Along with the start of school, autumn signals the beginning of a new sports season for many parents and children. While exercise is crucial for elementary school-aged kids, especially now that more and more children are overweight, parents need to be aware of the potential for sports-related injuries in their pint-sized athletes.
That's not to say parents and their kids should fear sports. "What I like to tell parents is that we tend to see fewer significant injuries from organized sports than from recreational free play," Cynthia LaBella, MD, medical director of the Institute for Sports Medicine at Children's Memorial Hospital in Chicago. "One of the great benefits of organized sports is that there is adult supervision, rules and protective equipment, all of which help to make them safer than free play."
Dr. LaBella warns, however, that injuries do occur when children are pushed into sports that they're not ready for yet. Below, Dr. LaBella talks about some of the most common injuries in kids and how parents can help their Little Leaguer or soccer goalie enjoy sports without getting hurt.
Why are children vulnerable to sports injuries?
School-age children are still developing their motor skills. So their coordination, strength and balance are still in the development stages. Given that they're not 100 percent yet, they are a little bit more prone to injury.
In addition, they're also learning how to interpret their body's signals, like soreness, discomfort, and fatigue. And then lastly, but probably most importantly, school-age children are actively growing, so their growth plates are at risk for injury during sports.
Growth plates are found at the ends of the bones in children. They're made up of cartilage and immature bone that is not yet calcified. As a result, growth plates are not as strong as mature bones and that's what makes them so vulnerable to injury.
What kinds of sports injuries are most common?
For elementary school-age children, serious sports injuries are much less frequent than in adults or adolescents, simply because the size and the speed of the competitors is so much smaller and slower. It is much more common to see overuse injuries than acute traumatic injuries in this age group, especially in sports like baseball and soccer that involve a lot of repetitive activity.
What is an acute injury?
When we say "acute injury," we mean something that occurs as a result of a single episode. So the classic example is someone who twists their ankle and suffers an ankle sprain. The most common types of acute injuries that we see are sprains, bruises and fractures in that age group.
What is an overuse injury?
Overuse injuries, instead of being triggered by one episode, develop over time with increased activity because of the repetitive stress on the muscles, tendons or bones, especially the growth plates. In school-age children, the most common sites where growth plates become stressed from overuse are the front of the knee, the heel, the shoulder and the elbow.
Probably the most classic examples of overuse injury are Little League elbow and Little League shoulder. These occur primarily in young pitchers from throwing a large number of pitches. This puts a lot of stress on the growth centers in the elbow and the shoulder. Initially, it only aches after practice and then it starts to hurt while they're throwing and then, if they keep throwing, a week later, it might hurt even when they're resting and doing daily activities.
How can you reduce risk of overuse injury?
The risk for overuse injury can be lessened by paying close attention to the frequency and intensity of the activity, making sure it's appropriate for the child's age and, very importantly, allowing for adequate time for rest between workouts. A young athlete should have at least one to two days off per week from their sports activities. If the child starts to complain of some soreness, it's time to take a break.
When shouldn't children participate in sports?
Children should never play through pain. Pain is the body's way of saying there's a stress or an injury. Children should not participate if they are sick, especially if there's a fever, vomiting or diarrhea. Occasionally, it's OK for a child with a mild cold to participate, as long as there's no fever or breathing difficulty, but the parents should keep in mind that they may fatigue sooner than usual, so the workout period should be shortened. A child should never be forced to play when tired because fatigue itself can be a risk factor for injury.
When is a child ready to participate in an organized sport?
Many children are developmentally ready for organized sports by about age six, but participation in organized sports also requires appropriate cognitive and social development. In other words, a child who is ready for organized sports is also able to interact with teammates and coaches, likes structure, has an appropriate attention span, is able to understand and follow instructions, has good memory skills and is not excessively shy or clumsy.
How can you make sure your child's physically ready for a particular sport?
Parents need to be aware that motor development follows a specific timeline. For instance, mature running skills come first, usually between ages four and five. This is followed by mature throwing, which occurs usually between six and eight. Mature kicking, hopping and catching occur between ages seven and eight. It's also important to remember that every child is programmed to develop these skills at his or her own pace.
Fundamental motor skills will not develop sooner simply because they are introduced at an earlier age. If a child is put in a position to try to play a sport that is beyond his motor development level, this can be very frustrating and may turn the child off from that sport or physical activity altogether. It may be helpful, from the parents' standpoint, to set up an appointment with the pediatrician to take a look at motor development before selecting a sport.
What is a good first sport?
Swimming is a common sport that kids can do very early on. Swimming can establish some basic strength and cardiovascular fitness, then the more fine motor skills that are associated with the other sports like throwing and kicking and swinging a bat can be built on top of that core of strength and cardiovascular fitness.
Soccer is a nice sport for young kids, too, and, early on, there's less emphasis on technique and more emphasis just on having fun and building up cardiovascular endurance and learning how to kick the ball.
Is it safe for kids to lift weights?
There are a lot of myths out there about strength training not being appropriate for kids. We've learned in the last few years that strength training is very safe for kids, if it's properly supervised. Kids can reap the same benefits as adults do, improve strength, improve bone density, improve self-esteem. Usually by the time they're ready for organized sports, age six or so, they're ready for strength training.
There is no formula for strength training, but the guidelines are to start slowly, increase weight gradually and aim for 8 to 12 repetitions, so that by the last repetition, you feel as though you could not do another rep. If you cannot do at least eight repetitions, you're using too much weight. If you can do more than 12, you're using too little weight.
How does protective gear prevent injury?
Protective gear is very important. Most sports have rules governing the proper use, but parents should make sure that the equipment fits properly and is in good condition. Rules mandating specific protective gear are made by the governing bodies for each sport, such as USA Lacrosse, or the state or national association that governs sports for a particular level of play, such as National Collegiate Athletic Association (NCAA). There are some sports that don't have rules mandating protective equipment, but for which it's highly recommended. Helmets, for instance, are mandated in football and hockey, but are also highly recommended for sports like bicycling, skateboarding, inline skating and skiing. Parents should encourage their kids to wear helmets during those sports, too.
What are appropriate warm-ups and cool-downs?
A proper warm-up is crucial, and it doesn't have to last very long. It can be 10 minutes of light jogging or cycling or just doing some easy jumping jacks before practice. The reason a warm-up is important is because it increases blood flow to the muscles, making them more pliable, less prone to strain or rupture. I don't like to have people stretch before they are warmed up because that can potentially lead to injury. During the cool-down, I encourage people to stretch.
When should you take your child to the doctor for an injury?
When children start to complain of pain or soreness, have them stop the exercise. Rest for a day or so, then try the activity again for a shorter period of time and at a lower level of intensity and, if the pain either does not go away with the two days of rest or recurs with the activity, then that's a reason to be evaluated by a physician. In terms of an acute injury, the child should see a doctor when there's significant pain, any swelling and, certainly, an inability to perform daily activities.
Are certain children more injury-prone than others?
This label is kind of applied to two types of kids. The first is children who are frequently injured simply because they are always on the go and involved in multiple sports. In other words, they just expose themselves to the risk of injury far more often than the average child.
Then there are the kids whose motor skills are not well developed. These are the kids that are often labeled as clumsy or uncoordinated. I encourage these kids to be active because that will help fine-tune those motor skills, but they really need to be careful about which sport they pick, at least, initially. Sports such as swimming or running are better initial choices.
How can dehydration in kids be prevented?
The best thing that a parent can do is to teach their child to drink plenty of fluids before, after and during activity and that is the key to avoiding dehydration. For an 80-pound child, an appropriate amount of fluid is 16 ounces within the hours before they start activity and then about five or six ounces every 20 minutes during activity. Water is fine, unless the activity will last longer than an hour, in which case a sports drink with some glucose and some electrolytes is the best choice. The liquid should be cool: A sports drink or water that's chilled is more palatable, so they'll drink more of it.
What is your overall advice to parents?
The important thing that I try to tell parents is encourage participation in a variety of sports. This provides for balanced muscle development and will also decrease the risk for overuse injuries. It's also more fun for the child and prevents burnout.
Be sure your child has a comprehensive sports physical prior to starting any sport. Allow the child to choose a sport or sports she likes, and check in with her frequently to make sure she's still having fun and is not having any pain or soreness.
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