The unknown risks of youth rugby need urgent assessment to ensure the safety of junior players, a leading British brain doctor said yesterday

Writing in the respected BMJ British Medical Journal, Michael Carter, a paediatric neurosurgeon at the Bristol Royal Hospital for Children, argued that “rugby sidesteps many safeguards intended to ensure pupil wellbeing” and called on schools, clubs, medical facilities and regulatory bodies to work together to investigate the risks of junior rugby.

Carter’s concerns echo worries expressed by health experts about injuries in professional rugby and other contact sports such as boxing and American football, where evidence suggests multiple knocks to the head can cause brain damage and lead to dementia and other neurodegenerative diseases.

In British schools where rugby is played, some children start at age eight, and by age 10 are engaging in “contact” rugby, which carries a greater risk of injury, Carter wrote.

He said injuries can be avoided if children are taught the right sporting skills, but cautioned that not all young players learn them, and noted that children at this age are often vastly different weights and sizes.

Describing what he said was a “quick check with neurosurgical colleagues” in the UK, Carter said they reported at least 20 children’s rugby injuries over the past decade that needed neurosurgical consultation or intervention – including two deaths, four or five serious spinal fractures and several depressed skull fractures.

“Schools, coaches and parents all contribute to a tribal, gladiatorial culture that encourages excessive aggression, suppresses injury reporting and encourages players to carry on when injured,” he wrote.

Carter called for teachers and coaches to improve the situation, noting that using pre-season and early season strength and conditioning training “are possible solutions that other rugby playing countries have already adopted”.

He added that weight as well as age should be considered during squad selection.

“It is vital that schools, clubs, medical facilities, and, most importantly, regulatory bodies cooperate now to quantify the risks of school rugby,” Carter said.

“Failure to do so will inhibit the development of rational policies around the sport, put junior players at risk, and may ultimately threaten the survival of rugby in its present form.”