Эпидемиолог объясняет родителям, как выбрать безопасный вид спорта для детей на фоне роста травм мозга

After recent reports of dozens of former Australian footballers diagnosed with chronic traumatic encephalopathy and the death of 27-year-old footballer Nathan Fitzgerald from an on-field brain injury, many parents are wondering whether they should let their kids play footy. As a parent of two young boys, I have asked myself the same question. As an epidemiologist who is researching concussion in kids, I let data and the precautionary principle guide my actions. Here’s how I think about it. First, the benefits The benefits of participating in sport and physical activity are undeniable. There are physical benefits: - increased cardiovascular fitness, which lowers the risk of cardiovascular disease, type 2 diabetes and some cancers - musculoskeletal strength, which lowers the risk of osteoporosis - motor skills, which lower the risk of falls. There are mental benefits such as better mood, cognition and resilience. There are also social benefits such as improved communication, cooperation and teamwork. The challenge for parents is to make choices that maximise these benefits and minimise the harms. Deaths are rare but make headlines There are many pitfalls when it comes to evaluating risks. News about fatal injuries in sport grab our attention, but they can also mislead us to think these tragic incidents are more common than they really are. In Australia, there are about 60 sport-related fatalities each year. About one-third of them involve children and young people. Wheeled motor sports (motorcycling and riding all-terrain vehicles) and wheeled non-motor sports (cycling and skateboarding) account for 43% of these fatalities. Australian rules football and rugby account for less than 1% each. In comparison, there are about 300 drowning deaths and 1,200 road fatalities each year in Australia. But fatal injuries represent only the tip of the iceberg. What sports have the most injuries? Non-fatal injuries are far more common and therefore a greater contributor to the overall burden of sports injuries. Data show that wheeled motor and non-motor sports are the top two activities resulting in sports injury-related hospitalisations among Australian children. Rugby and Australian rules football come in at fifth and sixth place, with injury-related hospitalisation rates of about four per 1,000 child participants per year. Brain injuries cause me most concern Not all injury types are equally worrisome. Parents today – myself included – are particularly concerned about brain injuries and concussions. We’ve heard a lot recently about concussion’s potential long-term consequences such as increased risk of neurodegenerative diseases. But other potential shorter-term consequences are important considerations – in particular, that children hospitalised with concussion have an increased risk of poor school performance. Children who have been hospitalised with concussion are about 30–40% more likely not to achieve the national minimum standard on NAPLAN assessments for literacy and numeracy in years 3–9, compared to uninjured children. And they’re about 77% more likely not to finish year 12. Poor school performance can adversely impact on social outcomes throughout the person’s life, such as whether they go to university, their career prospects and income. Data show that wheeled motor sports, wheeled non-motor sports and horse-riding are the top three sports activities resulting in brain injury-related hospitalisations among Australian children, with rates of about 1–2 per 1,000 child participants per year. Rugby and Australian rules football comes in at fourth and sixth place, with brain injury-related hospitalisation rates of about 0.5 per 1,000 child participants per year. While these rates are relatively low, for every injured child who is admitted to hospital, there are typically another five or six injured children who visit the emergency department without being admitted to hospital. And there is a much larger number of injured children who either receive care directly from primary or allied health care practitioners or don’t seek any medical care at all. Risks also change with age Another thing for parents to keep in mind is that the risk of injury can change from childhood to adolescence, and that change varies dramatically across sports. The injury-related hospitalisation rates per child participant for wheeled motor and non-motor sports are substantially lower among 15–17-year-olds compared to younger children. In contrast, the injury-related hospitalisation rates per participant for rugby and Australian rules football are two to three times higher among 15–17-year-olds compared to younger children. Parents ought to consider both current and future levels of risk when making decisions for their children’s participation in sports. How to decide what’s best for your family Look beyond the news headlines, but err on the side of caution. The question is not whether kids should play sport. It’s a question of selecting sports that maximise benefits and minimise harms. At the end of the day, kids just want to have fun while they play sport. And they usually have more fun when they’re not getting knocked in the head.