Current Recommendations For Children’s Sports: A Sports Medicine Perspective

I attended several pediatric conferences in the last few weeks, and brought you a post about the new public health campaign in my state to close a “language gap” affecting children in the public school environment (you can see the interesting discussion in that post when some folks asked my opinion about the intersection of this campaign and Waldorf parenting, where we often do not speak as much to the young child and tend to use our speech in verse, rhyme, and song..Great questions and observations by parents! ).  One of the other interesting sessions I attended was about the history of children’s sports in the United States, and current recommendations in a country where the children are being pushed into elite travel teams and many hours of practice a week..and ending up with many injuries, surgeries and rehabilitation programs as a result.  The pediatric sports medicine doctors at this conference had quite a bit to say.

First of all (much to my personal dismay), they truly felt that the country was not going to “go back” and leave competitive sports for the upper middle school and high school levels the way it used to be.  They cited the 60 million dollar contract ESPN made with Little League in order to televise the Little League World Championship games, and the websites that list the top 7 and 8 year olds in basketball in the nation.  Yes, it seems crazy to those of us who are older and remember how things used to be.   Just crazy.

They also pointed out that history is not really on the side of going back to not having competitive teams for children younger than high school  either.  Essentially, at one point in time, the United States did “go back” and limited interscholastic participation in sports to those 10th grade and above (around 1939, after there was a flourishing of sports under Theodore Roosevelt and others prior to this time).  There were  many playgrounds about  during this time, and without coaches and such involved,  parents just  took over in teaching their children and forming sports leagues themselves.   Of course, in this day and age, this has further morphed into elite travel teams and the like.

The other reason cited for not being able to “go back” is that this is seen as the most scheduled generation of all time.  Parents know where and what their children are doing practically every second of the day, so free play seems like a huge barrier to overcome.  Even if children go outside to “free play”, generally a parent is standing there.  Some children are afraid to play in their own neighborhoods. Safety and lack of greenspace and such are seen as barriers to free play.  Finally,  the last barrier  is an electronic one, where children will stay inside and play on a screen or watch a screen rather than being outside.

The sports medicine doctors recognized that by age 14, 73 percent of the children involved in competitive sports QUIT!  The differences between child and adult led games were discussed.  When children organize games, it is much different than when adults do!  When children organize games, the children organize it around ACTION.  There is not a lot of sitting on the sidelines usually, even if a game is stopped in the middle and players are traded to make teams more “equal”.   Children craft games hinging on challenging and exciting experiences, close scores because children don’t  usually want a blowout (sometimes there are “mercy endings” if scores are really disparate), the rules are bent or changed or added to make things more fun or more even (remember “do-overs”?) .  There are even things like “ghostmen”, or having the bigger children  “handicapped” (throw with your left, kick with your left)  to make the game and teams more even.  So much different than when adults get involved!  The pediatric doctor acknowledge this, and hope to do a few things so this spirit is not lost forever.

The wish of the sports medicine doctors and athletic trainers in the room seemed to be for  a focus on safe skill acquisition, and to encourage fun, peer support, enthusiastic and safe coaching (and they pointed out that most coaches do not learn anything about child development at all!) and most of all, rotation of sports throughout the year without a “specialization” in one sport until the upper middle school grades.  They also want to encourage free play.

There was a  big push discussed  for pediatric providers to provide realistic expectations for parents.  There was a study in 2006 by Rohloff out of Wisconsin where 22 percent of the parents interviewed EXPECTED their child athletes to become pro players!  That is a super high expectation considering that  less than 7 percent of high school athletes even play in college.  In American football,  less than 1 percent of high school football players make the pros.  Out of the four million babies born in the United States, 300 will earn a pro paycheck long enough to say they had a career in pro sports.  In the meantime, is this tiny possibility enough to ruin a child’s body for life?  When we are dissecting what to do after shoulder surgeries for fourteen year old pitchers, rehabilitation for gymnasts who have severe back pain and need hardware implanted, etc. and the best way to rehabilitate a child whose identity is their sport,   is this what should be encouraged?  Instead, nurses, pediatricians, sports physicians, physical therapists, athletic trainers, coachers are being asked to provide parents with realistic expectations, with the idea that early specialization is not helpful or necessary to sports success in the later years and that the focus should be on establishing health, not pro players.

There is a call and a push for better training for coaches in the area of child development, injury assessment and prevention of injury; to develop safety programs, products and rule modifications for safer play;  to encourage free play as much as possible and to discourage early competitive specialization, and to help parents and those working with student athletes to understand readiness cues for sports that are related to development.  It doesn’t seem as if any organization is taking this under their wing as a public health campaign at this point, however, and I am not certain the message is really getting out to the average American parent.  I wish there was.


10 thoughts on “Current Recommendations For Children’s Sports: A Sports Medicine Perspective

  1. I tried to comment earlier, but I don’t think it went through. I’m struggling with this right now, actually. In theory, I have always planned to delay organized sports until middle/high school. However, I just caved and let my 6 year old start a gymnastics class because she’s very physically active and taught herself to do quite a bit already, and really wanted to try a “real class.” Apparently she has some natural ability and was asked to join a competitive team after only a few lessons. I declined, and am sticking with one class a week for now. But this is a sport where people start at 2, 3 and 4 years old, and get competitive very early. I’m opting my daughter out of that for now, but wonder if I’m going to deny her a chance to really excel at something that she loves and is great at, because people seem to peak in their teens in gymnastics, unlike almost any other sport I can think of. Any insight, advice?

    • Alexis,
      My insight is to not specialize nor push competitive teams at such an early age…Remember, most children who start early quit by age 14. Gymnasts have a particular injury set, and are unfortunately a lot of the case studies shown at pediatric orthopedic conferences. Good coaches will have great respect for the developing body, developmental readiness for increasing training, and impeccable attention to biomechanics. So my other bit of advice is to never be afraid to take time off, to rest, to play and also to find coaches that are in sync with you. You are in the driver’s seat! It does get competitive early, but there are not exceptions to early specialization for gymnastics from any of the other sports. If you are really in doubt, make an appointment to talk to the head of your local pediatric sports medicine section of a children’s hospital or an athletic trainer who has been around a long time working with gymnasts – they will tell you what injuries a gymnast will be prone to over the years and what things should be happening when. Prevention is key. None of the surgeons or trainers in my conference were for early specialization, and many had done surgeries on children who wanted to return to play against medical advice to stop playing at all. We hate to see that, but this early pushing is not helping the children in the long run to have long careers in their sports.

  2. This is a great piece. Thank you. I definitely plan on delaying competitive sports for my kids. I was a very serious basketball player from an early age. I trained year round and was determined to play college and pro. I hurt my knee playing and had surgery at age 15. When things didn’t work out as I had planned, I spiralled for years, because so much of my identity and self-worth were caught up in basketball.
    I want my kids to have more balance. To have sports be something they do for fun, casually, alongside all the other things they do for fun.

    • MJ,
      I want to thank you for writing in…Your story is one that I see all too often in the pediatric sports medicine circles, and I do think boundaries around sports are as important for the 7-13 year old as they are around any other area we would shudder if that was all a child did or, as you say, their place and identity was totally wrapped in this..I see this in the horse world as well (my older girls ride)..

  3. Great article. I’m wondering what are the current recommendations for children starting things like horse riding if it’s purely for fun and/or learning a new skill i.e. absolutely no competing, races etc? I’d love to know your thoughts about suggested starting ages for this. My 7 year old daughter is desperate to start riding lessons but I am holding off for the time being! Thanks.

    • Hi Sam!
      Great question..As far as I know, there are NO recommendations as to what age a child should begin a sport by any pediatric organization. The doctors in the room of the conference didn’t seem to mind children starting, so long as specialization was not entertained and they didn’t see the parents getting more invested than the children or the child’s sole identity being tied up in sports and that the child had plenty of access to free play outside. They wanted to promote sports as health and recreation and movement. Our girls ride; most places do seem to start around age 7 but it is really the older children who “get” it, progress more quickly, and can get into the work aspect of barn life. For some children age 7 could be wonderful and they nmight really need it at that age; for some they are short, their legs barely wrap around the horse and they don’t have good attention or strength to ask the horse what to do and they would be just as happy to go to a barn and brush horses and feed them carrots. I would look for a barn where the child has to get the horse, curry the horse, tack the horse, etc themselves. They should learn good horsemanship and aspects of horse care – and be able to observe the farrier coming, the dentist coming, etc. I would also look at how the horses are treated – many barns do not treat their horses well. Look for a barn where the horses are given vacations off during the course of the year, the horses get chiropractic care, the trainers use natural horsemanship techniques.
      I would look very carefully for readiness cues in your child just like you would for any other sport or activity. Early starting can often lead to burnout or just being done by age 14, so that is something to keep in mind. I think fourth grade and up for horseback riding is the most perfect time to begin things, but as I said, it is not uncommon for smaller children to start riding or doing other sports and it may be the right thing for your child.

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