Keeping Kids Playing Injury-Free

Would you let your son or daughter ride in a car driven by an unlicensed, unqualified driver? Of course not. The inherent risks are obvious. Sports have inherent risks, too, yet every day parents drop their kids off for practices or games where there's no one trained to handle injuries.

To get an idea of the risks involved in youth and high school sports, identify the following statements as true or false:

1. An athlete can collapse from dehydration in cool weather or while playing indoors.
2. "Playing through the pain" can cause a minor injury to become serious.
3. Many coaches in church leagues, schools, and independent youth sports organizations are not required to know first aid and CPR.
4. Overuse injuries are more common than acute injuries. Insufficient rest after injury, poor training, and lack of conditioning are contributing factors.
5. Most injuries occur during practices.
6. The incidence of injuries requiring surgery is nearly as high for high school baseball and softball players as for football players.
7. Children aged 5 to 14 account for nearly 40% of all sports related injuries treated in ERs.

If you answered "True" for all the questions you were correct.

To raise awareness about sports safety, the National Athletic Trainers Association (NATA) and American Academy of Orthopaedic Surgeons (AAOS) recently ran a public service ad campaign, asking, "What will they have longer, their trophies or their injuries?" WebMD talked to two experts committed to raising safety standards for organized kids' sports so that "trophies" will triumph over "injuries."

Sports Injuries Spiking

In 2003, more than 3.5 million kids aged 5 through 14 engaged in organized or informal sports activities were treated for injuries, according to the U. S. Consumer Product Safety Commission (USCPSC) National Electronic Injury Surveillance System. That's up from 775,000 kids in 1995. Experts cite several reasons:

• Growing number of organized sports for boys and girls of all ages and increased participation.
• Organized sports attracting a generation of kids who have great finger dexterity from video games but lower cardiovascular health than previous generations of kids.
• Specialization and year-round play in a single sport leading to overuse injuries like strains and Little League Elbow.
• Parents pushing kids to excel. "Some parents are living through their kids, and 25% of parents expect their ninth graders will be pros," says Almquist, who is also athletic training specialist for the Fairfax County Public Schools, Fairfax, Va.
• Failure to rest after injury. "Some parents will doctor shop to find one who will clear their kid to play," says Almquist.
• Parent volunteers not trained in proper coaching techniques or first aid.
• Church and independent sports leagues without plans for events such as lightning or medical emergencies. "Whereas high school teams have a limited number of players and might employ an athletic trainer, church and independent leagues might have 300 to 500 players and no medical personnel," says April Morin, executive director of the National Center for Sports Safety (NCSS) in Birmingham, Ala.

"A lot more research needs to be done on youth and high school populations," says Almquist. "Most research is done on college kids, and it doesn't always translate well to younger populations."

NATA released a detailed three-year study in 1999 showing trends in high school injuries in 10 sports: boys football, boys basketball, girls basketball, boys wrestling, girls field hockey, girls volleyball, boys soccer, girls soccer, boys baseball, and girls softball.

Overall, in every sport except field hockey, sprains and strains accounted for at least half the injuries. Of injuries requiring surgery, 60.3% were to knees. On average, more than half the injuries occurred during practices.

Besides comparing injuries among sports, the study showed percentage rates for the comparative frequency of each type of injury (general trauma, fractures, etc.) within a given sport. For example, in baseball, sprains accounted for 16% of all injuries.

Following is a summary of study results for baseball, softball, basketball, football, and soccer:

Baseball and softball. The proportion of baseball injuries requiring surgery was nearly the same as that for football. Baseball and softball had the highest rate of fractures (8.8%), while baseball had the lowest rate of knee injuries (10.5%).

Basketball. The highest proportion of surgeries was for girl's basketball (4.0%). More than one-third of the injuries for both boys and girls were to the ankle and foot and occurred while players scrambled for loose balls.

Football. Football had the highest rate of injuries compared with the other sports. During the 1995 season, 39% of varsity football players were injured, but the severity of injuries had decreased compared with a 1988 study. Most injuries were to the hip, thigh, and leg, followed by the forearm, wrist, and hand. During games, the offensive lineup had 55.5% of injuries, the defensive team, 35.8%, and special teams, 4.3%.

Soccer. Of the 10 sports surveyed, the highest frequency of knee injuries was in girl's soccer (19.4%). Nearly one-fourth of the boys and girls playing soccer had at least one time-loss injury during a season. Nearly one-third of soccer injuries were to the ankle and foot.

Types of Sports Injuries

Two types of injuries occur in kids' sports: acute and overuse.

Acute injuries are caused by a sudden trauma and include bruises, sprains, strains, and fractures. They often occur when an athlete falls, twists an ankle, or collides with another player. "How the player is handled immediately following injury is important," says Almquist. "If there's an athletic trainer or medical professional on hand when an athlete suffers a concussion or other injury, their care can prevent a minor injury from becoming a major one."

Repetitive motion and specialization in a single sport, instead of playing various sports according to the season, account for most overuse injuries. A prime example is "Little League Elbow," a term for an injury resulting from throwing in various sports, not just baseball. Also common are tears in tissue where tendons attach to the leg bone or heel bone.

An overuse injury shows up as a nagging pain that doesn't go away and will gradually get worse over time, Almquist tells WebMD. "If your kid keeps complaining, get a professional evaluation."

According to the American Academy of Orthopaedic Surgeons, signs that your child should see an orthopaedic surgeon include:

• Inability to play following an acute or sudden injury
• Decreased ability to play because of chronic or long-term complications following an injury
• Severe pain from acute injuries, which prevent the use of an arm or leg
• Visible deformity of the arms or legs

"Prepare" is an online safety training course developed by NATA and NCSS for coaches and parents. "Parents can take our course or a course locally through the Red Cross," Morin tells WebMD. "We're not teaching how to provide care as much as how to prevent and recognize emergency situations and know what to do until professional help arrives on the scene."

NCSS and NATA have developed separate but similar safety guidelines including:

• Have an emergency plan. The plan should include who is responsible for providing first aid, how parents will be notified of an injury, emergency phone numbers, and a list of each student's medical conditions readily available at all practices and games. An emergency plan needs to be comprehensive, detailed, and distributed to every coach.
• Use qualified allied health professionals. A NATA certified athletic trainer or another qualified allied health professional should be on staff to provide education, immediate care, treatment, and rehabilitation of injuries.
• Have a team physician/consulting physician. Schools should have a team physician who knows sports medicine.
• Require pre-participation physicals. Annual physicals should be required for sports participation.
• Keep up to date medical alerts. Every team and league should require a medical alert form for players. Guidelines should be in place so that treatment for conditions such as asthma or anaphylaxis is readily available to be administered when needed. "Parents have a responsibility to tell the coach if their child has a medical condition, such as asthma, diabetes, or pre-existing injury," says Morin. "And the child needs to carry an inhaler or emergency sugar resource or insulin. Getting ready for practice, it's easy to forget those things."
• Group kids in youth leagues according to size. "This is most important in contact sports," says Morin. "An 8-year-old who weighs 60 pounds shouldn't be playing against a 10-year-old who weighs 120 pounds."
• Weather protocol. Guidelines should be in place in the event of lightning or extreme heat. "No child should die as a result of lightning or heat exposure," says Morin. "It's totally preventable."
• Education of coaches. Coaching staff should be required to have ongoing education in coaching techniques, CPR, and first aid. "Coaches who haven't had safety training in the last five year are not up to date," Almquist says.
• Keep first aid kits on hand. "If a child has severe bleeding, does someone know how to use the kit?" Morin asks.
• Conditioning programs. Supervised pre-season, in-season, and out-of-season conditioning programs should be available to all student athletes.

The experts tell WebMD that safety should be of concern to everyone involved: national safety and sports associations, communities, schools, sports leagues, the medical profession, parents, and athletes themselves.

"We can't eliminate all injuries," says Almquist. "But through safety education and on-site care, we'll have more minor injuries because we'll get to them before they become severe."

"Parents pay a lot of money for kids to participate in sports, and they assume there's someone in charge of keeping their children safe," says Morin. "But they have to ask if anyone is educated to recognize injuries and respond? If parents aren't asking for that, we can't raise the standard of safety."