I used to work for many years at a community health center in the poorest city in my state. Obesity was a huge problem for my pediatric patients, many of whom lived in neighborhoods too dangerous for children to safely play outside. When a boxing club opened up in town, many of the boys, but also some of the girls in my practice, signed up. While I cringed a little to think of these teens suiting up and having at it in the ring, I watched them gain self-confidence, learn discipline, tone muscles and shed pounds. Boxing is gaining popularity. More than 18,000 youth under the age of 19 were registered with USA Boxing in 2008. But while the activity may benefit youth in myriad ways, it remains a dangerous sport. Just how risky it is a little hard to quantify because national boxing organizations such as Boxing Canada and USA Boxing don’t keep data on their members’ injuries. Some injury data is available in amateur boxing, but the data doesn’t distinguish the injuries by age, so again, information is limited. In a study from U.S. emergency departments from 1990-2008, an average of 8,700 injuries per year of boxing-or one injury per boxing hour-was reported. Another study by the Center for Injury Research and Policy of the Research Institute of Nationwide Children’s Hospitals found a 211% increase in boxing injuries during the same time period. In this study, fractures were the most common type of injury, most to the hand, followed by the head and neck. Concussion occurs commonly in boxing and brain injury is the most significant risk in the sport. Reports of concussions in amateur boxers range from 6.5% to 51.6% across age ranges. But concussions in children and adolescents are especially concerning due to the special vulnerability of a youth’s developing brain and a child’s longer recovery time needed from concussion when compared to adults. Our improved understanding of the dangers of multiple concussions, as well as the recognition of the need for physical and cognitive rest, has led the American Academy of Pediatrics (AAP) to endorse the Concussion in Sports Group’s return to play guidelines. Concussed athletes in public middle and high schools are now removed from play and not returned that day, are medically supervised through a graduated and individualized physical and academic protocol, and must be cleared by an experienced physician before returning to their sport. According to the AAP’s 2011 Policy Statement on Boxing Participation by Children and Adolescents, USA Boxing does not conform to these guidelines, instead restricting concussed athletes for at least 30 days, with longer restrictions imposed for longer periods of loss of consciousness. The AAP advises pediatricians to “vigorously oppose boxing,” to educate parents and children about the sport’s risks, and to encourage youth to participate in other athletics. In addition to its injury profile, boxing also is opposed because it “encourages and rewards deliberate blows to the head and face.” As a pediatrician, it’s a tough decision to tell a newly enthusiastic young athlete not to play his or her beloved sport. We struggle with this same issue in determining when to recommend retiring an athlete completely after multiple concussions. And I certainly struggle with balancing the benefits of weight loss and cardiovascular training with boxing’s inherent dangers. But as those of you who read my column know, I have a personal and passionate interest in preventing head injury in children. So for me, I’ll be siding with the AAP

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From issue: 28/11-12