Risk of injury from baseball and softball in children 5 to 14 years of age. American Academy of Pediatrics Committee on Sports Medicine.

Baseball is one of the most popular sports in the United States, with estimates of 4.8 million children 5 to 14 years of age participating annually in organized and recreational baseball and softball. Interest in and fascination with the sport have grown since the beginning of the 20th century, but it was not until 1965 that the issue of “Little League elbow” raised concern about the safety of the game. Recently, highly publicized catastrophic impact injuries from contact with a ball or bat have raised new safety concerns. These injuries provided the impetus for this review of the safety of baseball for 5to 14-year-old participants. The discussion focuses principally on baseball, but softball is considered in accord with the availability of relevant literature. This statement mainly concerns injuries during practices and games in organized settings; players and bystanders also can be injured in casual play. The term Little League elbow was used in 1965 to denote radiologic evidence of fragmentation of the medial epicondylar apophysis and osteochondrosis of the head of the radius and capitellum.”2 Subsequent studies of children 12 years old and younger ’4 have found a substantially lower incidence of abnormalities than originally described.”2 Early detection and intervention seem to permit the complete resolution of symptoms and underlying structural abnonmalities.5 More serious abnormalities become more common after the age of 13 years. The role that repetitive throwing in 5to 14-year-old children may play in the evolution of elbow overuse injuries at an older age remains to be determined. In response to concern about Little League elbow, many youth leagues have attempted to limit the stress placed on young pitching arms. For example, Little League Baseball, Inc limits pitchers to a maximum of six innings of pitching pen week and requires mandatory rest periods between pitching appearances.9 Instruction in proper pitching mechanics is another way to prevent serious overuse throwing injuries.5”0 The overall incidence of injury in baseball ranges between 2% and 8% of participants per year. Most injuries are minor soft tissue trauma, usually to the face and upper extremity.”2 Sliding is the cause of one third of the injuries to the lower extremity. In