So reads a policy statement published in the September 2011 edition of Pediatrics – and the AAP and CPS aren’t alone in their opinions. As recently as 2007 the American Medical Association (AMA) recommended that “until boxing is banned, head blows should be prohibited,” and in 2005 the World Medical Association recommended the sport be banned completely.
Even if you love watching the sport or even participate in boxing yourself, it’s fairly easy to see why pediatricians (in particular) have a less-than-positive view. Winning a bout is based on the number of times an opponent can hit another in the head and body. The only outright way to win is to knock out your opponent.
According to the policy statement, the AAP and CPS are most concerned about concussions. Brain injury is the most significant risk associated with boxing. Concussions are particularly dangerous for children and adolescents because their brains are more susceptible to injury and take longer to heal when compared to adults. Statement authors also raise concerns about chronic traumatic brain injury, which is thought to be caused by repeated blows to the head over time.
A study of high school athletes compared neuropsychological evaluations (a test of mood, personality and cognitive abilities) of athletes with no history of concussion, those who had a previous concussion but who had healed, those with two or more concussions who had healed, and those who had had a concussion in the past week. The athletes with two or more previous concussions had trouble with attention and concentration similar to those who had just suffered a new concussion. These results suggest there is a cumulative effect in those who experience repeated head injuries, like those often found in boxers.
While the AAP and CPS “vigorously oppose boxing for any child or adolescent”, the groups do not oppose other sports or activities where concussions are common like football, soccer, ice hockey and wrestling.
The researchers make the distinction that the head injuries sustained in boxing are “intentional” – that is, participants are trying to land blows to the head.
“In boxing, children and youth are encouraged and rewarded for hitting the head. We’re saying, don’t put kids in a sport where hitting the head is condoned and encouraged,” said Dr. Claire LeBlanc, co-author of the position statement.
Supporters of boxing point to benefits for young participants like providing an opportunity for exercise and development of skills like self-discipline and self-confidence. LeBlanc urges parents to find other ways to encourage exercise, asking “can’t kids get 60 minutes of aerobic activity without promoting violence or blows to the head?”
Specifically, the policy statement suggests swimming, tennis, basketball and volleyball as good alternatives with less risk for head trauma.
For his part, Dr. Robert Wack, Medical Director of FMH’s Pediatric Hospitalist Program, isn’t ready to tell his patients to hang up their boxing gloves.
“What’s really important is to keep kids active,” Dr. Wack says. “Almost all sports carry some risk of head injury; the key is to have the right coaching, the right training, and the right equipment to keep that risk as low as possible.”
Dr. Wack says it isn’t effective to single out one sport above all others in an effort to reduce head injuries. He argues a better method would be to study how well current safety equipment and coaching techniques work to protect participating kids and make improvements there as necessary.