One-Sport Kids: How to Counsel Families

Laurie Scudder, DNP, NP; Joel S. Brenner, MD, MPH


October 10, 2016

Editor's Note: Sports specialization in kids as young as 6 years of age is increasingly common and often displaces the activities of yesteryear, like driveway basketball or pick-up baseball. Yet, little is known about the long-term effects of such intensive training and competition in these youngest of athletes. In September 2016, the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness issued a clinical report[1] reviewing what is known, and not known, about the long-term effects of sports specialization on mental and physical health. The report concludes with recommendations for primary care. Medscape spoke with Joel S. Brenner, MD, MPH, immediate past chair of the council and lead author of the report, about the key messages. Dr Brenner is the director of sports medicine and adolescent medicine at Children's Hospital of The King's Daughters in Norfolk, Virginia.

A Changing Youth Sports Culture

Medscape: Why has this report come out now? Is it that a lot of kids are specializing in a single sport at a young age, or has the research caught up with the practice and provided sufficient answers to key questions about this?

Dr Brenner: It's actually a combination of factors. We have seen a change in youth sports culture. We see fewer kids just going out and playing in the neighborhood and the recreation centers—less of what we call "deliberate play." We are also seeing more kids playing year-round, often without any break. We see more kids who are specializing at an earlier age and more kids who are playing on multiple teams, often at the same time.

The other thing that's different now is that more kids are doing intensive training and have a more rigorous competition schedule. It is much more intense than it was in the past. With the change in society and youth sports culture, there has been more research than in the past. The initial clinical report on intensive training and sports specialization was published by the AAP in 2000,[2] and a lot has changed from a research standpoint since then. The concerning statistic is that 70% of kids drop out of organized sports by age 13 years. We needed to look at the research and youth sports culture, and give some guidance to the pediatricians, sports medicine physicians, athletes, and parents, because we know that they are dealing with this every day.

We know that parents are the most influential in terms of kids initiating a sport, but coaches are most influential in terms of a young athlete's intensive training and specialization.

Medscape: What is the epidemiology of specialization? Who are these young athletes, and what sports are typically involved? And does it work? Are these kids (the 30% who don't drop out) ultimately more successful athletes?

Dr Brenner: The kids who specialize aren't one subset of kids. It might be a young athlete who wants to get that college scholarship or who has a desire to go to the Olympics or become a professional athlete. Sometimes it's a child who just really enjoys that one sport and wants to play nonstop. Sometimes it is also pressure from the parent or the coach. We know that parents are the most influential in terms of kids initiating a sport, but coaches are most influential in terms of a young athlete's intensive training and specialization. There might be many reasons why kids are specializing more.

We see it in all sports. Some of it might depend on geography, but it's across the board: cheerleading, baseball, soccer, basketball. They can play year-round. They can specialize within any sport.

You asked whether the kids who specialize in a sport are ultimately more successful athletes. It looks like the answer is "no." Playing multiple sports, and delaying specialization, is more advantageous if your goal is to succeed athletically. Success, however, is defined by the individual. If the goal is to become elite, get a college scholarship, or become a professional, research and anecdotal evidence show that if you delay specialization and you play multiple sports, you're more likely to be successful. If you look at the NFL draft this year, 90% of those drafted in the first round were athletes who played multiple sports in high school. If you look at the 2015 Women's World Cup soccer team, most of the team members played multiple sports all throughout high school. It actually makes them more successful. Hopefully, it will also lessen the risk for some of the negative effects.

The Pros and (Mostly) Cons of Specialization

Medscape: Can you provide a summary of what is known about negative effects—both mental and physical—of sports specialization? There is a plethora of evidence out there. What are the key negative concerns you have with sports specialization?

Dr Brenner: Besides the mental and physical effects, there are overall concerns. If children specialize early—say, between the ages of 8 and 12—they are missing out on the opportunity to explore and experiment with other sports. If you don't do this as a child or a teenager, you might never have that chance again, and you will miss out on experiencing a sport that you may have really loved and one in which you could participate into adulthood. Or you could miss out on a sport that you were very good at and you might even have excelled at. That's one definite concern.

From a physical standpoint, we see a rise in overuse injuries, and some of that is from specialization. There are also nutritional concerns because these young athletes are still going through their growing phase. They have different nutritional requirements—not only for their athletic needs but also for their growth in terms of calories, iron, and calcium. From a physical standpoint, those are concerns.

We often forget about the mental aspect. There is a concern for burnout. If it's not on your radar when you're talking with a parent and the athlete, you can miss it. It might see you, but you won't see it. Burnout in children can have very vague symptoms and signs. Often, these children feel depressed, their energy is low, or they are irritable. They are just not enjoying it anymore. Burnout is definitely something to be concerned about, as well as isolation. Children who are specializing in just one sport can be socially isolated from some of their peers who don't play that sport. They are not getting that variety of social interaction.

Children who are specializing in just one sport can be socially isolated from some of their peers who don't play that sport.

Medscape: On the flip side, are there some positives to the practice of specialization? If so, are there particular sports for which specialization can be beneficial? Gymnastics, for example, is a sport that is hard to blend with other sports.

Dr Brenner: The short answer to the question of whether there are positives is "no." When you look at the athletes, even in gymnastics and figure skating, who make it to the elite level, they don't necessarily have to specialize early. With gymnastics, they peak a little bit earlier because of maturity, growth, and development, but even the majority of gymnasts don't have to specialize early.

Medscape: For young kids who are just entering sports, as well as their families, what are the key messages that they should hear from the pediatric care provider?

Dr Brenner: We definitely want to encourage them to have their kids participate in sports and physical activity, but it doesn't necessarily have to be organized sports. We often forget about deliberate play. Deliberate play means that it is voluntary, informal interaction in sports. It is participation for the main purpose of enjoyment. It's what we used to do when I was younger; we would go out and play, whether it was basketball or pickup football—just a bunch of kids without adult involvement. We made up our own rules and our own teams. We played for fun. We don't see that as much anymore.

We recommend that kids do more deliberate play, but also just that they participate in other physical activities, such as paddleboarding, kayaking, yoga, or Pilates. We should emphasize that diversifying and playing multiple sports is actually beneficial, mentally and physically. Doing this uses different muscles and different bones, and it allows kids to explore. Furthermore, making sure that kids take some time off from one particular sport is very important both physically and mentally.

Last, we should try to find out the goals of the young athlete. That's key. It must be the goals of the young athlete, not the goals of the parent or the coach. This should be about the young person.

Medscape: When that young athlete is 4 or 5 years old, I suspect that can be pretty tough.

Dr Brenner: When you are talking about a 4- or 5-year-old, often the child's goal is just to go outside and have fun and play with friends. That's a great goal, and that is what we should be encouraging.


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