The Pediatric Athlete

A pediatric athlete can be any child or adolescent usually under the age of 18 years who participates regularly in sports activities.

Understanding physical and physiologic differences between pediatric and adult patients aids in the prompt recognition and management of most medical and orthopedic conditions affecting a pediatric athlete.

Activity type, skill level, and motivation for sports participation greatly vary at different ages and levels of maturity; therefore, it is best to understand young athletes in the context of their chronologic age, developmental stage, and physical maturity, coupled with an assessment of the nature and level of sports participation.

It is important to understand both the child’s and parent’s motivation for sports participation and to capitalize on opportunities to educate parents, athletes, and coaches on healthy athletic participation and sports safety.

Sports specialization is defined as intense activity in only one sport throughout the year. Avoiding early sports specialization may decrease the risk of injury, overtraining, and burnout.

The ultimate goal of youth sports participation should be the promotion of lifelong physical activity, pursuit of recreation, and enjoying the challenge of competition.

Healthcare professionals face challenges at both ends of the physical activity spectrum: the sedentary obese child, who faces a lifetime of morbidity related to physical inactivity, and the highly competitive, overzealous, often anxious, and potentially undernourished young athlete are both at risk for a myriad of injuries associated with sedentary behaviors or excessive exercise. A successful pediatric athlete will lead a healthy, balanced lifestyle and integrate exercise, nutrition, and recreational pursuits with an adequate amount of rest and recovery.

Several conditions that affect pediatric athletes are similar to those that affect adult athletes. Examples include cardiac conditions (e.g., cardiac arrhythmias), pulmonary conditions (e.g., asthma), mental health conditions (e.g., eating disorders and stress/anxiety/depression), endocrine disorders (e.g., diabetes and obesity), renal conditions (e.g., polycystic kidney disease), and infectious diseases (e.g., community-acquired methicillin-resistant Staphylococcus aureus [CA-MRSA], HIV, mononucleosis, and coronavirus-19 [COVID-19]).

Prompt recognition and management of these conditions may lead to safe and early return to sports.

A preparticipation physical examination (PPPE) (refer to Chapter 3 ) is recommended for pediatric athletes before organized sports participation. It is usually a state-mandated legal requirement for participation in high school interscholastic athletics.

The PPPE is a helpful tool for physicians to identify medical conditions that may affect participation in sports and physical activity.

According to 2018 guidelines from the US Department of Health and Human Services, children ages 6 to 17 years should engage in 60 minutes of physical activity every day, which should include 3 days per week of vigorous-intensity, muscle- and bone-strengthening activities. These guidelines also suggest that children ages 3 to 5 years should try to obtain 180 minutes of physical activity throughout each day.

Suggestions to encourage physical activity:

• Limit or reduce sedentary time (television, computer, video games, and phone) to 30 minutes/day outside of mandatory school computer time.

• Find fun activities that children enjoy.

• Incorporate parent role models.

• Emphasize the social aspect of participating in team sports.

• Promote the use of activity trackers (step counters, wireless trackers, wearables, etc.).

There are numerous benefits of exercise in pediatric patients ( Box 10.1 ).

Obesity is the most important health concern among children in the United States.

The prevalence rate of obesity in children is 11%–22%, and it has doubled in the past 20 years.

Childhood obesity is increasing at an epidemic rate, particularly in economically disadvantaged areas and minority populations.

Concerns regarding potential negative effects of athletic competition on growth and maturation have existed for many years, particularly attributable to the trend of intense competition at younger ages.

• The demands of sports require a certain level of physical and psychological maturity in order to participate. Feelings of insecurity, frustration, and failure may cause young athletes to quit because of burnout or inability to perform up to expectations.

• While young athletes are struggling to master advanced sports-specific skills, their coaches may be less experienced and less educated in appropriate training techniques; these barriers can negatively affect a young athlete’s enjoyment and participation in his or her sport(s).

A significant challenge for sports medicine healthcare providers is the consideration of the development of the neurologic, cognitive, somatic, and psychological interdependent processes and the effects of each of these on the health and well-being of pediatric athletes.

• An understanding of fundamental principles of normal child and adolescent growth and development is essential in providing quality healthcare for young athletes.

Growth and maturation is a natural, fundamental, continuous process, with achievement of the same milestones in the same order.

• The rate of progression varies greatly and seems predominantly genetically regulated.

• Neuropsychological development often does not parallel physical development.

• Growth refers to an increase in size of the body and its parts, including stature, body systems, and body composition.

• Maturation refers to a biologically mature state of skeletal, sexual, and somatic development with variable timing and tempo.

• Neurodevelopment is culturally mediated and is the acquisition and mastery of behavioral competence.

• Quantitative milestones are easy to measure by the number of skills performed.

• Qualitative milestones are harder to measure because they reflect mastery of specific skills.