Pediatricians Stress Moderation for Little Leaguers

February 29, 2012

By Genevra Pittman

NEW YORK (Reuters Health) Feb 28 - Baseball and softball are some of the safest sports for kids to play, but parents and coaches should still be sure youths are properly trained to avoid getting hurt in the field or batter's box, according to the American Academy of Pediatrics.

New guidelines from the AAP also emphasize the importance of keeping an automated external defibrillator (AED) nearby and having protective equipment that fits well.

But one of the most concerning risks, and a growing one, is that kids are stressing their arms too often and learning new skills before their bodies are ready to take them on, the organization said.

"Sometimes for their own good, you have to hold them back, and that's what gets lost on people," said Dr. Stephen Rice, one of the guidelines' lead authors from the Jersey Shore Sports Medicine Center in Neptune.

Dr. Rice added that a paradox about youth baseball and softball is that, while injuries are infrequent compared to other sports, those that do occur are more likely to be severe, such as broken bones and concussions.

Still, catastrophic, life-threatening injuries are very uncommon, occurring in the range of about one per one million participants each year.

The new guidelines address injury prevention through equipment and teaching -- as well as moderation when it comes to growing athletes.

The youngest Little Leaguers especially should use lower-impact balls and wear face guards on their batting helmets or use other protective eyewear. Batting gloves and rubber spikes (instead of metal ones) are also recommended, as are cups for boys.

Despite interest in safeguarding kids' hearts, there's no evidence that chest protectors can prevent injury or death, specifically when heart rhythm is deranged after a ball hits the chest, according to the report.

All kids should be taught how to avoid fastballs coming at them in the batter's box, or line drives hit straight back to the pitcher's mound. As in other sports, anyone with signs of a concussion after getting hit in the head needs to be sidelined until seen by a doctor.

Researchers agreed that the most preventable injuries, and some of the most worrisome, are overuse injuries. Pitchers especially shouldn't pitch if their arms are still tired from the last game, shouldn't learn new pitches like sliders and curveballs too soon and should do exercises to strengthen their core muscles.

"Moderation is key here. Don't push that kid too hard, too young," said Dr. Timothy Hewett, head of the Sports Medicine Biodynamics Center at Cincinnati Children's Hospital, and a consultant to the AAP's guidelines committee.

"There are so many young Roger Clemenses out there that don't make it into high school or college ball, because their arms are shot by the time they get there."

Dr. Hewett told Reuters Health that kids 14 and under shouldn't be throwing more than 65 pitches a day, and should be pitching no more than three days a week.

Orthopedic surgeons are treating more and more injuries in kids that used to be typical only in older, more experienced athletes, said Dr. Frederick Mueller, director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill.

"A lot of these kids are not only pitching in one league, they're pitching in multiple leagues, and then they're pitching on weekends in showcases," Dr. Mueller, who wasn't involved in the new guidelines, told Reuters Health.

"If they don't follow the (limits on) pitch count, they're really having problems."

He added that with softball, there's less evidence that pitching multiple days in a row is dangerous. That's because softball pitchers -- who throw underhand -- use their legs and torso more than baseball players, who put most of the pitching strain on their arm and shoulder.

Dr. Rice told Reuters Health that sometimes parents have to hold kids back and let them take their time to learn new skills and get playing experience, even if they think they have a rising star with big potential on their hands.

"Every child grows and moves forward at different rates," he said. "You don't want to hurry and push your kid to do things they aren't ready for."

The AAP guidelines were published online February 27 in Pediatrics.


Pediatrics 2012.


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