Children's Hospital Colorado

Sports and Exercise Tips

Two soccer teams - one in red shirts and black shorts, the other in light blue shirts and black shorts - compete on a green grass field.

All kids are different, but generally kids need to be about 6 or 7 years old before they can listen and pay attention for long enough to grasp and follow the rules. 

Although 3- and 4-year-old children can throw and run, it’s not really until the first grade or so that they develop the physical coordination to do both at the same time. This is also the time they gain the emotional maturity to understand concepts like taking turns and playing as a team, which are essential to most sports.

Of course, lots of sports do offer programs for preschoolers, and certainly they can’t hurt — as long as the kiddos are having a good time. Choose a program that emphasizes basic skills and fun, and don’t be too surprised if they spend the whole time kicking the ball to the wrong end of the field or digging a hole in the dirt with their toe.

Source: Dr. Aaron Provance

Well, you saw this answer coming: sometimes. And it depends.

Kids grow. They also have a tendency to lose interest. If your kiddo is just starting out playing a sport, in most cases it makes sense to take a “wait and see” approach to gear-related spending, if just to gauge their seriousness. And even then, unless they’re older teens, whatever gear you buy they’ll grow out of soon. Spending a bit more for better designed and better quality gear can make a difference in performance, but it might be a good idea to wait until they’re done growing and become dedicated to a particular sport before throwing down the big bucks.

And extra spending won’t equate to extra safety. A recent study on football helmets looked at a number of football helmet brands and models and found no difference in the rate of concussion between helmet types or ages, even when the helmet was reconditioned by the manufacturer. The most economical option will offer just as much safety as the most expensive. Interestingly, the same study found that the risk for concussion was higher in players wearing a custom mouth-guard than those wearing a generic one. So in that case, it really is better not to spend the money.

Footwear, too, can make a big difference, the most important factor being a good fit. A properly fit shoe built for the proper purpose does wonders for comfort and performance, and helps prevent injury, too.

Source: Dr. Kyle Nagle

We asked teens that same question — what makes a good coach? — and found out something interesting.  According to teens, winning doesn’t matter that much. Of the kids who responded to our online survey, only 9% said a coach with a good winning record was most important. The rest thought the most important quality was giving everyone a chance to play (46%) and teaching new skills (45%).

They also looked for a coach who took the time to get to know and understand a player’s individual strengths and weaknesses, one who wouldn’t hold back on (constructive) criticism, one who could offer insight not only into the sport but into basic life-skills, such as positivity and perseverance.

Most important of all: making it fun.

Of course, it’s hard to gather all this info on a coach when you’re not the one showing up to practice and playing the games. The best thing you can do? Ask your child questions about his or her coach, and about his or her experience of playing in general, and listen! We all know teens aren’t always right, but they do have a point: at the end of the day, kids’ sports are supposed to be fun.

Source: Dr. Jay Albright

Different programs have different standards, but a decent rule of thumb is that the number of hours of practice per week should not exceed the players’ age; i.e., a 6-year-old shouldn’t practice more than six hours per week. 

Even in their teens, kids’ bodies grow. Too much sustained practice (especially with repetitive movements, such as in baseball or tennis) can strain on the growing areas of bones, tendons and joints, causing injuries like sprains, cartilage damage or stress fractures — some permanent. 

Another factor to consider is how much your kids want to practice. If they’re getting burned out, chances are good their interest in the sport won’t last.

Source: Dr. Aaron Provance

Lots of factors play a role in muscle cramps, and there is no cure, but a few precautions can certainly help. Good hydration is at the top of the list, so the first step is drinking water, and plenty of it. 

Another thing the body needs is salt. People tend to think of salt as dehydrating, which it can be, but it’s more accurate to say that the body needs to maintain proper balance between water and salt, and too much or not enough of either can be trouble. The body loses a lot of water during heavy exercise, but it also loses a lot of salt – both through sweat – so a hard workout demands replenishing both. Sports drinks include electrolytes (a fancy word for “salt”), but a big glass of water and a salty snack is just as good, if not better, since a salty snack is likely to contain some protein, where as a sports drink is not.

Good stretching and warm-up habits also help. A cold, tense muscle is much more likely to cramp and cause injury than a warm, loose one. 

That’s why it’s best not to play through a cramp. Have your child relax, drink water, eat something salty, stretch and wait for it to pass.

Source: Dr. Katherine Dahab

A concussion results from a blow to the head or an impact to the body strong enough to bounce the brain around inside the skull. Which, for a variety of reasons, is not good for the brain.

Concussions might not cause any loss of consciousness, but that doesn’t make them less serious. If you see your child take a hard hit, be on the lookout for symptoms — dizziness, headache, vomiting, confusion, acting dazed, forgetting what happened — and take her out of the game to prevent further injury. And have her evaluated by a medical professional as soon as possible.

Recovery time varies from kid to kid and from concussion to concussion, but most kids and teens recover within a few days to a few weeks. Still, research suggests that a previous concussion ups the risk of more concussions, so it’s important to let your child recover fully, and wait until a medical professional gives the go-ahead to play.

Getting back in the game too fast can have negative consequences. Give the brain the time it needs to heal. 

Source: Dr. Julie Wilson

Absolutely! In fact, in some ways, low fat chocolate milk is an ideal workout recovery drink: it replenishes fluids and electrolytes for hydration, it’s a source of protein for good muscle repair and carbohydrates for an immediate energy boost, and it replenishes nutrients like calcium and vitamin D. Of course, kids could also get these benefits from a light snack, but after a hard workout, it’s often more appealing to drink than eat, and chocolate milk comes in liquid form.

Plus — and maybe most importantly — it’s delicious. Please keep in mind, chocolate milk also contains sugar, so drink it in moderation. 

Source: Dr. Katherine Dahab

Yes and no. Soccer header bands can certainly protect against cuts and bumps to the head in the area they cover, and they may help disperse the force of impact. But they’re far from failsafe. The brain is suspended in fluid inside the skull, so a hard hit can bounce it around in there even if padding cushions the blow, which is why football players get concussions even wearing helmets. 

Use of head bands is still optional, as their effectiveness in reducing concussions is not truly known.

Source: Dr. Julie Wilson

It’s hard to say definitively, since there’s no one governing body that counts sports injuries. In fact, there’s not even a definitive way of counting them. That said, looking at a few different sets of numbers reveals some pretty good rough conclusions, some surprising, some not.

For boys, football remains a leader in injuries overall. One study looking at high school sports found football injury rates during competition higher than 12 injuries per 1,000 athletic exposures, defined as one athlete’s participation in a practice or competition. Combining practice and competition, the total injury rate for football was nearly four per 1,000 overall. Wrestling racked up 2.23 per 1,000 overall, and boys’ ice hockey, soccer and lacrosse all averaged 1.7 to 1.8 overall. 

The lowest injury rate for boys went to swimming, tennis and cross-country, with rates of significantly less than one injury per 1,000 exposures overall.

Soccer, field hockey and basketball clocked the highest injury rates for girls, with 2.7, 2.0 and 1.8 injuries per 1,000 respectively, while swimming and tennis averaged the lowest risk for girls as well. Cheerleading, although relatively low-risk with an injury rate of 0.75 per 1,000 exposures, accounts for 65% of catastrophic injuries in female high school athletes.

In terms of concussions, football, hockey and lacrosse post the highest concussion rates for high school boys, while swimming, diving, baseball and track report the lowest. For high school girls, the highest concussion rates go to soccer, field hockey and lacrosse, with track, swimming, diving and volleyball posting the lowest.

Source: Dr. Kyle Nagle

Signing up for a league or a lesson is a time commitment and usually involves shelling out at least some amount of time, money, or both for the parent, too. For that reason, it makes sense to hold kiddos to the commitment for at least the length of the season or bundle of lessons, or some other predetermined amount of time. Learning a new skill in a new group of people can be intimating at first, or discouraging or boring. Talk with your child before she starts and strike a deal: that she may play, but if she does, she must ride it out until the end — even if she doesn’t like it — rather than abandoning hope at the first sign of struggle. 

Do this within reason, of course. As in any situation, the best thing to do is to listen to your kiddos, even if you don’t intend to acquiesce. Maybe she just needs to blow off some steam, or have a shoulder to cry on. Then again, maybe she really does have some compelling reason for wanting to quit. 

And when the agreed-upon length of time has elapsed, if she still wants to quit, hold up your end of the bargain, too, and let her.

Source: Dr. Stephanie Mayer

That’s simple – whatever they enjoy. Just get them active. There isn’t anything that's necessarily better than another. It can be dancing, soccer, running, swimming, football, jumping rope, bike riding – anything that keeps them moving and helps build an active lifestyle. 

Source: Dr. Julie Wilson

There is not a specific age when kids can move from a strider bike to a pedal bike. When your child has developed the motor skills and balance to glide on their strider bike for at least 10-15 seconds with their feet up off the ground, then they are ready to transition to a pedal bike. 

Lower the seat of the pedal bike so they can easily touch the ground and have them start by gliding. Once they are comfortably gliding, tell them to start pedaling while keeping their eyes up. As always, make sure your child has a properly fitted helmet whenever they are riding.

Source: Dr. Julie Wilson

The current recommendation from the American Heart Association is that sports pre-participation physicals should not include widespread ECG screening but ECG screening by individual quality-controlled local, community, or student-related initiatives were supported if conducted properly and with quality control and adequate resources. It is a highly debated topic in the sports medicine community. If there is a significant family history of cardiac issues or if a young athlete has any symptoms of heart trouble, it would be advisable to speak to their primary care physician about the need for testing.

Source: Dr. Aaron Provance

This is a very common question we're asked as pediatric sports medicine physicians. As mentioned above, football has all the benefits of other sports including cardiovascular health, psychological benefits, improved school performance, social development and learning how to be a team member. These attributes will aid in life-long learning skills that will be used throughout their lives and careers. On the flip side of the coin, football carries the burden of the highest rates of concussions per 1,000 athlete exposures. 

The majority of young athletes suffering concussions from football will have a full recovery within two to three weeks. There is significant concern over more long-term cognitive complications from multiple concussions. At this point in time, no true cause and effect relationship has been proven with medical research between multiple concussions and long term cognitive conditions. In football, there is also a risk of catastrophic head and neck injuries resulting in long term or permanent neurological deficits. These more serious injuries usually involve three to four athletes per year in the U.S. 

Looking at the statistics, there is a higher chance of a football player being hit by lightning than suffering a catastrophic head or neck injury. Allowing your young athlete to play football should involve a discussion with the athlete and their parents/guardians about the risks/ benefits. The benefits of playing football seem to outweigh the risks at this time but future research may change our perception. Learn more about football injuries we treat.

Source: Dr. Aaron Provance

Concussions can be scary and must be taken seriously, but we must also remember that youth sports like football are associated with innumerable benefits including improved physical health, psychosocial well-being, and even better school performance. The most effective tools for minimizing the risk for concussion are concussion education, proper helmet fitting and proper tackling techniques.

Knowing the facts about concussions is important because misinformation can cause injuries to be minimized in certain cases or cause unnecessary alarm or worry in others. Parents, athletes and coaches should all be educated on the signs and symptoms of concussion to ensure that concussions are recognized and your athlete then receives the proper medical care. Learn more about how to recognize concussions.

Many families are also asking if the new high technology football helmets can help prevent concussions. There is no magic football helmet that can prevent concussions, yet. Please visit our sports blog to learn more about the current research regarding high technology football helmets.

Source: Dr. Aaron Provance

There isn’t a specific age limit at which it is too young to begin weight lifting, fortunately research has made it clear that resistance training doesn’t lead to any disturbance in growth or risk of injury. However, general recommendation for middle school athletes is to perform body weight lifts and machine guided weight training instead of free weights. 
Additionally, they should be well supervised while lifting so they are doing it correctly, lifting weight that is appropriate for them and doing it with good form to get the best benefit out of it and to limit risk of injury.

Finally, the repetition range for lifts should be between 10 and 15 and one repetition “max lifts” should be avoided. For a sport like football, strength is indeed important, but at 7th grade level spending time working on his skills and on field conditioning may benefit him more than weight training depending on the position he plays.

Source: Dr. Aaron Provance

I would encourage you to let your child play any and all sports at an early age. Every young athlete is unique and may find passion and joy in differing settings and environments. I think the key to your question is the lifelong love of being active! This can be accomplished out of sport as much as in sport. Would hiking with the family every week be any less enjoyable than playing football? 

If you want to instill a passion for being active my best advice is to not worry about what is the best, but exposing the child to a multitude of activities then letting them decide. Just as important, modeling an active lifestyle as a parent and family is what kids really learn from. My experience is a family that is active regularly together teaches a lifestyle that is maintained in the children.

Source: Gregg Brueck, Athletic Trainer, Real Colorado Soccer Club, Orthopedics Institute, Children's Colorado

A pre-practice snack is very important to fuel a productive high school work out, especially if the athlete has lunch period as early as 10:30 or 11 a.m. It is also important to contribute to their total daily calorie needs that support both sports performance and growth. Look for snacks that are high in carbohydrate and fluids to provide energy for hard-working muscles and hydration. Also look for foods that are low in fat and fiber for easy digestibility. The goal is to prevent hunger and undigested food in your athlete’s stomach during practice. 

Here are some good examples:

  • Drinkable yogurt
  • Low-fat or fat-free yogurt
  • Yogurt and fruit smoothie
  • Low-fat or fat-free milk or milk substitute (soy milk, almond milk, etc.)
  • Low-fat chocolate or strawberry milk or milk substitute 
  • Fresh fruit
  • Sports bars can be used as occasional, on-the-go type snacks before a practice.  Here are some options: Clif MoJo Peanut butter pretzel bar®; Kashi Go Lean Crunchy Chocolate pretzel®; Luna S’mores or lemon zest bar®; and Kashi Go Lean Oatmeal Raisin Protein & fiber bar®

Source: Gregg Brueck, Athletic Trainer, Real Colorado Soccer Club, Orthopedics Institute, Children's Hospital Colorado

In most cases, I would stick to water and a healthy snack. The exception would be if your child consistently exercises at high levels of intensity (such as team or some individual sports) for an extended period of time (one hour or more) or if your child is exercising in harsh weather conditions (very hot or very cold). In these cases, it may be a good idea to drink something other than water in order to improve hydration and/or support recovery.

Source: Gregg Brueck, Athletic Trainer, Real Colorado Soccer Club, Orthopedics Institute, Children's Colorado

In general, children that have difficulty breathing during exercise may have exercise-induced asthma, especially if they carry a diagnosis of asthma. Either consult with your pediatric provider or have an asthma expert at Children's Colorado evaluate her. This may lead to a treatment regimen that may allow her to participate without having to sit out at all, and it may allow her performance to improve.

Shortness of breath associated with exercise can be one of several things apart from asthma. Underlying cardiac issues or even vocal cord dysfunction can cause difficulties with breathing during exercise. Certainly asthma can too. You can have exercised induced bronchospasms that can cause these symptoms. There are other questions that need to be asked, however, before we can say it is asthma. 

For example, how far into exercise do the symptoms occur and how long do the symptoms last after she stops exercising? Is there associated coughing as well? Can you hear wheezing? Is there a personal or family history of asthma or seasonal allergies? Any chest pain or palpitations? Any family history of heart conditions? Any history of fainting? Is this something new or has it been going on for a while? Are there episodes of shortness of breath that occur frequently with colds?

My recommendation is for your daughter to be evaluated first by her pediatrician with this question in mind. Your pediatrician may give a trial of albuterol before activities that can sometimes be helpful in diagnosing exercised induced asthma. If that does not help prevent her symptoms, she would need to be evaluated for other conditions. 

Source: Dr. Stanley J. Szefler

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