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AAP releases guidance on sports specialization, training in young athletes

Pediatricians should advise patients interested in athletics to participate in multiple sports, at least until puberty, as it can decrease the chances of injuries, stress and burnout, according to an AAP clinical report.

Other recommendations pediatricians should consider for young athletes include taking a 1-month break from training at least three times per year to allow for sufficient recovery and taking at least 1 or 2 days off per week from sports to decrease chance of injuries.

“Youth sports culture has changed dramatically over the past 40 years,” Joel S. Brenner, MD, MPH, FAAP, of the Children’s Hospital of the King’s Daughters, in Norfolk, Virginia, and chair of the AAP Council on Sports Medicine and Fitness Executive Committee, and colleagues wrote in the report published in Pediatrics. “… The norm has become for children and adolescents to participate in organized sports driven by coaches and parents, often with different goals for the game than its young participants. It is also less common now to have a multisport athlete in middle or high school, because the norm has become for young athletes to specialize in a single sport at younger ages.”

The committee members reviewed epidemiology of youth sports and the current trend of specialization, focusing on physiologic concerns regarding intensive training and the effect of specialization on athletes who are younger than 18 years. They drew data from the 2008 National Council of Youth Sports, which reported that 60 million children and adolescents aged 6 through 18 years participated in organized sports, of which 27% specialized in only one sport.

They also found that overuse injuries account for 46% to 50% of all athletic injuries. In addition, only 3% to 11% of high school athletes go on to compete at the college level, and just 0.03% to 0.5% reach the professional level. As many as 70% of children drop out of organized sports by age 13 years. Brenner and the committee also reviewed long-term athlete development programs, including those used by the U.S. Olympic Committee, and the Development Model of Sport Participation.

According to Brenner and the committee, studies show that intensive training in young athletes, whether specialized or not, may potentially affect aspects of their health, including cardiac, nutrition, maturation, musculoskeletal and psychological. However, no studies show any adverse effects on the cardiovascular system. In addition, studies indicate that Division 1 NCAA athletes are more likely to have played multiple sports in high school, though their first organized sport was often different than the one they would later choose to specialize in. Of the 322 athletes invited to the 2015 NFL scouting combine, 87% reported playing multiple sports in high school. Other studies of elite athletes showed that intensive training did not start until late adolescence. In addition, they suggested that, in most sports, late specialization with early diversification is most likely to lead to elite status. Meanwhile, athletes who engaged in sport-specific training had shorter athletic careers.

The results of their review led the committee to release the following guidelines for pediatricians:

• The primary focus of sports for young athletes should always be to have fun and learn lifelong physical activity skills;
• Playing multiple sports, at least until puberty, decreases the chances of injuries, stress and burnout;
• For most sports, waiting until late adolescence to specialize in a sport may lead to a higher chance of achieving athletic goals. Exceptions include figure skating, gymnastics, rhythmic gymnastics and diving, as peak performance typically occurs before full physical maturation;
• Early diversification and delayed specialization increases the likelihood of lifetime sports involvement, physical fitness and possibly elite participation;
• If a young athlete opts to specialize in a single sport, discuss with them their goals, and determine whether they are appropriate and realistic;
• Advise parents and guardians to closely monitor the athlete’s training and coaching environment in “elite” sports programs, and be aware of best practices;
• Allow for at least 3 total months of downtime from training throughout the year, spread out in 1-month increments, for physical and psychological recovery;
• Taking at least 1 to 2 days off per week from their sport of interest can decrease the chance of injuries; and
• Closely monitor young athletes who enter intensive training, noting the patient’s physical and psychological growth and maturation, and nutrition.

“Talented youth are starting to be ranked nationally as early as sixth grade,” Brenner and the colleagues wrote. “… Given what is currently known about early sport specialization, this changing paradigm should be discouraged by society. The AAP, NCAA, pediatricians, parents and other stakeholders should advocate banning national ranking of athletes and college recruitment before the athletes’ later high school years.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.