Health issues in youth sports

Rocky Mountain High School, football field

The health issues of youth sports are concerns regarding the health and wellbeing of young people between the ages of 6 and 18 who participate in an organized sport. Given that these athletes are physically and mentally underdeveloped, they are particularly susceptible to heat illness, eating disorders and injury; sufficiently severe conditions can result in death.

Heat illness and dehydration

Heat illnesses are a recent concern in youth athletics. They include heat syncope, muscle cramps, heat exhaustion, heat stroke and exertional hyponatremia.^[1] Heat illness and dehydration are typically brought on by conditions of high temperatures and high humidity. These conditions carry increased risk for young athletes, particularly if at the beginning of a season when they are less fit. Other factors which increase vulnerability include: heat-retaining clothing, recent illness, previous experience with heat illness, chronic conditions, or sleep deprivation.^[2] Additional precaution is to be taken if the child is taking supplements or using cold medication.

Heat illnesses are among the primary causes of sports-related death or disability, and as such they require immediate medical attention. Symptoms to watch for are as follows:

• dry or sticky mouth^[2]
• headache
• dizziness
• cramps
• unusual fatigue
• confusion^[1]
• loss of consciousness

Eating disorders

Eating disorders are generally not a primary concern amongst youth athletes, however they are unusually prevalent in wrestling and aesthetic sports such as gymnastics. These place heavy emphasis upon weight and body image as ingredients for success in competition. In order to compete, 81% of wrestlers will deliberately lose weight.^[3] This involves shedding 3% to 20% of their body weight — most of which being dropped within a short period of time. For rhythmic gymnasts, “success is strongly influenced by visual appeal and body aesthetics. Rhythmic gymnasts are often required to meet certain weight targets to attain and maintain a thin shape.”^[4] The pressure to please is intense, and correspondingly, 42% of female aesthetic athletes have been diagnosed with eating disorders.

Youth athletes employ a variety of methods to lose weight, including dehydration, fasting, diet pills, laxatives, vomiting, and the use of rubber exercise suits. These practices result in “decreased plasma and blood volume, reduced cardiac outputs, impaired thermoregulatory responses, decreased renal blood flow, and an increase in the amount of electrolytes lost from the body.”^[5]

Long-term effects

It has been postulated that wrestlers may suffer impaired growth and development due to their fluctuating body weight.^[5] However, a study^[3] examining high school wrestler growth patterns concluded that participation does not stunt growth. In relation to eating disorders, young female gymnasts may suffer from delayed menarche, menstrual irregularities, low body fat, and delayed maturity.^[4] Of these athletes, 11% are at risk for a mental disorder, while 40% risk delayed physical maturation.

Injuries

An issue unique to youth athletics is that the participants’ bones are still growing,^[6] placing them at highest risk for injury. Around 8,000 children are rushed to the emergency room daily because of sports injuries.^[7] High school athletes suffer approximately 715,000 injuries annually. Regarding American football, there are five times more catastrophic injuries in high school than compared to college-level competition.^[8]

Overuse injuries

Nearly half of all injuries in pediatric sports medicine are due to overuse. Such injuries can be attributed to inappropriate workout intensity and overlong athletic seasons.^[9] Other risk factors include sleep deprivation, general physical and cognitive immaturity, dietary imbalance and inadequate physical fitness.^[9] Among young athletes, common overuse injuries are stress fractures, which include injury of the:^[6]

• femoral neck/pubis
• femoral shaft
• tibia
• fibula
• metatarsals
• calcaneus
• cuboid

Concussions

Per year, high school athletes sustain 300,000 head injuries, 90% of which being concussions.^[10] Though by the beginning of high school, 53% of athletes will have already suffered a concussion. Less than 50% of them say something about it in order to stay in the game. If an athlete returns to competition before being completely healed, they are more susceptible to suffer another concussion. A repeat concussion can have a much slower recovery rate and be accompanied by increased symptoms and long-term effects. The severity of complications from concussion can include brain swelling, blood clots, brain damage and more.^[11] Ice hockey, soccer, wrestling and basketball carry a high risk for concussion, with football at the top. ). Concussion causing situations that involve leading with the head, hitting head to head and striking a defenseless athlete have become subject to penalty in order to discourage players and coaches from this type of play.^[12] These rule changes have resulted in technique changes at the youngest levels of sports, and youth athletes are now being trained in methods avoiding illegal contact. Youth sport organizations have also made equipment changes to better protect players. A widespread myth is that helmets protect athletes from concussions; they are actually worn to prevent skull fractures. Facts like this have prompted trainings on proper equipment use and not relying on helmets as an implement of contact.^[11] A history of concussion in football players can contribute to sports-related sudden death.^[13]

Sports-related death

Sometimes sports injuries can be so severe as to result in actual death. Over the past year, 48 youths died from sports injuries.^[14] The leading causes of death in youth sports are sudden cardiac arrest, concussion, heat illness and external sickling. Cardiac-related deaths are usually due to an undiagnosed cardiovascular disorder.^[15] Trauma to the head, neck and spine can also be lethal.^[13] Among young American athletes, more than half of trauma-related deaths are to football players, with track and field, baseball, boxing and soccer also having relatively high fatality rates.

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