American Academy of Pediatrics, Council on Sports Medicine and Fitness, Canadian Paediatric Society, Healthy Active Living and Sports Medicine Committee

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. Pediatrics 2011; 128:617–623 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 andmedical organizations have called for boxing to be banned (Table 1), citingmedical, ethical, legal, andmoral 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 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 gangrelated 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. AMERICAN ACADEMY OF PEDIATRICS, COUNCIL ON SPORTS MEDICINE AND FITNESS, CANADIAN PAEDIATRIC SOCIETY, HEALTHY ACTIVE LIVING AND SPORTS MEDICINE COMMITTEE