There appear to be increasing numbers of children who specialize in a sport at an early age, train year-round for a sport, and/or compete on an "elite" level. Media coverage of national and international competition in sports such as gymnastics, figure skating, swimming, diving, and tennis has focused attention on a number of very talented but very young competitors. The successes of young athletes can serve as a powerful inducement for others to follow. Most Olympic sports have selection processes that attempt to identify future champions and initiate specialized training—often before the prospect finishes elementary school. The lure of a college scholarship or a professional career can also motivate athletes (and their parents) to commit to specialized training regimens at an early age. The low probability of reaching these lofty goals does not appear to discourage many aspirants.
To be competitive at a high level requires training regimens for children that could be considered extreme even for adults. The ever-increasing requirements for success creates a constant pressure for athletes to train longer, harder, more intelligently, and, in some cases, at an earlier age. The unending efforts to outdo predecessors and outperform contemporaries are the nature of competitive sports. The necessary commitment and intensity of training raises concerns about the sensibility and safety of high-level athletics for any young person.
Adverse consequences from intense training and competition have been reported in the lay and medical literature.1,2 Many pediatricians can cite examples of undesirable outcomes from sports participation involving patients in their own practices. Unfortunately, anecdotal reports and case studies are insufficient grounds for drawing conclusions about the safety of intense training or high-level competition.
The short-term and long-term health consequences of such training in young athletes need to be further investigated. Physical, physiologic, and psychologic tolerances to stress in children have been studied in laboratory settings and can be defined by observing the threshold for injury in clinical settings. Unfortunately, this information is difficult to directly apply to the specific clinical scenarios of concern to the pediatrician. Studying the risks of "specialized," "intensely trained," or "elite" athletes is hampered by the lack of clear definitions of these at-risk populations. Even if a study group could be defined, the level of variation between sports, individuals, and training regimens creates further methodologic challenges for investigators.
Despite recognized inadequacies of current information, pediatricians can still help safeguard their young athletic patients by being aware of potential problems associated with intense training. Because pediatricians serve as the primary medical contact for most young athletes, they may have the best opportunity to recognize, treat, and monitor injuries or illnesses resulting from strenuous training.
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