Physical Activity, Sports and the Prepubescent Child

From Sally S. Harris, M.D., MPH

Winter 2005 Issue "To Your Health"

Parents often wonder what physical activities are best for their child. The answer is that there is no "best" physical activity. Any physical activity the child enjoys that is safe and developmentally appropriate will be beneficial. The most important goal is to encourage participation and enjoyment in physical activities in general.

Activities that are sustainable over a lifetime are ideal, such as walking, hiking, cycling, rollerblading, dancing and swimming. You may need to restrict time spent watching television and designate a specific period of time for physical activities. Be sure to reinforce positively your child's behavior when he or she is physically active.

When it comes to choosing a sports activity for your child, look for a community-based sports program that encourages participation for everyone and emphasizes age-appropriate skill development rather than competition and winning. Ensure that safety issues are addressed, and that the coaching and structure are suitable for your child's age. The level of enjoyment and fun experienced by the children who are participating are some of the best indicators of a good program.

Organized sports, coed sports, competitive sports and more.

A child need not participate in organized or competitive sports to achieve the benefits of physical activity. Younger children will enjoy active games played with other family members, such as tag and hide-and-seek.

Sometimes parents are concerned that their child runs awkwardly or more slowly than other children. In most cases, the cause is simply a temporary delay in motor-skill development. Like other develop-mental milestones, the rate at which children master motor skills is highly variable. The child should ultimately catch up to his or her peers and should experience no long-term disadvantages.

The best experience for such a child may come from activities (such as walking, cycling and swimming) that do not require advanced motor skills, individual rather than team sports, non-competitive physical activities and participation with younger children whose skills may be of an equivalent level.

In a minority of cases, poor motor skills may be due to an underlying physical condition or a learning disability, which can be evaluated by the child's doctor.

Organized sports: Prior to 6 years of age, most children do not have the motor skills necessary to participate in organized sports.

School-based physical education: These programs emphasize the health value of exercise, development of a variety of motor skills, physical fitness, and participation in activities that are sustainable throughout a lifetime. These benefits are not necessarily emphasized or acquired through organized sports.

Coeducational sports: Prior to puberty, there are no significant differences between boys and girls in height, weight, strength or endurance. Therefore, from a physical standpoint, children can participate equitably in all sports and physical activities on a coeducational basis until puberty.

Competitive sports: Prior to age 10, most children do not have the cognitive ability to understand and remember complex strategies required for competition. Additionally, they are not able to master complex motor skills required for most competitive sports. Throughout childhood, skill development, fun and participation should take priority over competition.

Contact sports: Young children have a lower risk of injury than older children in contact sports like football because they do not have the size and strength to cause forces great enough to cause serious injuries. A more important concern would be whether the activity and the associated competition are appropriate or necessary at this age. It is probably okay for a pre-pubescent child to participate if he or she enjoys it, but the emphasis should be on participation and skill development rather than winning.

Weight training: Weight training is no riskier for injuries than other sports activities if done with appropriate equipment and proper supervision. Pre-pubertal children should do several sets of multiple repetitions and avoid maximum lifts of ballistic maneuvers. Even pre-pubescent children can improve their strength, but strength gains are greater after puberty.

Overuse injuries

Sometimes parents are concerned that their child's participation on a team that has hour-long daily practices, and several hours of games on weekends may put the child at risk for overuse injuries. Prior to puberty, children are at low risk for such
injuries. A greater concern would be whether the sport is requiring too much time at the expense of other experiences that comprise a well-rounded lifestyle, such as school, friends, family and unstructured time. If the coaching is age appropriate, the emphasis is on fun and skill development and, most importantly, if the child enjoys the experience, then it is fine to participate.

Preventing overuse injuries

Most sports are safe for pre-pubescent children because the children are not big enough to generate the forces that cause the more serious injuries seen in adolescents. Injuries can be prevented by appropriate supervision, training, adherence to rules and use of proper equipment. Overuse injuries can be prevented by curtailing the activity associated with pain. The philosophy of "no pain, no gain" is not appropriate for children. Fortunately, most injuries in this age group are minor, such as bruises, abrasions, strains and sprains.

An overuse injury may be developing when musculoskeletal symptoms are occurring more frequently and lasting longer. Overuse injuries generally progress as follows:

• Soreness lasting several hours or less only after activity
  
• Soreness or pain during and after activity, not resolved by the next morning
  
• Soreness or pain during activities of daily living, as well as during sports

Symptoms showing this progression should be evaluated by a health care provider for overuse injury.

Stretching and warming up: Stretching and warming up are most important during periods of rapid growth, such as during the adolescent growth spurt. Stretching and warming up have not been proven to prevent injury, but seem prudent.

In general, activity sessions should be structured to include:

• Limbering up (5 minutes)
  
• Stretching (5-10 minutes)
  
• Warm-up (5 minutes)
  
• Primary activity
  
• Cool down and stretching (5-15 minutes)

Stretching should involve the major muscle groups and be done slowly and steadily, holding each stretch for 15-20 seconds and repeating the stretch several times.

Treating your child's sports-related injuries

All injuries should be treated initially with rest, icing, compression and elevation (R.I.C.E.). The child should take a rest from any activity causing pain. Ice the injured part for 20 minutes at a time, making sure to protect the skin with a thin towel. Compress swelling with an ace wrap applied firmly but not too tightly. Elevate the injured part above the level of the heart. Any injury in which there is significant swelling, deformity or limitation of function that does not improve quickly should be evaluated by a doctor.

Preventing dehydration

In most situations, water is an adequate fluid to prevent dehydration. It should be readily available during exercise. Sports drinks, which usually contain six to eight percent carbohydrate, are beneficial only for exercise activities lasting longer than 90 minutes. However, children may drink more of a flavored drink if they prefer the taste. Children should be encouraged to drink before they feel thirsty, because mild dehydration occurs before one feels thirsty.

Approximately one cup of fluid is required for every 15 to 20 minutes of strenuous exercise to prevent dehydration. Young athletes should under-stand that even mild dehydration impairs performance and leads to fatigue. Salt tablets should be avoided; they can cause dangerous side effects and are unnecessary, because salt loss is adequately replaced through a normal diet.

A word about growing pains

"Growing pains" are harmless and affect 10 to 20 percent of growing children and is some-what more common in girls. Despite the name, growing pains do not occur during the time of most rapid growth, such as the adolescent growth spurt, or at specific sites of growth, nor do they affect the growth of children who have them. Approximately one-third of children with growing pains also experience other forms of recurrent pain, such as headaches or abdominal pain. Listed below are the characteristics of growing pains.

• They occur in children ages 3 to 12 years of age.
  
  
• The pain usually occurs in the legs, especially the thighs and calves. It may be in one or both legs, and may vary in location. Pain in the arms is less common, but may
  occur in conjunction with leg pain. Pain that is confined to a single joint, such as the right knee only, is not typical of growing pains, and should prompt further diagnosis.
  
  
• The pain occurs almost exclusively in the evenings and at night time, causing awakening during the night. The child can usually fall back to sleep after comfort measures such as massage, heating pad, or taking a mild non-prescription pain medication. Stretching the large muscle groups of the legs, such as the calves and thighs, can lessen symptoms, but this may not be practical for young children.
  
  
• The pain does not occur consistently during the daytime, or interfere with usual playground, recreational or sports activities. However, children may complain more
  frequently in the evenings or nights following days during which they are very active. Occasional complaints of pain during long walks, standing for long periods of time, or wanting to be carried, are common. Growing pains do not cause limping.
  
  
• The child may experience pain for months or years, as frequently as almost every night. Often there are symptom-free intervals of weeks or months. Symptoms may wax and wane, but usually remain stable with time. Most children outgrow growing pains within several years.
  
  
• The physical exam is normal. X-rays and lab tests, although usually not needed, are also normal.

If any of the following are present, the diagnosis of growing pains is unlikely and other causes should be evaluated:

• Symptoms of general illness, such as fever or weight loss
  
• Pain specific to a single joint
  
• Pain that worsens with time
  
• Pain that interferes with usual daytime activities
  
• Limping
  
• Restricted motion, redness, swelling and/or warmth of the affected part

Summary

Physical activity, whether through informal or organized sports, is important for optimal health, growth and development of children. The many health benefits far outweigh the risks of injury, most of which can be prevented or appropriately treated. The importance of physical activity beginning in childhood is even more important in the current time of rising childhood obesity.