Body checking should be kept out of youth hockey until boys are at least 15 years old, according to paediatricians. Even then, they added, it should be restricted to the highest levels of competition.
According to the new American Academy of Paediatrics (AAP) policy statement, checking is related to a higher risk of injury across all levels of boys' youth ice hockey. Checking is not allowed in girls' hockey.
A "check" involves a player hitting a skater on the opposing team to try to separate him from the puck.
Risk of concussion
USA Hockey, the sport's governing body in the US, currently allows checking in leagues for boys ages 13 and older. That's up from a minimum age of 11 before the 2011-2012 season.
"Whatever age you introduce body checking, the injury risk dramatically increases," said one of the statement's lead authors, Dr Alison Brooks from the University of Wisconsin School of Medicine and Public Health in Madison.
The AAP recommended in 2000 that checking not be allowed in hockey leagues for children ages 15 and younger. But at the time, Brooks said, there weren't a lot of data to support that position.
"In the last 10 years there's been a lot of great research that's come primarily out of Canada to provide a strong scientific evidence base that body checking dramatically increases risk of injury, severe injury and concussion," she told Reuters Health.
Some of those studies, she said, suggested being in a league that allows checking triples or quadruples a young person's risk of sustaining a concussion.
Reinforcement of rules
In the new statement, the AAP Council on Sports Medicine and Fitness says that checking skills can be taught in practice starting at age 13 for those players that are headed to the more elite levels of youth hockey.
The group also calls for reinforcement of rules that prohibit an athlete from making contact with another player's head or checking him from behind – both of which also increase the risk of serious injury.
Brooks said she and her colleagues would like to see more non-checking leagues available for older kids who aren't planning to play at an elite level.
Right now, she said, boys are often forced to play in a checking league or drop out of the sport. But if they're not hoping to play college or professional hockey, there's no need for them to be checking when they're in high school.
The policy statement was published in Paediatrics, the journal of the AAP.
In a separate study released in the same issue of the journal, researchers from Minnesota describe the ice hockey injuries among kids ages 18 and under seen at their trauma centre between July 1997 and July 2013.
Injuries can be minimised
The centre treated 168 injuries in 155 children during that time, including 26 girls. Injuries to the arms, legs, hands and feet were most common, and the majority of those were broken bones. Almost one-quarter of the injuries were brain injuries – either a concussion or intracranial bleeding.
Sixty-five of the children needed to be admitted to the hospital, and 14 required intensive care.
"Hockey is a fast moving contact sport played on a hard surface with players striking a frozen object with sticks; injuries will happen but can be minimised with proper equipment, coaching and parental supervision," Dr Michael B Ishitani told Reuters Health in an email.
He and his colleagues from the Mayo Clinic in Rochester found that intentional contact, including body checking or fighting, was responsible for 38% of the injuries, more than any other cause.
USA Hockey did not respond to a request for comment on the policy statement.
Brooks emphasised that the document is not intended to keep kids from playing hockey.
"We're trying to grow and improve hockey as a youth sport and a lifelong sport that more people can enjoy," she said.
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Image: Young hockey players from Shutterstock