Amid reports of childhood obesity, inactivity and type 2 diabetes, one encouraging development goes overlooked: 25 million children and adolescents today participate in organized sports–a rate about double that of three decades ago.
While parents can feel good about seeing their child on the soccer field or baseball diamond rather than in front of a video game, there are nevertheless hazards, both on and off the field, such as under training, overtraining, injuries, stress and burnout.
The American Academy of Pediatrics (AAP) recommends that, at least until adolescence, children participate in a variety of activities and develop a range of skills rather than specializing heavily in a single sport. They should have proper training and equipment as well as a coach who understands the “unique physical, physiologic and emotional characteristics of young competitors, ” AAP guidelines state.
Identifying and Treating Injuries: A coach should be familiar with training methods, technique and ways of identifying and dealing with injuries.
Young persons are more vulnerable than adults to injury, and they’re more likely to suffer permanent damage if the injury is overlooked or not treated properly. Jeff, 37, still has painful, stiff knees that he blames on his high school football coach. “My knees were seriously injured, but he told me I had to learn to play through the pain. I never did get the treatment I needed.”
Charging into action without adequate training increases the risk of injury. So does overtraining, overuse of certain muscle groups and poor technique.
As a Little League pitcher, Derek was compared to Nolan Ryan as he struck out the other side inning after inning. His budding career was over by his junior year of high school, however, his arm weakened from overuse, lack of rest and a technique that put extra strain on his elbow.
A good coach should also recognize the dangers of dehydration and heat stress. Because of their greater surface area to body mass ratio, young people are more vulnerable than adults to the effects of heat. Contrary to what many adults may have been told during their own playing days, athletes need to consume plenty of fluids before, during and after exercise.
Good Nutrition: For all athletes, good nutrition is crucial, both for optimal performance and good health. While an adult may use intensive exercise as a means of losing weight, such a strategy is not recommended for a growing child.
A child or adolescent needs a balanced diet, based on the FDA Food Pyramid, high enough in calories to meet the needs of both training and normal growth. It’s also important for athletic youth to have adequate quantities of calcium and iron-rich foods such as red meat.
Managing Medical Conditions: Children with chronic medical conditions such as asthma or diabetes can and should participate in physical activities, but they need information from their physicians about ways of safely managing their health needs.
Asthma is the most common chronic diseases affecting children, and the prevalence is increasing. Exercise can bring on an attack in a child who has never been diagnosed as well as those who are known to be asthmatic. The risk apparently is higher in areas where the pollution level is high.
Too many asthmatic athletes ignore warnings to have their bronchodilator inhalers with them. One study involving 80 asthmatic children on soccer or baseball teams found that only 18 had their inhalers nearby during games. “Nearby,” doctors point out, means on or near the bench and not in the car.
Some teams keep bronchodilators in first aid kits, along with medication for children who may be allergic to bee stings. Diabetic children usually need to have their own supply of snacks and know the signs of low blood sugar.
Special Considerations for Females: Females undergoing intensive training are at risk of the “female athlete triad”: abnormal eating patterns, menstrual irregularity and low bone mineral density.
Either unintentionally or as a deliberate strategy to lose weight and body fat, a female athlete may decrease food intake below what she needs and/or increase her training beyond the normal regimen. This is a syndrome that can range from mild to severe but at any level carries health risks.
Menstrual dysfunction may involve delayed puberty, irregular menstrual periods, periods at longer-than-normal intervals (such as 35 days) or loss of menstruation for three months or longer. A girl experiencing any of these is at risk of decreased bone mineral density and premature osteoporosis (some of which may be irreversible).
Equally serious is the possible development of eating disorders such as anorexia (severe restriction of eating) and bulimia (binge eating coupled with purging). Often entwined with depression and extremely difficult to treat, these eating disorders can produce severe physical and mental dysfunction.
Substances To Avoid: Also because of societal pressures, young male athletes–but also some females–may be tempted to use performance-enhancing substances such as steroids or creatine.
Steroids are illegal–although readily available–and carry the risk of serious side effects, including stunted growth. Creatine can be purchased in health food stores and is widely used by professional and even college athletes, but the long- and short-term safety of the substance has not been adequately documented. The American College of Sports Medicine specifically recommends against use by persons under age 18.
One study of 1,103 middle and high school students in Westchester County, New York taking pre-participation sports physicals found that 5.6 percent admitted to taking creatine. Although the rate was highest among older students (44.4 percent for high school seniors), use was found as early as sixth grade and not only among athletes in strength sports such as football and wrestling but also those in tennis, field hockey and cheerleading.
In addition to being highly competitive, young people participating in sports are concerned about appearance and subject to peer pressure. It’s up to adults to see that their energy remains focused on positive outcomes–for their teams and their own health.
Tana N Kaefer, PharmD
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