The Pediatric Endurance Athlete

Nutrition for Children and Adolescents Who Practice Sport: A Narrative Review

At a developmental age, adequate physical activity is fundamental to overall health and well-being and preventing obesity. Moreover, establishing active behavior can help children and adolescents meet their growth and neurodevelopmental goals. Nutritional requirements vary according to intensity, frequency, and practiced physical activity or sport; therefore, pediatricians should give children and adolescents and their families adequate counseling, avoiding both nutrient deficiencies and excessive or inadequate supplement intake. The focus should be not only on sports performance but also on the child's well-being, growth, and neurodevelopment. Our narrative review aims to discuss the nutritional needs of children and adolescents who practice physical activity, non-competitive sports activity, and elite sports activity while also analyzing the role of food supplements and the risk of eating disorders within this category of subjects.

Primary Care Considerations for the Pediatric Endurance Athlete

PURPOSE OF REVIEW

This study aimed to provide an overview of some of the medical concerns surrounding the care of the pediatric endurance athletes and add to the limited literature specific to the pediatric endurance athlete.

RECENT FINDINGS

Endurance athletes are at risk for overtraining, relative energy deficiency in sport (RED-S), overuse injuries, nutritional deficiencies, and sleep dysfunction. Youth runners and female endurance athletes are particularly high-risk populations for RED-S; nutritional deficiencies and their care should involve thoughtful mitigation of modifiable risk factors. The growing endurance athlete may experience slightly different cardiac adaptations than the adult endurance athlete with the long-term implications of these changes still unclear. Endurance sports are common among youth athletes. Multidisciplinary care that includes screening and early intervention for high-risk areas is critical to optimize their care and promote, safe lifelong sport participation.

Associations between objective measures of performance-related characteristics and perceived stress in young cross-country skiers during pre-season training

Monitoring performance-related characteristics of athletes can reveal changes that facilitate training adaptations. Here, we examine the relationships between submaximal running, maximal jump performance (CMJ), concentrations of blood lactate, sleep duration (SD) and latency (SL), and perceived stress (PSS) in junior cross-country skiers during pre-season training. These parameters were monitored in 15 male and 14 females (17 ± 1 years) for the 12-weeks prior to the competition season, and the data was analysed using linear and mixed-effect models. An increase in SD exerted a decrease in both PSS (B = -2.79, p ≤ 0.01) and blood lactate concentrations during submaximal running (B = -0.623, p ≤ 0.05). In addition, there was a negative relationship between SL and CMJ (B = -0.09, p = 0.08). Compared to males, females exhibited higher PSS scores and little or no change in performance-related tests. A significant interaction between time and sex was present in CMJ with males displaying an effect of time on CMJ performance. For all athletes, lower PSS appeared to be associated with longer overnight sleep. Since the females experienced higher levels of stress, monitoring of their PSS might be beneficial. These findings have implications for the preparation of young athletes' competition season.

Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes

The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.

Running-related injuries in middle school cross-country runners: Prevalence and characteristics of common injuries

BACKGROUND

Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention.

OBJECTIVE

To determine the prevalence of running-related injuries and describe factors related to a history of injury.

DESIGN

Retrospective cross-sectional study.

SETTING

Survey distributed online to middle school runners.

METHODS

Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation.

MAIN OUTCOME MEASUREMENTS

Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age.

PARTICIPANTS

Youth runners (total: 2113, average age,  13.2 years; boys: n = 1255, girls: n = 858).

RESULTS

Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p < .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p < .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p < .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p < .001).

CONCLUSIONS

Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.

Injury characteristics in male youth athletics: a five-season prospective study in a full-time sports academy

OBJECTIVES

To describe the injury characteristics of male youth athletes exposed to year-round athletics programmes.

METHODS

Injury surveillance data were prospectively collected by medical staff in a cohort of youth athletics athletes participating in a full-time sports academy from 2014-2015 to 2018-2019. Time-loss injuries (>1 day) were recorded following consensus procedures for athletics. Athletes were clustered into five event groups (sprints, jumps, endurance, throws and non-specialised) and the number of completed training and competition sessions (athletics exposures (AE)) were calculated for each athlete per completed season (one athlete season). Injury characteristics were reported overall and by event groups as injury incidence (injuries per 1000 AE) and injury burden (days lost per 1000 AE).

RESULTS

One-hundred and seventy-eight boys (14.9±1.8 years old) completed 391 athlete seasons, sustaining 290 injuries. The overall incidence was 4.0 injuries per 1000 AE and the overall burden was 79.1 days lost per 1000 AE. The thigh was the most common injury location (19%). Muscle strains (0.7 injuries per 1000 AE) and bone stress injuries (0.5 injuries per 1000 AE) presented the highest incidence and stress fractures the highest burden (17.6 days lost per 1000 AE). The most burdensome injury types by event group were: bone stress injuries for endurance, hamstring strains for sprints, stress fractures for jumps, lesion of meniscus/cartilage for throws and growth plate injuries for non-specialised athletes.

CONCLUSION

Acute muscle strains, stress fractures and bone stress injuries were identified as the main injury concerns in this cohort of young male athletics athletes. The injury characteristics differed between event groups.

Resistance Training for Children and Adolescents

Resistance training is becoming more important as an integral part of comprehensive sport training regimens, school physical education classes, and after-school fitness programs. The increasing number of youth who are involved in sport activities, coupled with the health problems of inactivity and being overweight, have resulted in increased interest in resistance training. Secular declines in measures of muscular fitness in modern-day youth highlight the need for participation in youth resistance training for nonathletes as well as athletes. Parents often ask pediatricians to offer advice regarding the safety, benefits, and implementation of an effective resistance-training program. This report is a revision of the 2008 American Academy of Pediatrics policy statement and reviews current information and research on the benefits and risks of resistance training for children and adolescents.

Dietary nutrient intake of Korean adolescent distance runners

This study examined the dietary nutrient intake of Korean adolescent distance runners and analyzed the difference between weekdays and weekends. The participants were 40 male middle- and long-distance runners aged 13 to 18 years, 36 of whom were analyzed. The 3-day diet records including 2 weekdays and 1 weekend day, were investigated according to the food record method and analyzed using the computer-aided nutritional analysis program. A paired t-test was used to compare the energy and nutrient intakes of the weekdays and weekends, and the chi-square test was used to compare the distribution of the nutrient intake below the estimated average requirement. The results showed that the energy intake per day was quite low at 2,051.0±304.3 kcal, with a body mass index percentile of 16.8±9.8. The nutrients that showed remarkably lower levels than the dietary reference intakes for Koreans were vitamin D, vitamin C, vitamin B₂, and calcium, among which calcium was the highest at 86.1% in the proportion of those who consumed less than the estimated average requirement. The intakes of vitamin C and calcium, in particular, showed a significant decrease during the weekends. Therefore, to improve the dietary nutrient intake of adolescent male runners, appropriate management of the weekend diet as well as school meals should be considered.

Themes Depicted in Running-Related Films: An Opportunity for Co-Viewing and Active Mediation

Sport participation is an important part of the development of children and adolescents. The objective of this study was to identify and quantify themes depicted in a select number of running-related films. Thirty-one running-related films were independently viewed and analyzed by 4 reviewers. The number of positive and negative themes was 29.5 (95% confidence interval = 26.1-33.4) and 9.0 (95% confidence interval = 7.9-10.2) mean events per hour for all included films, respectively. The most common positive themes were "overcoming physical limitations," "overcoming mental obstacles," and "encouragement from family/friends/fans" (2.6, 2.4, and 2.3 mean events per hour, respectively). The most common negative themes were "giving up/losing confidence," "ignoring injuries," and "discouragement/ridicule from coach/athletic trainer" (1.2, 1.1, and 0.66 mean events per hour, respectively). In conclusion, the co-viewing of running-related films with pediatric athletes in order to focus on "teachable moments" may encourage the acquisition and development of positive themes and the avoidance and de-emphasis of negative themes.

The Effects of Endurance Sports on Children and Youth

In the United States, youth participation in sports continues to increase yearly. This increase in participation, in conjunction with the trend toward early sports specialization and year round training, has led to a similar increase in athletically developed injuries. These injuries vary in nature and acuity, with the type of injury often related to the athlete's age, sport, and level of training. Endurance athletes are at an elevated risk of injury as they frequently push their body to the limit during their arduous training. Pediatric endurance athletes can be particularly vulnerable, especially to overuse injuries, given their unique and ever-changing physiological state. It is important to understand the specific challenges facing not only the physical, but also the emotional well-being of these pediatric endurance athletes to maximize performance while minimizing injury and potential long-term sequelae.