Couch-potato children are a problem, but pediatricians also worry about another breed of kid.
Lean machines who exercise to the extreme.
Dr. Joel Brenner, a sports medicine pediatrician at Children's Hospital of The King's Daughters, has noticed more torn ligaments, Little League elbow, stress fractures, bone injuries and plain- old burnout.
A report being released today in the journal Pediatrics is designed to give guidance to doctors who see these fallout injuries in many of the estimated 45 million youngsters ages 6 to 18 who play competitive sports.
Brenner worked with nine other pediatricians from across the country over the past two years to craft the recommendations.
"We have two epidemics going on, obesity and young athletes who take sports to the extreme," Brenner said. "We need to find the happy medium."
The doctors, who make up a sports medicine council for the American Academy of Pediatrics, advise:
-- No more than five practices in a single sport a week.
-- An annual break from a sport of two to three months.
-- One day a week without any organized sports.
-- Increasing by no more than 10 percent a week the length of training, the number of repetitions or total distance.
Brenner said the council began studying the issue because the pediatricians were seeing more sports injuries as youth leagues became more competitive. More children are playing a single sport year-round rather than during a single season. Practices of more competitive "elite" teams are more intense than those of rec leagues.
And pediatricians are not just seeing the typical sprains and fractures from baseball and football, but also overuse injuries in activities including gymnastics, field hockey, cheerleading, swimming, rugby, and training for triathlons and marathons.
Steve Bialorucki, head coach of Old Dominion Aquatic Club, said that when serious swimmers move into the top echelon of competitive meets and are vying for scholarships, 12 to 20 hours of training a week is not uncommon.
Taking a three-month break would be unheard of for some swimmers.
"We have kids who do six to 10 practices a week," said Bialorucki, whose year-round team includes about 200 swimmers from throughout the area. "Volume is key. There's a point in time when two practices a day can turn a season and pay dividends."
Bialorucki said an important factor in preventing injury for the more intense breed of athlete is to teach correct and consistent stroke techniques from an early age.
The Pediatrics report urges moderation and said parents need to be aware that only a small percentage of youngsters -- less than 1 percent -- will fall into the category of those who will compete professionally. An injury not only can do permanent damage but also can keep a youngster out of the game for a while.
Fourteen-year-old James Miller of Norfolk can attest to that.
Last year, the Norfolk soccer player -- whose practices fell well within the doctors' recommendations -- started feeling back pain he initially thought was a strained muscle.
When it didn't go away, X-rays showed he had sustained a stress fracture to his spine. That meant four months in a back brace -- and six months without soccer.
"I was kind of upset about that," he said.
Physical therapy, stretching exercises and some weight training should put him back in the game this summer.
"It'll be great," he said. "The worst thing was going to the games and just watching."
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