Background: Football (soccer) is the most popular sports in children and adolescents worldwide. While it has been embraced as a low-risk-for-injury sport, discussions about potential long-term effects have emerged. As part of a legal settlement, the US Soccer Federation has issued a ban for heading in children aged 10 years and younger in 2015. Purpose: What is the scientific evidence for this decision and should other countries adapt it? Main findings: When reviewing the literature, it becomes evident that data on acute/persistent effects of heading and head-related injuries is inconclusive and hampered by limitations. These include recall biases, flaws in statistical analyses and inappropriate assessments of heading-frequency and head-injuries - mainly performed retrospectively via questionnaires. Epidemiologic data indicates that the majority of head-injuries is due to contact with other players (35-75%) followed by surfaces/objects (13-32%) and ball-contact (20-30%). Conclusions: Overall, current evidence seems insufficient to support a ban of heading in children`s football. Until more solid data is available, heading should not be started before children confirm to be ready to do so. Then, heading should be introduced stepwise and controlled using structured heading training focusing on technical aspects. Whether this should be at age 11 years or earlier needs to be determined.
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