A 12-year-old soccer player comes into your office with knee pain. After a thorough history and physical exam, you appropriately make the diagnosis of Osgood-Schlatter.  As part of the history, you learn that your patient is playing soccer year-round, sometimes on two teams at the same time. She has had only three weeks off from soccer during the past 12 months (during the winter holidays) and usually plays somewhere between five and seven days per week. Your patient and her parents tell you that she would like to play in college and hopefully get a scholarship.

This encounter has become commonplace in the office of pediatricians and pediatric sports medicine physicians. It is becoming rarer for kids to go to the park and play pick-up games with no adult involvement. Instead of “deliberate play,” young athletes are spending more time in “deliberate practice,” where the activity is highly structured with the goal of improving performance as opposed to enjoyment.

The new AAP clinical report Sports Specialization and Intensive Training in Young Athletes reviews the background of specialization, discusses concerns with intensive training and answers common questions regarding sports specialization in young athletes. Included in the report is an infographic that can be used as an educational tool for patients, parents and coaches.

The report, from the AAP Council on Sports Medicine and Fitness, is part of the September issue of Pediatrics.

Guidance for pediatricians

The following guidance outlined in the report can be helpful for pediatricians when discussing sports specialization with young athletes, parents and coaches:

• The primary focus of sports for young athletes should be to have fun and learn lifelong physical activity skills.
• Participating in multiple sports, at least until puberty, decreases the chances of injuries, stress and burnout in young athletes.
• For most sports, specializing later (i.e., late adolescence) may lead to a higher chance of the young athlete accomplishing his or her athletic goals.
• Early diversification and later specialization provide for a greater chance of lifetime sports involvement, lifetime physical fitness and possibly elite participation.
• If a young athlete has decided to specialize in a single sport, discussing his or her goals to determine whether they are appropriate and realistic is important. This discussion may involve helping the young athlete distinguish these goals from those of the parents and/or coaches.
• Having at least three months off throughout the year, in increments of one month, from their particular sport of interest will allow for athletes’ physical and psychological recovery. Young athletes can still remain active in other activities to meet physical activity guidelines during the time off.
• Having at least one or two days off per week from their sport of interest can decrease the chances of injuries in young athletes.

Now when you encounter another young athlete who loves playing a sport, you can use these tools to provide encouragement to remain active, learn lifelong physical activity skills and most importantly have fun.

About Joel Brenner, MD

Dr. Joel Brenner is a leading specialist in overuse injuries and concussions, as well as medical director of CHKD's Sports Medicine Program. He is a past chairman of the American Academy of Pediatrics' Council on Sports Medicine and Fitness.