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AAP Clinical Report: Young Children Risk Injury in Single-Sport Specialization

8/29/2016
Playing multiple sports more likely to lead to lifelong physical activity, benefits

As more children specialize in a single sport at a younger age, research suggests that they face a higher risk of overuse injuries from training, as well as increased potential for stress and burnout, according to a clinical report from the American Academy of Pediatrics (AAP).

The AAP in its report, "Sports Specialization and Intensive Training in Young Athletes," reviewed the epidemiology of youth sports and found the culture has changed dramatically over the past 40 years. This document is intended to offer guidance to pediatricians, their patients and families, and will be published in the September 2016 Pediatrics (online Aug. 29).

"More kids are participating in adult-led organized sports today, and sometimes the goals of the parents and coaches may be different than the young athletes," said lead author Joel S. Brenner, MD, FAAP, past chairperson of the AAP Council on Sports Medicine and Fitness.

"Some are aiming for college scholarships or a professional athletic career, but those opportunities are rare," Dr. Brenner said. "Children who play multiple sports, who diversify their play, are more likely to enjoy physical activity throughout their lives and more successful in achieving their athletic goals."

The AAP encourages children to play multiple sports and delay specializing in a single sport until late adolescence. The academy advocates banning the practice of ranking athletes nationally and recruiting for college before they reach their late high school years.

About 60 million children age 6-18 participate in organized sports annually, according to the 2008 National Council of Youth Sports. Of those, about 27 percent participated in only one sport, the council found. Increasingly, children specialize in one sport early and play year-round, often on multiple teams. By age 7, some participate in select or travel leagues that are independent of school-sponsored programs.

About 70 percent of children drop out of organized sports by age 13, research shows.

While many factors could account for the drop-out rate: "One reason could be pressure to perform better and lack of enjoyment due to a variety of reasons, including a lack of playing time," Dr. Brenner said.

As seen during the recent Olympic games in Rio, some sports -- such as figure skating, rhythmic gymnastics and diving – may require early specialization because peak performance occurs before physical maturation. For these sports, more research is needed on the long-term health effects, according to the AAP.

Among the recommendations from the AAP:

  • Delay sports specialization until at least age 15-16 to minimize risks of overuse injury.
  • Encourage participation in multiple sports.
  • If a young athlete has decided to specialize in a single sport, a pediatrician should discuss the child's goals to determine whether they are appropriate and realistic.
  • Parents are encouraged to monitor the training and coaching environment of "elite" youth sports programs.
  • Encourage a young athlete to take off at least three months during the year, in increments of one month, from their particular sport. They can still remain active in other activities during this time.
  • Young athletes should take one to two days off per week to decrease chances of injury.

    "The ultimate goal of sports is for kids to have fun and learn lifelong physical activity skills," Dr. Brenner said. "We want kids to have more time for deliberate play, where they can just go out and play with their friends and have fun."

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The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.


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