America's Pediatricians Consider Causes of Injury, Burnout in Youth Sports

While research shows that children and teens can gain many physical and mental health benefits by participating in sports, research shows that about 70% drop out of these organized activities by the time they are 13 years old. The American Academy of Pediatrics is calling attention to the potential causes of these sport drop-out rates in its report "Overuse Injuries, Overtraining and Burnout in Young Athletes."

The report, published in the February 2024 Pediatrics, updates a prior report from 2007 with the latest evidence on how excessive training can lead to overuse injury, overtraining, impaired well-being and decreased quality of life.

“Sports are such a powerful and fun motivator to keep youth physically and mentally active, but some youth may feel pressure from parents, coaches and others to measure success only by performance,” said Joel S. Brenner, M.D., MPH, FAAP, an author of the report, co-authored by the AAP Council on Sports Medicine and Fitness. “Pediatricians can help families determine what sport participation practices will benefit children most and help encourage physical activity as a lifelong pursuit.” 

Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP board of directors and published in Pediatrics. 

The report outlines common sports-related injuries, such as those caused by repetitive stress, and states that children and adolescents may be at an increased risk for overuse injuries compared with adults. Growing bones in children are less tolerant of stress than those of adults and may be more susceptible to the development of stress injuries.

The AAP defines overtraining as a decrease in performance due to an imbalance of training and recovery that is often accompanied by persistent fatigue, impaired sleep and alterations in mood. Excessive training volume and overscheduling are also suggested as two potential risk factors for burnout. Research finds that it is more common to see young athletes participate on multiple teams at the same time and training year-round. 

“Whether training is specialized or multisport, it becomes a problem when an athlete no longer has any free play time or opportunity to engage in other non-sport-related activities,” said Andrew Watson, M.D., MS, FAAP, co-author of the report. “Athletic competition and training will always prompt some stress that, when delivered in an appropriate way, leads to adaptation, success and enjoyment. When that stress becomes excessive, it can lead to burnout.”

The AAP recommends:

  • Athletes undergo a pre-participation exam within their medical home, so their pediatrician can provide a comprehensive approach toward sports involvement.
  • Encourage athletic autonomy and intrinsic motivation, measure success on participation and effort, and foster positive experiences with parents, coaches and peers.
  • Promote skill development and being well-rounded in physical activities while avoiding overtraining and overscheduling.
  • When there are signs of overtraining or burnout, encourage the athlete, parent and coach to modify the causative factors and involve a mental health professional, if needed.
  • Keep workouts interesting and fun by incorporating age-appropriate games and training.

The report also includes specific recommendations for clinicians working with families.

“It’s important to teach our athletes to focus on wellness and to listen to their bodies,” Brenner said. “We can encourage mindfulness, time away from sports and other ways to prevent injury or burnout.”