This is a summary about the important medical and growth factors for child and adolescent athletes.  Read on to find out why children are NOT the same as adults for athletic injuries and risk factors.  If your child participates in any kind of sports or physical activities then this article will give you insight into appropriate activities, training levels, and injury prevention measures.  It also reviews some athletic injuries that are unique to the child and adolescent athlete.

 

 

Goals and Principles

• Successful integration of exercise, nutrition, and recreational pursuits
• Find FUN activities that children enjoy
• Limit or reduce sedentary time to 30 minutes per day
• AHA recommendations for activity:
  • Participation Age 2+ in 30 min moderate, age-appropriate, and varied physical  activity daily
  • Multiple small periods (2-15 min or 3-10 min) of exercise are acceptable alternatives

 

 

Pediatric Organized Athletics

• 30 – 45 million youth age 6-18 participate in athletics
  • 2/3 in organized sports
  • 1/3 in recreational
• Many in year-round sports teams or multiple sport teams simultaneously
• Increases risk for overuse injuries

 

Which is NOT a positive effect of exercise in children?

1. Weight control
2. Decreased BP
3. Increased HDL
4. Decreased risk of injuries
5. Reduction of DM
6. Improvement of self-esteem

 

Answer: 4

• Sports activity actually increases the risk of injuries related to a certain sport
• Benefits to decreased obesity important because:
  • Obesity prevalence 11-22%
  • Obesity rate has doubled in last 20 years
  • Obese children rates increasing epidemically, especially in economically depressed and minority populations
  • Every hour of television = 2% increased obesity risk

 

Risks of Adult Obesity

• 50% of children obese at age 6 are likely to remain obese into adulthood
• 80% of children obese at age 10 are likely to remain obese into adulthood
• Additional risk with concurrent parental obesity
• BMI 85^th-95^th percentile = overweight
• BMI >95^th percentile = obese
• See the CDC child and teen calculator for BMI to calculate
• Nutrition interventions and exercise recommendations can come from your child’s physician

 

Growth and Maturation

• Growth peaks: Age 6 years &  Puberty
• Girls gain more fat mass, boys more fat free mass
• CNS integration of psychomotor skills begins at ages 6-8 years
• Preadolescence (6-10 yrs): avg gain 2-3 in/yr and 2-3 kg/yr
• Adolescence (see chart)

	Growth Spurt Starts	Max Growth	Growth Ceases
Girls	~ 9 yrs	~12 yrs	~16-18 yrs
Boys	~11 yrs	~14 yrs	~18-20 yrs

 

Growth and Development – Infancy (0-2 yrs)

• The infant’s natural curiosity will stimulate motor and proprioceptive skills
• Help facilitate with tactile, verbal, musical stimulation
• Use brightly colored toys, balls of different shapes
• Rolling, crawling, sitting, standing, walking, running occurs rapidly

 

Growth and Development – Early Childhood (2-5 yrs)

• Master skills of running, kicking, and throwing
• Unstructured play is important
• Visual skills not yet mature
• Emphasize FUN!
• Competition is not appropriate
• Walking, running, swimming, tumbling – appropriate activities

Growth and Development – Childhood (6-9 yrs)

• CNS integration of psychomotor skills
• Visual skills improve
• Avoid emphasis on winning
• Acquisition of skills for eventual competition
• Swimming, baseball, gymnastics, soccer – appropriate activities
• Not ready for complex skill and rapid decision-making sports (football, volleyball, basketball)
• But, many children start these sports earlier with modified rules/teams, etc.

 

Growth and Development – Preadolescence (10-12 yrs)

• Better able to master complex motor skills and use memory strategies for rapid decision-making sports (e.g., football, volleyball, basketball)
• Should be able to compete in any sport

 

Growth and Development – Adolescence (>12 yrs)

• The early adolescent growth spurt may cause a temporary decrease in postural control
  • Awkward, gangly teenage years
• Physical and emotional maturity are important

 

Children are NOT Adults!  Special Considerations

• Increased susceptibility to injury:
  • Epiphyseal (growth) plates
  • Apophyses (muscle attachments)
  • Articular(Joint) cartilage
• Rapid bone growth can result in reduced soft tissue flexibility
• Less medical supervision of children and adolescent athletes
• Potential mismatch of body size and development
• Impact of training on normal growth and development (e.g., gymnastics, figure skating, ballet) on delayed menarche & short stature:
  • Current evidence suggests these reflect size demands of particular sports rather than outcomes of sports participation if nutrition is adequate
  • Eating disorders may confound these outcomes
• Early sports specialization may lead to psychological burn-out and injuries

 

 

Exercise Training and Physiology

• Aerobic training
  • Increased VO2 max (maximal oxygen consumption)
• Anaerobic training
  • Marked anaerobic capacity increase with growth
• Resistance training (weight lifting)- Years of controversy, limited data
  • AAP 2008: “Proper resistance techniques and safety precautions should be followed so that strength-training programs for preadolescents and adolescents are safe and effective.”
  • AAP & AOSSM: NO body building, powerlifting, and max lifts until physically and skeletally mature

 

Sport Safety Modifications

• Use smaller fields and courts
• Size and weight appropriate equipment
• Shorten duration of games and practices
• Smaller number of participants playing at a time
• Teach and enforce rules and safety
• Promote equal playing time & rotate positions
• Avoid score keeping and win-loss records; reinforce FUN as goal
• Proper supervision (greatest injury risk)

 

Thermoregulation – Predisposition to Heat Illness in Children and Adolescents

• Greater heat production during exercise
• Less sweat production
• Higher threshold for sweat production
• Larger surface-to-mass ratio (absorb more environmental heat)
• Less peripheral perfusion
• Slower environmental acclimatization

 

 

Vulnerability of the Immature Skeleton to Injury

• Three sites of cartilage growth:
  • Epiphysis (growth plate)
  • Articular (joint surface) cartilage
  • Apophysis (tendon attachments)
• Results of prepubertal growth spurt:
  • Muscle-tendon imbalance
  • Relative weakness of growth centers

 

Growth Plate Damage Can Cause Permanent Deformity

• Children should be evaluated for significant pain or tenderness to palpation after trauma, or for persistent pain
• Because of “open” growth plates, damage and fractures are not always visible on plain X-rays
• When in doubt children should be restricted from aggravating activities and should see a doctor
• Beware of diagnosing “sprains” in children, because ligaments are usually stronger than the growth plate in children

 

 

Common Childhood Overuse Injuries

• Little leaguer’s shoulder: a stress fracture of the shoulder that presents as outside shoulder pain, usually is self-limited and resolves with rest.
• Little leaguer’s elbow: inner elbow stress injury; treatment consists of complete rest from throwing for four to six weeks followed by rehabilitation and a gradual throwing program.
• Spondylolysis: a stress fracture of the spine. Diagnosis and evaluation can be done with x-rays, bone scan, CT scan, and/or MRI. Treatment usually is rest from aggravating activities.
• Spondylolisthesis: the forward movement of one spine bone over another and may be related to a history of spondylolysis. Diagnosis is made with x-rays and is graded in severity depending on how much the bone has moved.
• Osgood-Schlatter disease: Painful lump in the front of the knee (at the top of the shin). Diagnosis is made based on symptoms and exam, and most patients get better with rest, icing, and avoiding aggravating activities.
• Sever’s disease: Heel pain from Achilles tendon pulling on the heel bone.  Common cause of heel pain in young athletes.
• Runner’s Knee (Patellofemoral Pain Syndrome): Pain around and behind the knee cap due to abnormal tracking of the knee cap caused by weak gluteus muscles.  The most common cause of non-traumatic knee pain.  Treat by stabilizing hips, strengthening gluteus muscles, and stretching IT Band.

 

References:

1. Andrew Nichols, MD. UH JABSOM Sports Medicine Fellowship Director and UH Head Team Physician.
2. AAP, Committee on SM and Fitness and Committee on School Health: Organized sports for children and adolescents. Pediatrics 107(6):1459-1462, 2001.
3. Madden, et al. Netter’s Sports Medicine. Saunders © 2010.
4. Child and Adolescent Sports-Related Injuries.  KYLE J. CASSAS, M.D., and AMELIA CASSETTARI-WAYHS, M.D., Methodist Health System, Dallas, Texas. Am Fam Physician. 2006 Mar 15;73(6):1014-1022.

 

Thank for reading about the child and adolescent athlete.  Hopefully this article was helpful and useful.  It would definitely make me happy if this information helps to diagnosis or prevent any injuries.  Please feel free to let me know if you have any personal experiences or questions related to kid athletes.  You may also contact me through social media on Facebook, Instagram, etc.

 

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