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Research and rule changes have shed light on a few strategies to prevent concussions when kids play sports, but there's not enough evidence to answer key questions that many parents and athletic directors have, a consensus panel concluded.

Disallowing body checking in young boys' ice hockey games lowered concussion risk, for example, and limiting contact during practices in American tackle football reduced head impacts, reported Frederick Rivara, MD, MPH, of the University of Washington in Seattle, and colleagues.

But there's no evidence about what age children should start playing contact sports, they wrote in , or at what point they should stop.

"The brain is developing up until early in adulthood," Rivara said. "There's no evidence that says there's an age -- 10 or 12 or 15 or 18 -- in which contact sports should be started," he told MedPage Today.

"But there's no evidence that younger kids can't learn proper kinds of techniques if they are playing contact sports," he said. "And rules can make a difference, regardless of the sport you play."

When to have a child retire from a sport due to concussions is "a complicated decision," Rivara added. "There's no specific data on the number of concussions, that when you reach that number, you should stop playing that sport. It depends on a variety of factors."

The consensus report builds on previous papers, including one issued 5 years ago by the Institute of Medicine (National Academy of Medicine) and a statement from a . But evidence has changed in the past 5 years, and many recommendations were geared toward older players, Rivara said. "There has not been a lot focused on younger kids," he noted.

The about concussions for children and adolescents, but it focused on diagnosis, prognosis, and concussion management, not prevention.

To develop their report, Rivara and colleagues used a modified Delphi approach that included systematic reviews of evidence in multiple rounds. They addressed seven questions ranging from starting to stopping contact sports, including risks, rules, and protective gear. Their findings included:

• Parents, kids, and coaches should be aware that concussion risk is higher in kids with a history of head injury
• Children should be taught contact techniques for the sport they're playing
• The age when full contact should be introduced is sport-specific and needs more research
• Evidence about multiple concussions in youth and long-term neurological changes is inconclusive
• Technology to measure head impact exposure and advanced neuroimaging methods need further development before they can be used clinically
• Helmets should be worn in high-impact sports including American tackle football, ice hockey, boys' lacrosse, downhill skiing, snowboarding, skateboarding, and bicycling
• There's little evidence to recommend using current headgear in soccer or rugby, and this needs more research

The panel also recommended:

• Delaying body checking in ice hockey until age 13 to decrease concussion risks
• Limiting contact and collision in practice in American tackle football
• Research about training for sport-specific contact and collision techniques across age groups
• Research about rule enforcement and fair play at all levels of play

Concerns about sports-related concussion are emerging against a backdrop of an obesity epidemic, owing partly to increased screen time and sedentary behavior, Rivara noted. National physical activity guidelines recommend school-age children and adolescents have at least 60 minutes of moderate to vigorous daily physical activity, and sports participation is highlighted as a practical strategy to help children reach that target.

Unanswered questions about concussion prevention shouldn't stop parents from letting their kids play sports, Rivara emphasized: "We don't want to tell kids not to be active."

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