AAP policy: Raise body checking age to 15 to cut concussions among hockey players

Size, age not equal

USA Hockey, the United States’ governing body for the sport, allowed checking at the Pee Wee level (ages 11-12) but raised it to the Bantam level (ages 13-14) in the 2011-’12 season. Hockey Canada increased the age for legal checking to the Bantam level starting in the 2013-’14 season.

In Canada, where ice hockey is the official winter sport, checking is a hotly debated topic. In 2012, the Canadian Paediatric Society (CPS) released a position statement that supports the elimination of body checking from all levels of organized recreational/non-elite competitive male ice hockey and checking only in competitive leagues for boys ages 13-14 years and older, preferably age 15. CPS continues to include checking in the boys’ Bantam elite level, however.

The Academy continues to support an age cut-off of 15 years because of a concern about the potential discrepancy in the sizes of 13- and 14-year-old boys competing against each other in a collision sport, noted Dr. Loud.

“There’s an enormous range from the underdeveloped late-blooming 13-year-old, who has yet to start puberty, and the 14-year-old who started at age 11 or 12. That is another important reason why the checking should be delayed past 15,” he said. The potential size and strength difference is not nearly as great at any other two-year age span, he added.

Keeping it fun

Ice hockey has developed into an almost year-round activity in the United States, with the number of youth players growing from 200,000 in 2000 to more than 350,000 in the 2011-’12 season.

As more kids take up the sport for fun, experts should look at the new injury evidence and reconsider the body checking rule at the boys’ Bantam level, said Alison Brooks, M.D., FAAP, co-author of the policy.

“Should we allow body checking to exist because of the very small percentage who want to go on and play elite hockey (see table), or should we protect the vast majority of kids who want to play hockey because it is fun and it’s great exercise and they can play it in a lifelong sport?” she asked.

Girls’ and women’s leagues do not allow body checking, noted Dr. Brooks, team physician for women’s ice hockey at University of Wisconsin, Madison. “We’re not saying that by removing body checking from ice hockey that we’ve made ice hockey a non-contact sport. It is a very aggressive, physical sport.”

Most injuries occur due to intentional contact. The result includes traumatic brain injuries and injuries to the spine that are more common in children ages 14 and younger vs. ages 15 and older, according to a study released in the June Pediatrics http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2013-3628 (doi: 10.1542/peds.2013-3628). Independent of the AAP policy, the study also points out that injury patterns are influenced by age and gender and calls for targeted preventive efforts.

In Dr. Loud’s experience as the father of a Bantam-age player, a sports medicine pediatrician and a hockey player in an adult non-checking league, not everyone is comfortable with body checking. Pediatricians, parents and USA Hockey all have opinions on when to allow checking, he said. “It might be nice to get the kids’ perspective.”

When counseling patients, pediatricians should continue to include ice hockey as a way to promote a patient’s lifelong commitment to physical activity and emphasize injury prevention, according to the policy, which cites the significant decrease in eye and mouth injuries since the introduction of protective equipment.

“Protective gear is essential,” said Dr. Loud. “Helmets protect against skull fracture, lacerations and other injuries. Full face masks are essential for eye and teeth protection.” As for the marketing of concussion-decreasing helmets — “we just don’t believe that technology exists.”

Policy recommendations

• Expand non-checking programs for boys 15 years and older.

• Restrict body checking in boys’ ice hockey games to the highest competition levels. Skills can be taught in practices at 13 years for players geared to elite participation.

• Reinforce rules to prevent body contact from behind, into and near boards.

• Educate players on preventing contact from behind.

• Continue to study effects of and injury from legal body checking.