CHILDREN IN SPORTS
OBJECTIVES
GROWTH AND MATURATION
PHYSIOLOGICAL DIFFERENCES
NUTRITIONAL CONSIDERATIONS
PSYCHOLOGICAL CONSIDERATIONS
THE IMMATURE MUSCULOSKELETAL SYSTEM
OBJECTIVES
 ACUTE SPORTING INJURIES
 OVERUSE INJURIES
 CHRONIC CHILDHOOD ILLNESS
 ACUTE ILLNESS AND SPORTS PARTICIPATION
 PRE-PARTICIPATION HEALTH EVALUATION
 INJURY PREVENTION
GROWTH AND MATURATION
1) VARIABILITY IN THE PHYSICAL GROWTH OF 6 YEARS
2) PEAK HEIGHT VELOCITY ( PHV )
3) 12 YEAR OLD: SIGNIFICANT DIFFERENT HEIGHT,
MUSCULAR STRENGTH, CARDIOVASCULAR FITNESS
LEVELS
4) NO REASON TO SEGREGATE SEXES UP TO 14 YEARS
OLD
PHYSIOLOGICAL DIFFERENCES
1) AEROBIC POWER:
- MAX.AEROBIC POWER THE SAME WITH ADULTS
( ENDURANCE )
- METABOLIC COST OF WALKING AND RUNNING
HIGHER ( TRAINING )
PHYSIOLOGICAL DIFFERENCES
2) ANAEROBIC POWER:
- SIGNIFICANTLY LOWER IN CHILDREN
( SHORT TERM POWER OUTPUT )
- IMPROVES WITH GROWTH
- IN GIRLS LITTLE CHANGE AFTER 12 YEARS OLD
- CHILDREN: LESS USE OF GLYCOGEN, LESS ABLE TO
REDUCE PH
PHYSIOLOGICAL DIFFERENCES
3) CARDIOVASCULAR SYSTEM:
- CHILDREN: HIGHER MAXIMAL HEART RATE
- LOWER STROKE VOLUME
- LOWER SYSTOLIC BLOOD PRESSURE
- BETTER PERIFERAL BLOOD FLOW ADJUSTMENT TO
SPORT
PHYSIOLOGICAL DIFFERENCES
4) RESPIRATORY SYSTEM IN CHILDREN:
- SHALLOW BREATHING PATTERN RESULTING IN
LOWER ABSORPTION OF OXYGEN FROM
INSPIRATION
- HIGHER RESPIRATORY FREQUENCY RESULTING IN
GREATER OXYGEN COST IN RESPIRATION
PHYSIOLOGICAL DIFFERENCES
5) EXERCISE IN HOT AND COLD ENVIRONMENTS:
CHILDREN ARE MORE VUNERABLE: RATIO OF SURFACE
AREA TO VOLUME 30-40% HIGHER THAN ADULTS
RESULTING IN FASTER INCREASE OR LOSS OF BODY
HEAT FOR CHILDREN. SWEATING MECHANISM IS FULLY
OPERATIVE AFTER ADOLESCENT GROWTH SPURT DEHYDRATION
NUTRITIONAL CONSIDERATIONS
1) ADOLESCENT GROWTH SPURT ( Because of the
massive physical changes happening in puberty,
teenagers have bigger nutrition needs compared
both to adults and young people who’ve finished
their growth spurts.)
2) IRREGULAR EATING HABITS ( Snacks, Missing
Lunch, etc )
3) ESSENTIAL: CALCIUM, FOLIC ACID, ZINC, IRON,
VITAMINS A,B6,C
4) DIETARY MANIPULATION (Eating Disorders)
PSYCHOLOGICAL CONSIDERATIONS
1) CHILDHOOD PLAY IS IMPORTANT FOR SPORT.
( FIRST 7 YEARS OF LIFE ESPECIALLY)
IT ENHANCES:
- BALANCE AND CO-ORDINATION
- PROPREOCEPTION ( POSITION SENSE )
- PRAXIS ( SPATIAL AWARENESS )
PSYCHOLOGICAL CONSIDERATIONS
2) REWARDS OF PHYSICAL ACTIVITY
- SELF ESTEEM AND ADMIRATION
3) SPORTS VERSUS PLAY ( AFTER 6 YEARS OLD )
GROUP GAMES, RULES OF GAMES, “GOAL”
GAMES = PREPARATION AND FEELINGS FOR
GAME SPORTS
PSYCHOLOGICAL CONSIDERATIONS
4) PSYCHOLOGICAL COSTS OF SPORTS:
- EFFORT OVER OUTCOME; praising effort over
outcome is best for children.
- MODELLING EFFECT; also called
observational learning or imitation. Involves the
use of live or symbolic models to demonstrate a
particular behaviour, thought, or attitude.
THE IMMATURE
MUSCULOSKELETAL SYSTEM
1) PRESENCE OF GROWTH CARTILAGE IN SKELETON;
cartilage at ends of long bones consists of the
epiphyseal, physeal, and articular cartilage
components.
A) ARTICULAR SURFACES (joint surfaces some of which
are cushioned by malleable cartilage)
B) EPIPHYSEAL PLATES, APOPHYSEAL INSERTIONS; are
susceptible to injury during adolescent growth spurts
due to muscle tightening across joints.
THE IMMATURE
MUSCULOSKELETAL SYSTEM
2) EFFECTS OF EXERCISE:
- INTENSIVE PROGRAMMES LEAD TO BONY
DEFORMATION
- HEAVY PHYSICAL TRAINING LEADS TO LONGER
PREPUBERTAL STATE IN GIRLS
- SPECIAL INTENSIVE TRAINING LEADS TO
STRENGTH IMBALANCE: SHOULDER
THE IMMATURE
MUSCULOSKELETAL SYSTEM
3) FACTORS ASSOCIATED WITH INCIDENCE OF
SPORT INJURIES;
- 3 INJURIES PER 100 CHILDREN PER YEAR
- 0.69 SERIOUS INJURIES PER YEAR PEAK FOR
BOYS: 14 YEARS OLD AND GIRLS: 15 YEARS
OLD
THE IMMATURE
MUSCULOSKELETAL SYSTEM
- INCOMPLETE RECOVERY FROM INJURY: 30%
- FOUL OR ILLEGAL PLAY: 13%
- OVERUSE INJURIES: 50%
STATISTICALLY, ORGANISED COMPETITION ACCOUNTS FOR
35% OF TOTAL SPORTING INJURIES . OF THAT FIGURE:RUGBY LEAGUE 32%,SOCCER, RUGBY UNION 11% (
MARTIAL ARTS, HORSE RIDING AT 2% WAS RATED THE
SAFEST), 30% REQUIRED MEDICAL ATTENTION, 11%
REQUIRED HOSPITALIZATION, 12% RESULTED IN LONG
TERM DYSFUNCTION.
ACUTE SPORTING INJURIES
1) HEAD AND NECK : VERY RARE BELOW 11 YRS. 1-5%
OF ALL SPORT INJURIES SERIOUS Central Nervous
System DAMAGE
2) DIAPHYSEAL FRACTURES
3) GROWTH PLATE INJURY: SALTER-HARRIS
CLASSIFICATION
4) AVULSION FRACTURE OF ACL (knee ligament)
5) AVULSION FRACTURE MUSCLE GROUPS
6) Slipped Upper Femoral Epiphysis: 30% SUDDENLY,
70% GRADUAL
OVERUSE INJURIES
1) OSTEOCHONDROSIS; a condition where a fragment of
bone and cartilage detaches from the joint surface.
2) STRESS FRACTURES: Can be caused by sudden increases in
training intensity. Confirmed via x-rays or bone scans.
3) MALALIGNMENT SYNDROMES:
TARSAL COALITIONS - Tarsal coalition is a congenital
abnormality that results in a partial or complete fusion
between two bones of the foot.
PERONEAL TENDONITIS - lnflammation or crowding of the
peroneal tendons. Usual cause is repetitive trauma. Direct
trauma (i.e., ankle fracture) or chronic lateral ankle
instability.
OVERUSE INJURIES
1) OSTEOCHONDROSES:
“ SELF-LIMITED,IDIOPATHIC, DEVELOPEMENTAL
DISORDERS OF PRIMARY OR SECONDARY OSSIFICATION
CENTRES”
- OSGOOD-SCHLATTERS, SINDING-LARSEN-JOHANSSON,
SEVERS
OVERUSE INJURIES
1) OSTEOCHONDROSIS:
- ARTICULAR SUBCHONDRAL ( bone / cartilage)
- PERTHES DISEASE ( femur)
- KIENBOCKS DISEASE ( wrist )
- KOHLERS DISEASE ( mid-foot )
- FREIBERGS DISEASE ( 2ND Toe)
OVERUSE INJURIES
- ARTICULAR CHONDRAL (splitting of the bone)
- OSTEOCHONDRITIS DISSECANS ( femur, capitelum,
talar)
- PHYSEAL: SCHEURMANNS (thoracic spine)
- BLOUNTS ( tibia )
CHRONIC CHILDHOOD ILLNESS
1) ASTHMA:
EXERCISE INDUCED BRONCHSPASM ( EIB)
EXERCISE INDUCED ASTHMA ( EIA )
2) DIABETES: INCREASED FATIGUE, ABNORMAL
THIRST, FREQ.URINARY,WEIGHT LOSS
3) EPILEPSY ( PETIT MAL, TEMPORAL LOBE,
GRAND MAL )
CHRONIC CHILDHOOD ILLNESS
4) CYSTIC FIBROSIS ( GENERAL EXOCRCINE GLAND
DYSFUNCTION )
CHRONIC RECURRENT SINUS AND RESPIRATORY
TRACT INFECTIONS
DIGESTIVE TRACT DISORDERS AND
MALNUTRITION
* SWIMMING OF PARTICULAR BENEFIT IN
BRONCHOSPASM HYGIENE
CHRONIC CHILDHOOD ILLNESS
5) HYPERTENSION:
(?) CAUSES, PRIMARY OR SECONDARY
SPORT IS CONSIDERED TO BE BENEFICIAL FOR
PRIMARY HYPERTENSION BUT AVOID PRIMARY
ISOMETRIC ACTIVITIES SUCH AS WEIGHT
LIFTING, WRESTLING, ICE-SKATING
CHRONIC CHILDHOOD ILLNESS
6) HEART DISEASE:
- CONGENITAL HEART DISEASE IN 5/1000 SCHOOL AGED
CHILDREN.
- RHEUMATIC HEART DISEASE IN 1/1000.
- VALVULAR DAMAGE, CARDIOMYOPATHY, MYOPATHY,
HEREDITARY SYNDROME IN 0.8/1000
- RHYTHM SIGNIFICANT DISORDER IN 0.7/1000
- CONGENITAL CORONARY ANOMALIES IN 2/100,000
CHILDREN
CHRONIC CHILDHOOD ILLNESS
6) HEART DISEASE
CARDIAC CONDITIONS ASSOCIATED COMMONLY
WITH SUDDEN DEATH IN SPORT ACTIVITIES:

AORTIC STENOSIS,

TETRALOGY OF FALLOT,

HYPERTROPHIC CARDIOMYOPATHY,

PULMONARY HYPERTENSION,

MYOCARDITIS
CHRONIC CHILDHOOD ILLNESS
CARDIAC CONDITIONS ASSOCIATED WITH SUDDEN
DEATH IN YOUNG ATHLETES:




HYPERTROPHIC CARDIOMYOPATHY
ABERRANT LEFT CORONARY ARTERY
AORTIC DISSECTION ( MARFANS SYNDROME )
CORONARY ARTERY DISEASE
ACUTE ILLNESS AND SPORT
PARTICIPATION
1) INFECTIONS
MONONUCLEOSIS ( GLANDULAR FEVER )
- SELF-LIMITED ACUTE VIRAL ILLNESS
- 90% INFECTED BY 30 YEARS OLD
- PEAK INFECTION RATE IS 15-25 YEARS OLD
- EPSTEIN-BARR VIRUS (EBV)
- DIAGNOSIS FROM POSITIVE HETEROPHILE
ANTIBODY TEST (MONOSPOT)
- ENLARGED SPLEEN 40-60%, RUPTURE 0.1 –0.2%
- 4 WEEKS ABSENCE, SYMPTOMS CAN LAST UP TO 6
MONTHS
ACUTE ILLNESS AND SPORT
PARTICIPATION
2) OTHER ACUTE ILLNESSES:
-HAEM.STREPTOCOCCUS (Scarlet Fever, Tonselitis)
-MYCOPLASMA PNEUMONIA (Bacterial Pneumonia)
-SIMPLE HERPES (not dangerous but it may be
exasperated by picking or scratching)
-TINEA PEDIS (Fungal infection of the toes and feet)
PRE-PARTICIPATION HEALTH
EVALUATION
* HISTORY TAKING, PHYSICAL EXAMINATION,
INVESTIGATIONS, ANTHROPOMETRIC MEASUREMENT
CONDITIONS REQUIRING FURTHER EVALUATION AND
POSSIBLE DISQUALIFICATION FROM SPORT:
1) UNRESOLVED ORGANIC HEART DISEASE
2) SUSTAINED HYPERTENSION WITH EXERCISE
PRE-PARTICIPATION HEALTH
EVALUATION
3) LOSS OF CONCIOUSNESS WITH EXERCISE
4) SERIOUS CNS TRAUMA OR SURGERY
5) HISTORY OF RECURRENT CNS SYMPTOMS
( SEIZURE ETC )
6) PERSISTENT HEAT INTOLERANCE
7) INTRACTABLE ORTHOPAEDIC PROBLEMS
PRE-PARTICIPATION HEALTH
EVALUATION
8) SINGLE ORGAN
9) HAEMORRHAGIC DISSORDERS
10) CHRONIC INFECTIONS
11) CHRONIC DEBILITATING ILLNESS
12) ENLARGED ABDOMINAL VISCERA
13) OBVIOUS PHYSICAL IMMATURITY
INJURY PREVENTION
1) FACTORS CONTRIBUTING TO SPORT INJURIES
- LACK OF COACHING EDUCATION
- INADEQUATE PRE-PARTICIPATION PHYSICAL EXAMS
- HAZARDOUS PLAYING FIELDS
- CONDITIONING AND TRAINING ERRORS
- EQUIPMENT; LACK, IMPROPER, POORLY FITTED
- PLAYING WHILE INJURED OR OVERTIRED
- GROUPING TEAMS BY AGE NOT SIZE
- POOR NUTRITION
- RULES AND OFFICIALS
INJURY PREVENTION
- IMPROPER TECHNIQUE
- INADEQUATE SUPERVISION
- PSYCHOLOGICAL STRESS
- WEATHER CONDITIONS
INJURY PREVENTION
PREVENTION STRATEGIES:
- GENERAL FITNESS – TRAINING
- RANGE OF SPORT ACTIVITIES
- TRAINING WELL BEFORE SEASON
- ALLOW CHILDREN TO CONTROL INTENSITY OF
ACTIVITIES
- MODIFY RULES OF ADULT GAMES
- LESS EMPHASIS ON WINNING
INJURY PREVENTION
- OPPONENTS TO BE MATCHED IN AGE, HEIGHT, WEIGHT,
MATURITY
- STRICT SUPERVISION
- NO MORE THAN A 10% INCREASE PER WEEK IN TRAINING
- WARM-UP AND COOL-DOWN TIME
- PRE-PARTICIPATION EXAMS.