontics
The American Academy of Otolaryngology-Head and Neck Surgery
The American Association of Oral and Maxillofacial Surgeons
The American Chiropractic Board of Physicians
The American College of Sports Medicine
The American Dental Association
The American Medical Society for Sports Medicine
The American Optometric Association
The American Orthopaedic Society for Sports Medicine
The American Osteopathic Academy of Sports Medicine
The American Public Health Association (Position Statement)
The British Columbia Injury Research and Prevention Unit
The National Eye Institute
The National Institute of Health
The National Society to Prevent Blindness
The Naval Safety Center
The Ontario Injury Prevention Resource Center
The University of Michigan Kellogg Eye Center, affiliated with Little League corporate sponsor,
Kellogg’s Frosted Flakes
The Women and Children’s Hospital of Rhode Island
Dr. Creighton Hale, former President of Little League International and current member, Little League Board of Directors:
Hale was interviewed by ABC news anchor Stone Phillips in 1991. According to the interview, Hale (who was Little League’s President from 1973-1994), wrote in the Journal for Sports Medicine:
“Estimates are that there are 170,000 injuries to the face, eyes and mouth each year. Some sort of facial protection could reduce injuries by 54,000. Little League experience shows us that injuries can be reduced by using face protectors." 13
Twenty eight years ago, when Hale was president, he made four recommendations to reduce injuries in youth baseball - eliminate steel spikes, eliminate sliding or use breakaway bases, eliminate the on-deck circle and use face protectors.
Since that time:
Steel spikes have been eliminated (although rules were redefined by the Little League Congress in 2001 to indicate that Junior and Senior Divisions can wear them.)
Head-first sliding was eliminated in 1996 (for participants 12 years old and under)
Breakaway bases were mandated in 2008, over a quarter century after Dr Hale’s recommendation.
The on-deck circle was eliminated in 1995, only for those 12 and under, despite the fact that Little League did away with the on-deck circle, “When it noticed that more of its players we getting injured while on-deck than anywhere else in the field”, according to an article on the Little League website.
Only one recommendation has yet to been mandated - the use of face protectors.
John Sadler Jr., member, USA Baseball‘s Medical/Safety Advisory Committee and President of Sadler & Company, the endorsed insurance agency for Dixie Baseball:
In 1995, Dixie Youth Baseball League, the second largest youth baseball organization for children ages 6-12 mandated the use of batting helmet faceguards for all their players-approximately 594,000 players in approximately 39,000 teams that year.14
Sadler & Company, the endorsed insurance agency for the Dixie conducted a survey which showed a decrease in injuries as more children wore face guards. According to the study, facial injuries to children playing offensive positions (e.g., batters and base runners) dropped from 5.8% of all injuries in 1994 (when about a third of all players wore face guards) to 0.7% of all injuries in 1995 (when face guards were required of all players.) 15
In 1996, Sadler wrote a letter to the CPSC to support mandating faceguards for all new batting helmets manufactured for children under the age of 15.
Sadler’s letter said, in part:
“On behalf of Dixie Youth Baseball I believe that the numbers justify that mandating the batter’s faceguard was a wise decision that will protect our youth for many years to come.
In addition, it must be remembered that a facial injury has the potential to be much more severe than the average baseball injury, and as a result, the protection provided by the batter’s faceguard is even more impressive.” 16
On his website’s safety blog, Sadler has said that batting helmets with faceguards are almost 99% effective in preventing injury.17
Wes Skelton, Commissioner, Dixie Youth Baseball, Inc. (The second largest youth baseball organization in the world):
“We did see a significant drop in insurance rates at that time (1995) but more importantly we completely eliminated facial injuries caused by thrown balls. Dixie Boys also adopted a face guard requirement for ages thirteen-fourteen only.
This is our 14th consecutive year to require face guards and we believe it has saved hundreds of kids from serious injury”, Skelton said. There are approximately 300,000 players in the Dixie Youth Baseball programs.18
Mike Oliver, Executive Director, National Operating Committee on Standards for Athletic Equipment (NOCSAE):
“In the grand scheme of things, the chance of being hit by a thrown ball is relatively low,…but in this case, the cost of protection is also low — a face guard costs about as much as a single batting helmet [around $27] — so it’s probably worth the expense.” 19
For those with concerns about faceguards causing injuries when players slide or run bases, there isn’t any statistical evidence that indicates that, Oliver said “Look at other sports,” he says. “You don’t see injuries occurring in football from players’ facemasks latching onto the ground or other players.” 20
USA Baseball, designated by Congress in 1978 to be the governing body for the sport of baseball:
Nearly every major national amateur baseball organization in America is a member of USA Baseball.
USA Baseball’s Medical/Safety Advisory Committee asked scientists at the University of North Carolina’s (UNC) Injury Prevention Research Center to conduct a study to determine if certain safety equipment, including faceguards, reduced the risk of injury in youth baseball. 27
Primary researcher Dr. Stephen W. Marshall said, “Little League Baseball, which was highly supportive, shared with us extensive data they had on injuries compensated by insurance…
Faceguards reduced the risk of facial injuries by 35 percent." 28
The study involved analyzing injury information resulting from three years, or more than 6.7 million "player-seasons," of Little League participation. It was the largest and most comprehensive study of its kind ever done.29 The study was published in the Journal of the American Medical Association in 2003. 30
Assisting Marshall were principal study investigator Dr. Frederick Mueller, Professor and Chair of Exercise and Sport Science at UNC and current chairman of USA Baseball’s Medical/Safety Advisory Committee. He is also the director of the National Center for Catastrophic Sports Injuries.
Other study researchers/authors were Health Behavior and health education doctoral student Jingzhen Yang of UNC and Daniel P. Kirby, Director of Risk Management, Little League Inc. 31
Richard Hilton, coach, Little League World Series championship team, 1983:
Hilton coached the East Marietta, GA team. He said his team improved its home run performance, from an average of 20 a season to 65 the first year its players used faceguards. All batters and base coaches used faceguards and their players won the Little League World Series in 1983. 32
The South Shore All Stars, Little League World Series quarter finalists, 2009:
The members of the Staten Island, NY team used faceguards all season, including when they played in the Little League World Series.
Little League approved the use of batting helmets with faceguards over 30 years ago.
They still consider them optional equipment, even though they have been proven to reduce injuries by studies, users, medical and sports experts.
They are already required by the second largest youth baseball organization in the world and have been used by teams going all the way to the Little League World Series.
They are comparably priced to standard batting helmets 33 and they protect children from needless facial, oral and eye injuries.
The time to require faceguards for players 12 and under is here.
Mr. Keener, what are you waiting for?
Sources:
[1] CPSC Petition HP 95-1, dated December 18, 1996, http://www.cpsc.gov/
[2] AAPD letter to Consumer Product Safety Commission (CPSC), August 6, 1996
[3] IBID
[4] American Academy of Pediatric Dentistry Policy Statement, Prevention of Sports–Related Injuries, Revised 05/99
[5] Dotinga, R., (2008, June 5), Batted Balls Threaten High School Baseball Players, The Washington Post
[6] Danis, RP et al, (2000). Acceptability of baseball face guards and reduction of oculofacial injury in receptive youth
league players. Injury Prevention 2000; 6:232–234
[7] IBID
[8] Author not provided, (2003, June 8), Ralph Nader and League of Fans Call for Federal Government-led Advancement in Prevention of Sports Injuries, Leagueoffans.org.
[9] IBID
[10] Cimons, M., (1996, June 16), Agency Recommends Softer Ball For Youth Baseball - Changes Would Reduce Injuries, Says Commission, The Los Angeles Times
[11] DeSafey Liller, K. (Ed.). (2006). Injury Prevention for Children and Adolescents: Research, Practice and Advocacy.
Washington, DC: American Public Health Association.
[12] IBID
[13] ABC news anchor Stone Phillips interview with Creighton Hale, television show ‘20/20.’ According to Phillips, Hale wrote an article in the 1979 Journal of Sports Medicine from which the quotes were obtained.
[14] Consumer Product Safety Commission Safety Review Summer 1996 Volume 1 Number 1
[15] IBID
[16] CPSC Petition HP 95-1, dated December 18, 1996, http://www.cpsc.gov/
[17] Sadlersports.com website, January 2009 safety blog
[18] Personal email from Wes Skelton, Commissioner of Dixie Baseball, dated August 13, 2008
[19] Conklin, A, (1998, July), Saved? Athletic Business Journal p.66
[20] IBID
[21] Little League safety newsletter As Safe As Possible (ASAP), July 2005, Vol. 12 #3
[22] IBID
[23] IBID
[24] Little League safety newsletter, ASAP, Feb./March 2006, Vol. 13 #2
[25] Little League safety newsletter, ASAP, Feb. 2007, Vol. 14 #1
[26] Little League safety newsletter, ASAP, July 2008, Vol.15, # 5
[27] Williamson, D (2003, Feb 4), Study Shows Safety Balls, Faceguards Cut Number of Little League Injuries, UNC News Services
[28] IBID
[29] IBID
[30] Marshall, SW; Mueller, FO; Kirby, DP; Yang, J, Evaluation of Safety Balls and Faceguards for Prevention of Injuries in Youth Baseball JAMA. 2003;289:568-574
[31] IBID
[32] Brody, J. (1993, April 14)), Personal Health, the New York Times
[33] Dick’s Sporting Goods (Little League corporate sponsor) website, www.dickssportinggoods.com
