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Athletes need to enjoy their training. They don’t enjoy going down the track with their coach making them do repetitions until they’re exhausted. From enjoyment comes the will to win.

Arthur Lydiard, New Zealand runner and legendary athletics coach

Participation in youth (i.e. child and adolescent) sports is increasingly popular and widespread in Western culture. Children as young as 6 years of age initiate year-round training and specialisation in their sports, some training more than 20 hours per week and travelling with teams to compete at national and international levels.

Clinical Sports Medicine Volume 1: Injuries explores some specific physiological characteristics and the management of orthopaedic conditions in childhood and adolescence. This chapter aims to guide the clinician involved in the medical management of the young athlete at all levels of participation.

In this chapter, we will discuss:

  • physiological characteristics of the young athlete

  • changes in sports performance with age and maturation

  • common paediatric medical presentations where a diagnosis needs to be made

  • differential diagnoses of the child with dyspnoea on exertion or deteriorating exercise performance

  • exercise prescription for children with a known life-long condition

  • contemporary principles for the management of concussion in the younger athlete.


Engaging in sports activities at a young age has numerous health benefits but also carries risk of injury. Health problems may appear for the first time due to increased participation and training intensity in sport. Some common conditions that may be diagnosed for the first time in the young athlete include type 1 diabetes, cardiac defects and asthma. Some of these conditions are covered in their own chapters in this volume, but this chapter focuses specifically on diagnosis and management in the young athlete.


At no time during the human lifespan does the body undergo as many changes as it does during childhood and adolescence.

Determinants of peak performance

Although some of the world’s best sports performances have been achieved by athletes in their mid-teens (e.g. Alina Zagitova, Olympic gold medallist in figure skating at age 15; Simone Biles, world all-around gymnastics title at 16; Martina Hingis, Grand Slam tennis champion at 16) most of the physiological determinants of sports performance improve throughout childhood and adolescence and peak in the early 20s.

In elite youth sport among children under 12 years old, there is equal representation of those who mature early, at the normal time and late; but in most elite adolescent sports, there is a preponderance of athletes whose physical maturation is early or on time. There is a performance advantage of reaching maturation early in many sports and often those born early in the year (therefore more physically mature) tend ...

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