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Pediatrics Academy Advises Doctors to Oppose Youth Boxing

YouthBox for Blog.jpg

Doctors should "vigorously oppose boxing in youth" and encourage participation in sports that don't revolve around impact to the head, according to a policy statementRequires Adobe Acrobat Reader from the American Academy of Pediatrics released Sunday.

More than 18,000 youths younger than 19 were registered with USA Boxing in 2008, according to data presented in the policy statement, published online in the journal Pediatrics. While one study found injuries to be more frequent in high school football, wrestling, and soccer than boxing, intentional head and face injuries occurred more often in the latter.

"While most sports have some risk of injury, boxing is especially dangerous because these athletes are rewarded for dedicated and deliberate hits to their opponent's head," said Dr. Claire LeBlanc, one of the authors of the policy statement, in a press release.

Another prospective cohort study found that the head accounted for more than 70 percent of injuries in amateur and professional boxing, with concussions being the most common injury (33 percent of the time). The headgear that boxers wear can't protect a boxer's brain from jostling back and forth in his head after an impact from a punch, just like football helmets can't ever be expected to prevent all concussions.

As the authors of the policy statement note, the rate of concussions in boxing should be a concern for amateur coaches, as "there is evidence that a child's brain is more vulnerable to injury and that recovery from concussion is prolonged when compared with adults."

What's even potentially more alarming: A few studies cited in the policy statement have uncovered signs of diminished neurocognitive function (in other words, potential brain damage) in former amateur boxers—even those who haven't suffered concussions.

While there's no conclusive evidence linking boxing to chronic traumatic encephalopathy, the authors note the risk of youths developing neurodegenerative diseases from repeated blows to the head. (A recent study published in Brain Pathology suggested that a single brain injury may cause long-term damage.)

It's worth noting that the AAP does not explicitly call for a ban on youth boxing. It's very deliberate with the language in the policy statement, strongly encouraging doctors to push young athletes toward other sports, but never outright suggesting the prohibition of amateur boxing in the U.S.

On the other hand, the American Medical Association, Australian Medical Association, Canadian Medical Association, British Medical Association, and World Medical Association all recommend that youth boxing be banned.

Advocates for youth boxing were quick to denounce the grave tone taken in the AAP policy statement, saying that the sport wasn't nearly as dangerous as the doctors were making it out to be.

"I have never seen a knockout in the small-weights division," said Robert Crete, executive director of Boxing Canada, to the Canadian Press. Crete said that amateur boxers spend most of their time punching bags, not human opponents, and that "if they compete twice a year, it's considered very often."

Joe DeGuardia, the owner of the Morris Park Boxing Club in the Bronx, echoed similar thoughts in an interview with Health.com. DeGuardia said that minor injuries such as bloody noses and cuts happen frequently in youth boxing, but serious injuries are uncommon because of the protective headgear that boxers wear.

Like Crete, DeGuardia noted that only a small proportion of a youth boxer's time will be spent actually sparring with a live partner, and said that the benefits of boxing—self-discipline, motivation, and physical fitness—"certainly outweigh the risks."

It shouldn't be surprising to hear people in charge of boxing organizations coming out in support of boxing. But these comments suggest that they're missing a critical piece of the "why youth boxing is so dangerous" puzzle: the fact that every hit to the head, even with headgear, could be doing long-term damage.

As Malcolm Gladwell noted in his 2009 New Yorker story on concussions, the leading concussion experts in the field find themselves extremely concerned about the impact of subconcussive hits on a young athlete's brain. In other words, even a light jab still generates a force that likely knocks the brain around inside a boxer's skull, albeit more lightly than an uppercut would.

And that's the main reason the AAP came out so strongly against youth boxing. With the knowledge that any hit—not just the biggest, hardest punches—could be causing long-term damage, the AAP believes that youth boxing simply isn't worth the risk.

Dr. LeBlanc did tell Health.com that the AAP could reconsider its policy statement if boxing changed its rules to prohibit punching above the neck.

Photo: Chris Adkins, 16, left, spars with Andrew Miller, 13, at the Dawg House Gym in Charleston, W.Va., earlier this year. The gym's youth boxing program accepts children from 8 years old through high school. (Craig Cunningham/Charleston Daily Mail/AP-File)

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