Currently viewing the tag: "tackle football"
WHY DID THE AMERICAN ACADEMY OF PEDIATRICS CHANGE THEIR VERY CLEAR OFFICIAL 1950’S POLICY AGAINST TACKLE FOOTBALL FOR KIDS UNDER 13 TO ITS CURRENT 2015 POLICY SUPPORTING YOUTH TACKLE?


In the 1950’s, the American Academy of Pediatrics had a clear policy concerned youth contact sports such as tackle football, boxing, and hockey. The AAP policy stated that these high risk sports had “no place in programs” for kids 12 & under —  and this in a time when sporting activities for kids included Lawn Jarts, backyard pool diving boards and free-fall trampolines — activities which today would completely freak out the current generation of parents. 

Over the last 65 years, a new law banned the Jart, insurance rates ended backyard diving boards and the firm policy of the AAP lead to adding nets to trampolines. Also in this same time frameAAP’s revised their policies (which are in effect for five years at a time) towards these three contact sports for youth with three completely different approaches. Any statement issued by AAP over the last 65 years as held to opposition to youth boxing, while it’s policy from hockey changed from opposed to a youth game to approving the sport with limiting checking for players 15 years of age and younger. 

But the one sport were there has been a completely reversal of policy — the one complete outlier in AAP’s policy in youth contact sports – is youth tackle football.

When the AAP felt youth tackle football had “no place in programs for kids” in the 50’s; now in 2015,this is a game so sacred to our society that while, modifying “would likely lead to a decrease in the incidence of overall injuries, severe injuries, catastrophic injuries, and concussions” the AAP cannot recommend limiting tackle for young children as “the removal of tackling from football would lead to a fundamental change in the way the game is played.”

And unlike the cases of boxing and hockey where the AAP had taken a clear stand to inform parents of the risks, in the case of football, children and their parents must decide the health risk of football injuries themselves against the benefits of the game if tackle is conducted in the “proper way.” 
“Removing tackling from football altogether would likely lead to a decrease in the incidence of overall injuries, severe injuries, catastrophic injuries, and concussions. The American Academy of Pediatrics recognizes, however, that the removal of tackling from football would lead to a fundamental change in the way the game is played. Participants in football must decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling”. 2015 AAP Report
 
 

AAP Policy towards Youth Boxing

The AAP has had a very clear policy in its opposition to youth boxing in effect for 20 of the last 65 years with 2015 policy in place for the next five years until 2020.
1953  AAP policy spoke at conference —  “opposed to boxing”
1957 expires 1962  Statement of Policy by the AAP — “boxing has no place”
1968 expires 1973  Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by AAP   “Boxing has no place in programs for children”
 
Gap of 24 years
 
1997 expires 2002  January 1997 “Vigorously oppose boxing as a sport for any child, adolescent, or young adult” + educate patient + suggest alternative sports
2011 expires 2015  September 2011  Revised – the three recommendations above plus “appropriate medical care is provided for children and adolescents who choose to participate in boxing, ideally including medical coverage at events, preparticipation medical examinations, and regular neurocognitive testing and ophthalmologic examinations.”
2015 expires 2020  June 2015 Reaffirms 2011 Policy


TIMELINE OF AAP POLICY and Contact Sports

AAP Policy towards Youth Hockey

The AAP has also had a clear policy in its opposition to youth hockey in effect for 15 years from 1953 to 1968, then it modified this policy only if a “school or community only could provide exemplary supervision medical and educational.” And for the last 16 years, 2000 to 2017, AAP policy has firmly recommended limiting checking in hockey players 15 years of age and younger.
 
1953  AAP Policy at conference —  “opposed to hockey”
1957 expires 1962  Statement of Policy by the AAP — 
1968 expires 1973  Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by AAP   Hockey along with other sports – “ Unless a school or community can provide exemplary supervision medical and educational it should not undertake a program of competitive sports, especially collision sports, at the pre-adolescent level.”
 
Gap of 27 years
 
2000 expires 2005 Pediatrics. 2000 The American Academy of Pediatrics recommends limiting checking in hockey players 15 years of age and younger as a means to reduce injuries
2014 expires 2019   However, because of ongoing concerns that a high number and proportion of boys’ ice hockey injuries are attributable to body checking, the AAP has elected to reassess its 2000 recommendation that “body checking should not be allowed in youth hockey for children age 15 years or younger.” — In the continued interest of promoting boys’ youth ice hockey as a safe, lifelong recreational pursuit, the AAP recommends: Expansion of nonchecking programs for boys aged 15 years and older. Pediatricians should advocate for development of these programs in their communities and encourage their patients to participate in them.

 

AAP Policy towards Youth Football

Over the last 65 years, the AAP was clear on opposing youth tackle football, modified its opposition and then after a gap of 43 of no officially policy, completely flip-flopped its football to letting parents decide the risks. This new policy is now in place for the next five years until 2020.
1953  Quote at conference —  “opposed to football”
1957 expires 1962  Statement of Policy by the AAP — “football has no place”
1968 expires 1973 Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by AAP   Football along with other sports – “ Unless a school or community can provide exemplary supervision medical and educational it should not undertake a program of competitive sports, especially collision sports, at the pre-adolescent level.”
 
Gap of 43 years
 
2015-2020 2015 AAP Statement on Tackle Football – Children and parents left to decide the risks vs benefits if played properly.     


How the AAP Policy on Contact Youth Sports evolved based Source Documents from AAP website and in public record

The first reference to the AAP and youth football, boxing and hockey was found in a newspaper article from 1953, with a quote from a doctor representing the AAP at two-day conference at the National Education Association: (Sources are all listed at the end of this post):
Strongly opposed to tackle football, boxing and ice hockey and other contact sports was Dr. George Maksim, representing the American Academy of Pediatrics. “Children under 13 aren’t mature enough for such sports,” Dr. Maksi said, “and the risk of permanent bone and joint injuries is just too great.”
In the 1957’s Statement of Policy by the AAP, the AAP’s position on youth tackle football and boxing was also very clear:
1957-page-2-e1458913280547.jpeg
1957-Page-3-e1458913239850.jpeg

In 1968-1973, a Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by American Academy of Pediatrics which held to the probation for boxing. There was an allowence for contact sports including football and hockey but with several caveats, a discussion of risk and a number of high standards to be met. 

Boxing has no place in programs for children of this age because its goal is injury and the educational benefits attributed to it can be realized through other sports. Sports with varying degrees of collision risk include baseball, basketball, football, hockey, soccer, softball, and wrestling. The hazards of such competition are debatable. The risks are usually associated with the conditions under which practice and play are conducted and the quality of supervision affecting the participants. Unless a school or community can provide exemplary supervision, medical and educational, it should not undertake a program of competitive sports, especially collision sports, at the pre-adolescent level.
From this point on there would be a 24 year gap in policy towards boxing, 27 year gap towards hockey and a 43 year gap before a policy towards football would be announced.
 

AAP BOXING POLICY

 
In the official 1997 Statement, the AAP was still “vigorously opposed” boxing for youth; and officially, states in Pediatrics January 1997, VOLUME 99 / ISSUE 1, a policy would stay in effect until 2002:
The American Academy of Pediatrics recommended that pediatricians:
  1. Vigorously oppose boxing as a sport for any child, adolescent, or young adult
  2. Educate “at risk” patients about the medical risks of boxing and provide information that supports the Academy’s opposition to the sport; and
  3. Encourage young athletes to participate in sports in which intentional head injury is not the primary objective.
The 2011 AAP Policy (2011-2015) was revised to keep the three recommendations from 1997, above plus “appropriate medical care is provided for children and adolescents who choose to participate in boxing, ideally including medical coverage at events, preparticipation medical examinations, and regular neurocognitive testing and ophthalmologic examinations.”
In 2015, the AAP did not let their policy on boxing lapse, and with the 2015 AAP Policy, they reaffirmed their 2011 Policy.
 

AAP HOCKEY POLICY

 
After a gap of 27 years, in 2000, The American Academy of Pediatrics recommended in Pediatrics limiting checking in hockey players 15 years of age and younger as a means to reduce injuries. This policy would expire in 2005.
 
In 2014, AAP Policy (2014-2019) because of ongoing concerns that a high number and proportion of boys’ ice hockey injuries are attributable to body checking, the AAP has elected to reassess its 2000 recommendation that 
 
“body checking should not be allowed in youth hockey for children age 15 years or younger.” — In the continued interest of promoting boys’ youth ice hockey as a safe, lifelong recreational pursuit, the AAP recommends: Expansion of nonchecking programs for boys aged 15 years and older. Pediatricians should advocate for development of these programs in their communities and encourage their patients to participate in them.
 

AAP TRAMPOLINE POLICY

 

On a side note, in 1999, the AAP’s issued a stern policy on Youth and Trampolines for parents, parks and schools after a high number of injuries and six deaths over a 9 year period. 

83,400 trampoline-related injuries occurred in 1996 in the United States… supports the American Academy of Pediatrics’ reaffirmation of its recommendation that trampolines should never be used in the home environment, in routine physical education classes, or in outdoor playgrounds… Since 1990, the CPSC has received reports of six deaths involving trampolines. Victims ranged in age from 3 years through 21 years, although the 21-year-old died 6 years after being injured on a trampolineCatastrophic cervical spine injuries are rare. However, head and neck injuries constitute a notable number of the more serious injuries requiring hospitalization…

AAP RECOMMENDATIONS

Despite all currently available measures to prevent injury, the potential for serious injury while using a trampoline remains.The need for supervision and trained personnel at all times makes home use extremely unwise.

  1. The trampoline should not be used at home, inside or outside. During anticipatory guidance, pediatricians should advise parents never to purchase a home trampoline or allow children to use home trampolines.
  2. The trampoline should not be part of routine physical education classes in schools.
  3. The trampoline has no place in outdoor playgrounds and should never be regarded as play equipment.

 

AAP YOUTH TACKLE FOOTBALL POLICY

 
While there are a number of studies and discussion listed in the AAP over the years on youth tackle football, there is not any official AAP policy towards tackle football from and the librarian at the AAP was not able to locate any additional policies. AAP policies expire after five years and so after 1973, the 1968 Policy Statement on Competitive Athletics for Children of Elementary School Age would no longer be in effect.
 
After what seems to be a gap of 43 years, in 2105, with the NFL lawsuit and scientific evidence pointing to brain injury in pro players, the AAP’s response to the controversy around youth tackle football was the publication of an official statement, several blog posts and a video:

The findings of the report can be summarized in this quote from the report itself:

 
“Removing tackling from football altogether would likely lead to a decrease in the incidence of overall injuries, severe injuries, catastrophic injuries, and concussions. The American Academy of Pediatrics recognizes, however, that the removal of tackling from football would lead to a fundamental change in the way the game is played. Participants in football must decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling.” 2015 AAP Report
 
The AAP clearly leaves everyone else on the hook to decide. Are children left to decide for themselves? Parents? Coaches? And further more the AAP implies there is a “proper” way to tackle… How do we know? What independent research has been done? 
In the comment section under AAP statement in Dec 2015, was a single comment – a reply from by Lewis H. MargolisAssociate Professor of Maternal and Child Health, University of North Carolina, Gillings School of Global Public Health, in which he asks of pediatricans, “Whatever Happened to First Do No Harm?” 
 
In his post, Marigolis points out the irony in an official report by the AAP, that parents, not doctors, are asked to weigh the risks for their children to play tackle based on the uncertain, flimsy data which is stated is unclear, even to top medical experts.
 
Marigolis points out how in the hemming and hawing of the report he counted: 
… over 40 uses of terms like “unclear,” “unknown,” “limited,” and “without scientific basis” in the statement, which, while adequately reflecting the state of an uncertain literature, do not support evidence-based recommendations.
The key problem with the AAP report is the concept of:
Advising parents to “decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling” undermines the concept of empowerment, because of the absence of information.
Then he cuts to the chase to pose the question: 
Until those [safety] questions are answered through rigorous research, pediatricians should advance primum non nocere, “first do no harm,” by advocating for the end of youth football.
  • 30 November 2015  — Whatever Happened to First Do No Harm?
    • Lewis H. MargolisAssociate Professor of Maternal and Child HealthUniversity of North Carolina, Gillings School of Global Public Health

    The Council on Sports Medicine and Fitness policy statement, Tackling and Youth Football, assures that many young athletes will suffer debilitating brain injuries.1 As the Council acknowledges, little is known about tackling per se, so that a statement limited to tackling is misleading about the risks of football where the risk of concussion is greater than for any other sport.2 Further, football participation dwarfs other sports, so this one sport contributes 60% or more of sport-related concussions in high school.3 Dompier et al. estimate that 99,000 youth players experience at least one concussion annually.4 These facts alone should raise questions about our culture’s willingness to tolerate, not to mention encourage, this cause of harm. Add to this the acknowledgement by experts that we are as yet ignorant of the long-term consequences of concussions. Meehan notes that “medicine has not figured out how many concussions is too many. And in fact, it is likely no such number exists.”5(p.125)

    The evidence supporting the effectiveness of the recommendations is meager. Indeed, there are over 40 uses of terms like “unclear,” “unknown,” “limited,” and “without scientific basis” in the statement, which, while adequately reflecting the state of an uncertain literature, do not support evidence-based recommendations.

    It is important for pediatricians to empower parents and their young potential football players. Advising parents to “decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling”1(p.e1426) undermines the concept of empowerment, because of the absence of information. If parents wanted to make an evidence-based choice, to whom would they turn other than pediatricians? And yet, the Council advises that “participants in football must decide whether the potential risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling.”1(p.e1426)

    Perhaps the millions of dollars being devoted to the diagnosis, acute treatment, and long-term management of concussions will help us answer questions like “can we end tackling?” and “can we make tackling safer?” Until those questions are answered through rigorous research, pediatricians should advance primum non nocere, first do no harm, by advocating for the end of youth football.

    1. COUNCIL ON SPORTS MEDICINE AND FITNESS. Tackling in youth football. Pediatrics. 2015;136(5):e1419-30. doi: 10.1542/peds.2015-3282 [doi].
    2. Institute of Medicine (IOM) and National Research Council (NRC). Sports-related concussions in youth: Improving the science, changing the culture. Washington, DC: The National Academies Press; 2013.
    3. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among united states high school and collegiate athletes. J Athl Train. 2007;42(4):495-503.
    4. Dompier TP, Kerr ZY, Marshall SW, et al. Incidence of concussion during practice and games in youth, high school, and collegiate American football players. JAMA Pediatr. 2015;169:659-665.
    5. Meehan WP. Kids, sports, and concussions. Santa Barbara, CA: Praeger; 2011.

The 2015 AAP report leaves so many questions unanswered, and one must look at the conclusions and wonder how is a parent to know the risks for their children if the doctors cannot take a stand as they clearly did with boxing and football and even trampolines. Should youth sports organizations who operate without any government oversight calculate risks and do their own research? And in the end, do parents, players, sports organizations, the AAP or the government have responsibly to make the call?

  • Who is responsible to collect the data on injury rates for youth sports or any activities for children ?
  • Who is responsible to inform parents of risks in sports without any alternative motive?
  • Who is responsible to determine safety claims like the new “safe tackle football” proposed by HeadsUp Tackling is a scientifically valid or just a recycling PR concept tried in past decades?
Doctors, parents, kids? The AAP clearly avoids their responsibility they felt so clearly with other contact sports.

CONCLUSION

This is America, and within the law, parents have the freedom to chose what sports their children play and decide what risks they take. But how is a parent to know the risk of injury in any particular sport for their child? 

Parents have always looked towards their pediatricians for health information about their children, and the AAP is the source of policy for these doctors. Over the last 65 years, the American Academy of Pediatrics been clear on its position against boxing, has had modified position to support hockey with no checking U15, but completely reversed it’s policy against to supporting tackle football without a modification for younger children. 

Now with NFL research determined to be flawed, what guarantee is there that injury risk in tackle football for youth been honestly portrayed for parents? The same parents who have been left by the AAP to make those life-changing decisions for their children. 


Source documents

Boxing

AAP Policy in Reference to Boxing
1953 – a quote from a doctor representing the AAP at two-day conference at the National Education Association:
Strongly opposed to tackle football, boxing and ice hockey and other contact sports was Dr. George Maksim, representing the American Academy of Pediatrics. “Children under 13 aren’t mature enough for such sports,” Dr. Maksi said, “and the risk of permanent bone and joint injuries is just too great.”
 
 1957 –  Statement of Policy by the AAP, the AAP’s position on Youth Tackle Football was also very clear:
1957-page-2-e1458913280547.jpeg
1957-Page-3-e1458913239850.jpeg

1968 –  a Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by American Academy of Pediatrics:

Boxing has no place in programs for children of this age because its goal is injury and the educational benefits attributed to it can be realized through other sports. Sports with varying degrees of collision risk include baseball, basketball, football, hockey, soccer, softball, and wrestling. The hazards of such competition are debatable. The risks are usually associated with the conditions under which practice and play are conducted and the quality of supervision affecting the participants. Unless a school or community can provide exemplary supervision medical and educational it should not undertake a program of competitive sports, especially collision sports, at the pre-adolescent level.
 
1997

This Policy Is A Revision Of The Policy In

Participation in Boxing by Children, Adolescents, and Young Adults

Committee on Sports Medicine and Fitness

The overall risk of injury in amateur boxing is actually lower than in some other collision sports such as football, rugby, and ice hockey. However, as opponents of boxing have emphasized, boxing is the only sport where direct blows to the head are rewarded and the ultimate victory may be to render the opponent senseless. Participants in boxing are at risk for dementia pugilistica, a chronic encephalopathy caused by the cumulative effects of multiple subconcussive blows to the head. Numerous studies of professional boxers document this hazard and its potentially devastating consequences on long-term health.2,4-

RECOMMENDATIONS

The American Academy of Pediatrics recommends that pediatricians:

  1. Vigorously oppose boxing as a sport for any child, adolescent, or young adult;

  2. Educate “at risk” patients about the medical risks of boxing and provide information that supports the Academy’s opposition to the sport; and

  3. Encourage young athletes to participate in sports in which intentional head injury is not the primary objective.

2011

This Policy Is A Reaffirmation Of The Policy Posted

From the American Academy of Pediatrics

Policy Statement

Boxing Participation by Children and Adolescents

AMERICAN ACADEMY OF PEDIATRICS, COUNCIL ON SPORTS MEDI

Abstract

Thousands of boys and girls younger than 19 years participate in boxing in North America. Although boxing provides benefits for participants, including exercise, self-discipline, and self-confidence, the sport of boxing encourages and rewards deliberate blows to the head and face. Participants in boxing are at risk of head, face, and neck injuries, including chronic and even fatal neurologic injuries. Concussions are one of the most common injuries that occur with boxing. Because of the risk of head and facial injuries, the American Academy of Pediatrics and the Canadian Paediatric Society oppose boxing as a sport for children and adolescents. These organizations recommend that physicians vigorously oppose boxing in youth and encourage patients to participate in alternative sports in which intentional head blows are not central to the sport.

INTRODUCTION

Amateur or Olympic-style boxing is a collision sport that is won on the basis of the number of clean punches landed successfully on an opponent’s head and body (Appendix).1,2 A match is won outright if an opponent is knocked out. Participants in boxing are at risk of serious neurologic and facial injuries.3,,7 Despite these potential dangers, thousands of boys and girls participate in boxing in North America. In 2008, more than 18 000 youths younger than 19 years were registered with USA Boxing (Lynette Smith, USA Boxing, written communication, August 2009).

The societal debate regarding boxing has raged for decades. Many authors and medical organizations have called for boxing to be banned (Table 1), citing medical, ethical, legal, and moral arguments.8,,13 Others state that participants should be allowed to make autonomous decisions about participation and that the role of the medical profession should be restricted to the provision of injury care, advice, and information only.14

TABLE 1

Position Statements on Boxing

Organization Position
American Medical Association9(2007) Recommends that until boxing is banned, head blows should be prohibited
American Academy of Pediatrics8(1997) Opposes boxing as a sport for any child, adolescent, or young adult
Australian Medical Association10(2007) Opposes all forms of boxing; recommends the prohibition of all forms of boxing for people younger than 18 y
British Medical Association11(2007) Opposes amateur and professional boxing; calls for complete ban on boxing; recommends banning boxing for those younger than 16 y
Canadian Medical Association12(2002) Recommends that all boxing be banned in Canada
World Medical Association13(2005) Recommends that boxing be banned

 

Supporters of amateur boxing state that the sport is beneficial to participants by providing exercise, self-discipline, self-confidence, character development, structure, work ethic, and friendships.14 For some disadvantaged youth, boxing is a preferential alternative to gang-related activity, providing supervision, structure, and goals.14 The overall risk of injury in amateur boxing seems to be lower than15 in some other collision sports such as football, ice hockey, wrestling, and soccer.4,16 However, unlike these other collision sports, boxing encourages and rewards direct blows to the head and face.

The American Academy of Pediatrics and the Canadian Paediatric Society oppose boxing and, in particular, discourage participation by children and adolescents.8

CONCLUSION

Despite the ongoing debate regarding boxing and clear opposition from medical associations around the world (Table 1),8,9,,13 boxing continues to be available to youths under 19 years. Because the sport encourages deliberate blows to the head, participants are at risk of head injuries that may be cumulative and even fatal. Pediatricians should strongly discourage boxing participation among their patients and guide them toward alternative sport and recreational activities that do not encourage intentional head injuries. For those youth who, despite education and counseling, choose to participate in boxing, appropriate medical care should be ensured by boxing organizations, including medical coverage at events, preparticipation medical examinations, and regular neurocognitive and ophthalmologic screening examinations, which should be provided by physicians who are knowledgeable about common boxing injuries and appropriate RTP guidelines after any injury.

RECOMMENDATIONS

The American Academy of Pediatrics and the Canadian Paediatric Society recommend that pediatricians:

  1. vigorously oppose boxing for any child or adolescent.

  2. educate patients who may be engaged in or considering engaging in boxing, as well as parents/caregivers/teachers/coaches, regarding the medical risks of boxing.

  3. encourage young athletes to participate in alternative sports in which intentional blows to the head are not central to the sport, such as swimming, tennis, basketball, and volleyball.

  4. advocate that boxing organizations ensure that appropriate medical care is provided for children and adolescents who choose to participate in boxing, ideally including medical coverage at events, preparticipation medical examinations, and regular neurocognitive testing and ophthalmologic examinations.

 
2015
From the American Academy of Pediatrics

Policy Statement

AAP Publications Reaffirmed or Retired

Policy Statement: Boxing Participation by Children and Adolescents. Pediatrics. 2011;128(3):617–623. Reaffirmed February 2015

 

AAP Policy in Reference to Hockey

 
1953 – a quote from a doctor representing the AAP at two-day conference at the National Education Association:
Strongly opposed to tackle football, boxing and ice hockey and other contact sports was Dr. George Maksim, representing the American Academy of Pediatrics. “Children under 13 aren’t mature enough for such sports,” Dr. Maksi said, “and the risk of permanent bone and joint injuries is just too great.”
_________________________________________________________________________________________
 
 1957 –  Statement of Policy by the AAP, the AAP’s position on Youth Tackle Football was also very clear:
1957-page-2-e1458913280547.jpeg
1957-Page-3-e1458913239850.jpeg

1968 –  a Policy Statement on Competitive Athletics for Children of Elementary School Age was approved by American Academy of Pediatrics:

Boxing has no place in programs for children of this age because its goal is injury and the educational benefits attributed to it can be realized through other sports. Sports with varying degrees of collision risk include baseball, basketball, football, hockey, soccer, softball, and wrestling. The hazards of such competition are debatable. The risks are usually associated with the conditions under which practice and play are conducted and the quality of supervision affecting the participants. Unless a school or community can provide exemplary supervision medical and educational it should not undertake a program of competitive sports, especially collision sports, at the pre-adolescent level.
1997

This Policy Is A Revision Of The Policy In

Participation in Boxing by Children, Adolescents, and Young Adults

Committee on Sports Medicine and Fitness

The overall risk of injury in amateur boxing is actually lower than in some other collision sports such as football, rugby, and ice hockey. However, as opponents of boxing have emphasized, boxing is the only sport where direct blows to the head are rewarded and the ultimate victory may be to render the opponent senseless. Participants in boxing are at risk for dementia pugilistica, a chronic encephalopathy caused by the cumulative effects of multiple subconcussive blows to the head. Numerous studies of professional boxers document this hazard and its potentially devastating consequences on long-term health.2,4-

 
Supporters of amateur boxing state that the sport is beneficial to participants by providing exercise, self-discipline, self-confidence, character development, structure, work ethic, and friendships.14 For some disadvantaged youth, boxing is a preferential alternative to gang-related activity, providing supervision, structure, and goals.14 The overall risk of injury in amateur boxing seems to be lower than15 in some other collision sports such as football, ice hockey, wrestling, and soccer.4,16 However, unlike these other collision sports, boxing encourages and rewards direct blows to the head and face.
 
 

The American Academy of Pediatrics and the Canadian Paediatric Society oppose boxing and, in particular, discourage participation by children and adolescents.8

Pediatrics. 2000 Mar;105(3 Pt 1):657-8.
 

Safety in youth ice hockey: the effects of body checking. American Academy of Pediatrics. Committee on Sports Medicine and Fitness.

[No authors listed]

Abstract

Ice hockey is a sport enjoyed by many young people. The occurrence of injury can offset what may otherwise be a positive experience. A high proportion of injuries in hockey appear to result from intentional body contact or the practice of checking. The American Academy of Pediatrics recommends limiting checking in hockey players 15 years of age and younger as a means to reduce injuries. Strategies such as the fair play concept can also help decrease injuries that result from penalties or unnecessary contact.
PMID:
10699128
[PubMed – indexed for MEDLINE]
From the American Academy of Pediatrics

Policy Statement

Reducing Injury Risk From Body Checking in Boys’ Youth Ice Hockey

COUNCIL ON SPORTS MEDICINE AND FITNESS

Conclusions  http://pediatrics.aappublications.org/content/133/6/1151

Abstract

Ice hockey is an increasingly popular sport that allows intentional collision in the form of body checking for males but not for females. There is a two- to threefold increased risk of all injury, severe injury, and concussion related to body checking at all levels of boys’ youth ice hockey. The American Academy of Pediatrics reinforces the importance of stringent enforcement of rules to protect player safety as well as educational interventions to decrease unsafe tactics. To promote ice hockey as a lifelong recreational pursuit for boys, the American Academy of Pediatrics recommends the expansion of nonchecking programs and the restriction of body checking to elite levels of boys’ youth ice hockey, starting no earlier than 15 years of age.

However, because of ongoing concerns that a high number and proportion of boys’ ice hockey injuries are attributable to body checking, the AAP has elected to reassess its 2000 recommendation that “body checking should not be allowed in youth hockey for children age 15 years or younger.”

 A recent study of high school sports revealed that the concussion rate in boys’ ice hockey (5.4 per 10 000 AEs) was second only to football (6.4 per 10 000 AEs); however, concussions accounted for a greater proportion of total injures in boys’ ice hockey (22.2%) than any of the other 20 sports, with 30% of the concussions in ice hockey resulting from a player being body checked. 20 

Official Policy of Medical Associations Regarding Hockey Safety

Since the 2000 AAP statement, the American Osteopathic Academy of Sports Medicine (2002), the Canadian Academy of Sports Medicine (2007), and the Canadian Pediatric Society (2012) have released position statements about injuries in youth ice hockey. USA Hockey raised the age of legal body checking in games from Pee Wee (11 and 12 years of age) to Bantam (13 and 14 years of age) for the 2011–2012 season subsequent to the 2010 Ice Hockey Summit, which called for postponing legal body checking in youth games until 13 years of age. State and local youth hockey associations can offer leagues without body checking—often called “recreational”—at all ages, but competition with high school and other elite hockey programs that may promise the potential for advancement to higher levels of ice hockey, which typically sanction body checking, may make this option rare in many communities.

Conclusions

There is consistent evidence that body checking remains a significant risk factor for injury at all levels of boys’ youth ice hockey. Concussion is a particularly concerning problem and is often the result of body-checking activity. Body checking can also be associated with more aggressive play that further increases the risk of serious injury. The delay of body checking to higher ages has been shown to decrease risk of injury in 11- and 12-year-olds. Although data for older boys is less extensive, it is reasonable to conclude that removing body checking would reduce injury rates and severity at all ages, particularly benefitting 13- and 14-year-olds, who may be more vulnerable because of wide discrepancies in physical maturity.

Recommendations

In the continued interest of promoting boys’ youth ice hockey as a safe, lifelong recreational pursuit, the AAP recommends:

  1. Expansion of nonchecking programs for boys aged 15 years and older. Pediatricians should advocate for development of these programs in their communities and encourage their patients to participate in them.

  2. Restriction of body checking in boys’ ice hockey games to the highest competition levels (eg, AAA, AA, Tier I, Tier II), starting no earlier than 15 years of age. Body-checking skills could be taught in practices starting at 13 years of age for those players geared to elite participation.

  3. Strict enforcement of zero-tolerance rules against any contact to the head, whether incidental or intentional.

  4. Reinforcement of rules to prevent body contact from behind, particularly into or near the boards.

  5. Continued emphasis on coaching and education to prevent body contact from behind.

  6. More research into the effects of legal body checking, including specific attention to injury risk attributable to differences in size and physical maturity.