Who wouldn’t want their child to run on to a rugby pitch, instead of sitting at home texting? Contact sport is heroic, character forming and British, for goodness sake. But when a paediatric neurosurgeon writes an editorial in the BMJ, describing how he has picked out skull fragments from the brains of teenage rugby players, it is hard not to rush on to the pitch with cotton wool.

The editorial’s author, Michael Carter, a consultant at the Bristol Royal Hospital for Children, is a “rugby parent” himself. He argues that just as rugby union exposes adult players to severe physical injury, so it does with children. Children in their early teens are often unskilled and don’t know how to avoid injury, and between the ages of 13 and 18 their weight and height may differ dramatically within a squad. Big kids can flatten smaller ones in a tackle. Carter agues that the gladiatorial nature of rugby means children are encouraged to carry on when injured. There is some evidence that concussion, in particular, gets overlooked and can lead to educational and psychological problems. So do you close your eyes on the touchline?

The solution

The data is not great on the frequency of rugby injuries in children. Carter and three colleagues recalled 20 injuries in 10 years that needed management from a brain surgeon. There were two deaths and up to five serious spinal fractures. Evidence from a systematic review of 15 studies found that injuries needing medical attention occurred between 27.5 to 129.8 times per 1,000 match hours. The highest incidence of concussion was 3.3 per 1,000 playing hours. The wide variation reflects the variation in data collection.

Particularly worrying were records of recurrent concussion within three weeks, when guidelines advocate a three-week break after concussion, which is sensible for an adolescent brain. A South African study, looking at injuries in adolescent players of high standard over a week’s tournament, found that under-13s were four times more likely to be injured than under-18s. Tackles were the most likely cause, with tacklers suffering upper-body injuries, including head injuries and broken arms, while ball carriers had thigh and knee injuries. There is, however, some evidence that improving tackling skills can reduce injury, as can training to improve flexibility, joint-position sense and strength. Injuries cluster early in the season so pre-season training could help. There is evidence, too, that young front-row players are more at risk of neck injury in scrums: the Scottish Rugby Union says that 15-year-old front-row players cannot play in under-18 teams.

If you were giving school rugby a report, it would probably say: “Could be safer.”