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Canadian pediatricians have a message for the children and teens who want to take up boxing: Just don't do it.
The Canadian Paediatric Society released a joint statement Monday with the American Academy of Pediatrics in which both bodies "vigorously oppose" boxing as a sport for children and teens. According to Boxing Canada, about 2,000 kids aged 11 to 16 are participating in the sport; 500 of them are female.
The two pediatrician groups put out a similar statement in 1997, but "the evidence to support our stance now is much stronger," says Claire LeBlanc, chairwoman of the CPS's Healthy Active Living and Sport Medicine Committee and one of the authors of the statement.
Furthermore, parents are enrolling their children younger than ever, she says.
"Many of these programs are getting children into combat sports as young as four and five years of age," she says. "Are children begging to take part in boxing and mixed martial arts programs? Or is this something that's being encouraged by parents or society in general? … We want to protect that child or youth if nobody else will."
The CPS recommends sports such as swimming, tennis, basketball or volleyball instead.
And those who continue to box despite warnings are urged to undergo regular neurocognitive and ophthalmological screening exams.
Many other doctor associations have lobbied for the sport to be banned outright, including the Australian Medical Association, the British Medical Association, the Canadian Medical Association and the World Medical Association. The U.S. AMA recommended in 2007 that until boxing is banned, head blows be prohibited for both adults and children.
The Canadian pediatricians pointed to new injury data and a heightened awareness of the particular risks of brain injury in children. Studies have found that teens who suffer concussion have more prolonged memory problems than adults, for instance.
While the total number of boxing injuries is not tracked, studies suggest the overall risk of injury in amateur boxing is lower than in other collision sports such as football and hockey. Still, the fact that boxing encourages and rewards blows to the head is the deal-breaker for pediatricians, says Dr. LeBlanc.
In Canada, injury data are collected by the Public Health Agency of Canada from 15 hospitals across the country, including 10 children's hospitals. From 1990 to 2007, boxing was the top cause of hospitalization due to combat sports, including judo and wrestling.
Of those hospitalized, 58 per cent had facial fractures and 25 per cent had "closed head injuries," which can include concussion and bleeding or bruising of the brain.
And of the total of 273 injured boxing athletes reported, about 70 per cent were in the 10-to-18 age range. Almost 30 per cent were 10 to 14, and almost 40 per cent were 15 to 18. (1 per cent were aged 5 to 9.)
"Yes, we're concerned about concussions that are happening in (all) sport today," says Dr. LeBlanc, who is taking up a position as pediatric specialist at Montreal Children's Hospital next month. "But if we have a sport where they're rewarded for knocking each other in the head, there's got to be something wrong with that."
The fact that amateur boxing rounds are shorter than professional rounds and protective headgear is widely used does not sway Dr. LeBlanc. "Until they eliminate head blows, they cannot say they're doing everything to prevent injury and make the sport as safe as it can be."
She cites rules that declared the male genitals out of bounds back to the 1830s in Britain. "Why are we ignoring the head?" she says. "Don't you think maybe that's an area that should be put out of bounds, too?"
Members of the Canadian boxing community challenge many of the assertions behind the doctors' stance. They point out that kids can train for a year before competing, and are not allowed to compete until they are 11."A lot of people see the Rocky movies and are confusing professional and amateur boxing," says Robert Crete, the Ottawa-based executive director of Boxing Canada.
In the amateur game, he says, the goal is not to get hit.
"Ninety per cent of amateur boxing is defensive mode," he says, adding he is not aware of any knockouts in the under-16 group. He and others in the boxing community say their sport is less dangerous than soccer or hockey.
But Dr. LeBlanc says youth hockey in particular is not getting a free pass, and the CPS is examining violence in that sport for an upcoming position statement.
"We will be making a statement on that as well. Stay tuned."