A for Athlete



Dr. Elaine Cox is the medical director of infection prevention at Riley Hospital for Children at Indiana University Health in Indianapolis. She is also the Riley clinical safety officer. Dr. Cox practices as a pediatric infectious disease specialist and also instructs students as a professor of clinical pediatrics at the Indiana University School of Medicine. The former director of the pediatric HIV and AIDS program, Ryan White Center for Pediatric Infectious Diseases at Riley, Dr. Cox helped lead the effort to change Indiana law to provide universal HIV testing for expectant mothers.

Kids and Sports: Can We Keep Our Eye on the Ball?[]

Parents and coaches can take these steps to mitigate the negative outcomes of youth sports

Creating a healthy sports culture for kids starts with adults.[]

By Elaine Cox, M.D., Sept. 21, 2015

Organized sports are big business in America. We love our teams, wear their apparel and spend millions on tickets, memorabilia and concessions. Professional athletes make millions of dollars in endorsements. Community-run sports leagues for kids seem to be following suit, with as much as $5 billion going to these groups annually. Families report that nearly 75 percent of young, school-age kids participate. The family income and time are often devoted to the development of the young athlete. We believe, as a nation, that sports have great benefits, even for our children. Is our perspective on target?

It's widely accepted that kids who participate in team sports reap benefits. They have overall improved self-esteem, confidence and the ability to work with others. Multiple studies have shown that children who partake in organized sports tend to have fewer symptoms of depression, social anxiety and distorted body image. Shy youth who play a sport for longer than a year showed decreased social anxiety over time. These young athletes may also show less risk-taking behavior as they age, due in large part to the social support network they build through organized team play. And, as caregivers have claimed for eons, a busy kid can't get into trouble, with rates of teen pregnancy, smoking and substance abuse going down as physical activity and sports involvement increases. Kids' time-management skills may also be honed out of necessity.

The physical health benefits are also often touted as justification for playing sports. Youth who participate in sports grapple less with obesity; have reduced body fat; better bone health; and improved cardiovascular and metabolic health profiles. They are also likely to continue exercising regularly into adulthood, keeping an overall better level of health.

However, the arena of kids' sports is not nirvana. With all the potential positives, there are often many negatives as well, which is likely at least partly responsible for the great attrition rate in participation in late middle and older adolescence. By late high school, however, fewer than 20 percent of students are participating in athletics. So why do they walk away from such a potentially positive experience?

The first part of the answer is easy. Physical development plays a big role, some of which is beyond anyone's control. As children progress from free play in the very young ages into middle adolescence, stratification of skills begins to occur. Having some athletic gifts at a young age is not predictive of future success. During puberty, teens will experience changes in their bodies. Coordination may decline; flexibility certainly becomes more limited; and balance, due to a changing center of mass, may result in poor play.

In addition, the threat of sports injuries, some of which will be "career enders" for children, is very real. The most common injuries are due to overuse. Because of the developmental phases children go through from kindergarten to high school, which are marked by times of rapid growth and changes to growth plates, they are more vulnerable to injury. In fact, between ages 5 to 24, generally thought to be the upper limit of adolescence and young adulthood, there are 2.6 million emergency department visits related to sports injuries, resulting in a health care expenditure of about $2 billion per year. That's not all. The lack of rest in between injuries, preventing a full recovery; intense and repetitive exposure to the offending movements; and playing while injured can result in long-term bodily harm. Concussions and heat stress are also becoming all too common in our young athletes.

The second reason, although harder for people to discuss, is the influence adults have on the negative aspects of kids' sports. There is often a disconnect between the athlete's reasons for engaging in sports, such as to have fun and make friends, versus the parent or coach's perception that kids play because they want to win. In this instance, we are applying adult expectations onto the milieu of kids, who are not ready for such constraints.

Parents also often overestimate their young child's skill set. As with so many other tasks and skills of childhood, most young children will hit under the bell curve, and for a time, have skill levels that are pretty much equal. For example, some children will hit kindergarten already knowing how to read and tie their shoes. People might think these children are gifted, but most of their classmates will be doing this as well by the end of first grade. However, parents, in their zeal to build up their child's self-esteem, may push their child to overplay. They may inadvertently push the child into early specialization (playing just one sport) and to over train with year-round activity such as school team, club teams and personal training in Olympic development programs. This can lead to burnout and sustained injury, increasing the likelihood of quitting their sport, and perhaps all physical activity in the future.

Coaches also play a huge role in the overall sports experience and satisfaction of the young player. In fact, there may be times when young athletes actually spend more time with their coach than their family. Interestingly, most coaches are not formally trained in coaching tactics, recognition of injury or the appropriate stages of childhood physical, emotional and cognitive development. Coaches can be verbally abusive at times in their zeal to win and succeed, thereby negating all the emotional benefits of participation. Disagreements with parents can set the stage for athletes to overhear comments about playing time, favoritism and skill levels, often putting wedges between the teammates themselves, decreasing the overall benefit of playing to make friends.

So how do we create a healthy sports culture for our youth?

It certainly can be done with a little common sense and behavior change, both responsibilities of the adults involved.

Firstly, the guidelines for sports participation should be followed. The American Academy of Pediatrics recommends that children not play organized sports until the minimum age of 6 years, a tenet frequently ignored, especially in Little League baseball and soccer.

Specialization is not encouraged until at least around age 13. Athletes should never feel pressure to play when injured or even year round. There should be involvement in only one sport per season, with at least one to two days off per week, and two straight months of non-play during the year.

It is incumbent on the mature adults to set these limits, even when the athlete wants to play through it. Pressure to succeed for the purpose of college scholarships should be avoided. Fewer than 4 percent of high school athletes will actually get a scholarship to play in college and will not get a full ride. What's more, it ends someday for everyone, with only 1 in 6,000 to 10,000 college athletes going on to play professionally. Even then, time will take its toll and an early retirement will ensue.

There are some tactics parents and coaches can take to enhance the benefits and mitigate the negative outcomes of youth sports participation. First, they should learn about the sport and its potential pitfalls, as well as how to train and coach athletes in the way that mimics how good leaders conduct themselves in the workplace. Positive feedback should be the order of the day, with at least a 5 to 1 ratio of accolades compared to criticism. Adults should have realistic expectations for the kids playing, and focus on the achievement of social interaction, having fun and social integration above winning.

Winning should not equate with success nor should losing equal failure. Appropriate conflict resolution and spectator-coach interactions should be modeled at all times. Athletes who are talented above their peers should not be coddled or excused from responsibilities, such as school work or societal norms, and humility and modesty should be encouraged to avoid the culture of narcissism seen at times in the professional world of sports.

The benefits of sports can be epic. Indeed, a new study found the positive effects can last more than five decades when the experience has been a good one. Maybe adults can take a page out of the kid's playbook and remember why he or she wanted to play, and let that be the child's success. Otherwise, society may have to throw a flag on the sports culture that seems to be increasingly evident, especially from the sidelines.