Doctor: Three common mistakes that put kids at risk in youth sports
Overuse, inadequate preparation of smaller muscle groups and rushed transitions raise injury risk; experts urge attention to sleep, hydration, training plans and emergency protocols.
A pediatric and adult sports medicine physician is urging parents to address three common errors that increase injury risk for children who play organized sports: inadequate scrutiny of program resources and emergency plans, rushed returns to practice after inactivity, and overuse combined with narrow training that neglects smaller stabilizing muscles.
Dr. Elise Bixby, an orthopedic surgeon and sports medicine specialist at NYU Langone Orthopedics, stressed that establishing good habits around sleep, nutrition, hydration and gradual conditioning early in a season can reduce injuries and improve performance for youth athletes. Studies indicate more than half of children ages 6 to 17 take part in organized sports, raising the stakes for coaches, clubs and parents to set safe practices.
Parents should begin by asking concrete questions of schools and clubs, Bixby said: Is there an athletic trainer or physical therapist present? What strength and conditioning programming exists, and who supervises it? Are there clear weather and heat protocols for outdoor activities, including plans for lightning and for treating heat illness? Is an automated external defibrillator available, and does staff know its location? Sudden cardiac arrest in young athletes is rare but can be fatal; immediate access to an AED significantly improves survival, and most models provide voice and visual guidance for untrained users.
The second frequent mistake is returning a child to full practice intensity after a period of relative inactivity. "If your child has been spending the entire summer on the couch, you can’t throw them back into practice five days a week right off the bat," Bixby said. She recommended a gradual ramp-up of activity, beginning with light jogging or informal play, and emphasized dynamic warm-ups before practice and cool-down stretching afterwards. Warm-up programs such as the FIFA 11+ and the Prevent Injury and Enhance Performance (PEP) program have been shown to reduce injuries including ACL tears when implemented consistently.
Overuse and early specialization form the third major pitfall, Bixby said. Growing bodies tolerate less repetitive load than adults, so a practical rule of thumb is that total organized-sport hours per week should not exceed a child’s age. Early sports specialization — defined as playing the same sport for more than eight months of the year — increases the risk of burnout, acute injuries and repetitive-stress problems. Encouraging children to play multiple sports engages a broader range of muscles and motor patterns and can lower overuse risk.
Neglecting smaller stabilizing muscles is another contributor to injury. "It’s not that we need a six-pack," Bixby said. "Strengthening the paraspinals in the back and the obliques on the sides of the torso not only helps to prevent low back pain, but it can also aid runners to sprint faster and pitchers to have higher velocities. Those small muscles really help, and putting in a little bit of effort with them is going to go a long way." She recommended incorporating core and posterior chain work into off-season and in-season conditioning, under appropriate supervision.
Nutrition, hydration and recovery underpin safe participation, Bixby added. Adequate calories, complex carbohydrates and protein support muscle repair and growth, while excess sugary foods provide calories with little recovery value. Hydration is essential even as temperatures fall; athletes should arrive at practice already hydrated, sip fluids during activity and rehydrate afterward. Recovery requires scheduled rest days and sufficient sleep: children 6 to 13 need nine to 11 hours nightly, and teens 14 to 17 require eight to 10 hours.
Parents and coaches should watch for warning signs that require medical evaluation. If a child cannot walk or bear weight on a hip, knee or ankle, if there is marked swelling of a joint, or if the child cannot fully straighten or bend a knee, medical attention is warranted. Mild popping or clicking without pain is often benign, but Bixby emphasized that playing through pain is discouraged because altered movement patterns can lead to additional injury and impede rehabilitation.
Not all teams build structured warm-ups and cooldowns into practice time; parents can help by having athletes arrive five to 10 minutes early to perform dynamic movements such as butt kicks and monster walks, and by staying for five to 10 minutes afterward to stretch and rehydrate. Strength and conditioning should include both major muscle groups and the smaller intrinsic muscles that support joints and posture.
Bixby said the goal is to keep children engaged in sport for the physical, social and emotional benefits while minimizing harm. "Sports can be so important to a kid’s development — and to their general happiness," she said. "We want to get them back on the field, but in the right way."
