Position Statement

Children and Musculoskeletal Health

This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

The American Academy of Orthopaedic Surgeons (AAOS) considers childhood musculoskeletal injuries and conditions a major problem around the world. A healthy musculoskeletal system – consisting of bones, joints, ligaments, tendons and muscles – is essential to a child’s growth and development. Decisions made regarding children’s diet and activities will not only affect them now, but also as they grow into adults. Improper diagnosis or treatment early on may increase children’s susceptibility to a number of bone and joint injuries and conditions later in life.

Many thousands of children and adolescents nationwide suffer from musculoskeletal conditions each year. In fact, for children 19 and under, abnormal musculoskeletal conditions accounted for 540,000 hospitalizations and more than 12 million physician visits in 2003 alone.^1,2 In addition, approximately 8 million children under 20 sustained musculoskeletal injuries in 2003.² These problems – requiring orthopaedic care – can range from congenital conditions such as clubfoot and hip dysplasia, to developmental conditions like scoliosis, and to acquired conditions such as injuries, infections and diseases.

Musculoskeletal abnormalities and deformities can deprive children of normal development and childhood experience. Besides the physical and emotional burden these conditions and injuries place on the patient and family, the financial burden they inflict is enormous for the patient and healthcare system.

Childhood obesity is reaching epidemic proportions. Sixteen percent of children and adolescents ages 6-19 years old are overweight: up 45 percent from 1994.³ A sedentary lifestyle – paired with obesity – is the second leading cause of preventable death in the U.S.⁴ Not only do excess weight and inactivity cause undue stress on children’s musculoskeletal systems, they also increase a child’s susceptibility to additional health problems (such as heart disease and diabetes) later on in life.

As the musculoskeletal system matures and grows during childhood, the American Academy of Orthopaedic Surgeons (AAOS) stresses the importance of physical activity for children to maximize strong bone and muscle potential and combat obesity. The AAOS also believes additional research should be conducted to improve patient care and enhance the treatment and prevention of childhood musculoskeletal conditions, drawing from evidence-based medicine.

In an effort to promote physical activity and minimize the risks of potential injuries and conditions among children, the AAOS recommends the following:

• Make physical activity – at least 30 to 60 minutes – part of a child’s daily schedule.
• Encourage physical involvement in age and size appropriate youth activities such as team sports (i.e., soccer, baseball and basketball), dancing, swimming, step aerobics, stair climbing, tennis and other racquet sports, skiing, skating, karate or bowling.
• Take the time to warm up and stretch. Research studies have shown that cold muscles are more prone to injury. Warm up with jumping jacks, jogging, walking or stationary cycling for three to five minutes.
• Drink plenty of water before, during and after activities.
• Do not encourage children to play through pain. It is important they take breaks if tired.
• Limit the number of teams a child plays on in one season. Kids who play on more than one team are especially at risk for overuse injuries.
• Make sure children get at least 1,200 mg of calcium per day. Vitamin D and a bit of sunshine are also needed to keep bones strong.
• Keep in mind that exercise alone isn’t enough – adolescents should consume a healthy diet to maintain strong bones.
• Be prepared for emergency situations. Supervising adults must have a plan to reach medical personnel to treat injuries such as concussions, dislocations, elbow contusions, wrist or finger sprains, and fractures.

Tips to get kids moving! Here are additional tips for parents and other adults to motivate children:

• Reinforce that exercise can be fun!
• Model active behavior. Join children for a bike ride, ball game or long walk.
• Use physical activity – such as a family canoe trip or a walk to the park – as a reward for positive behavior.
• Make exercise part of the daily routine. Simple chores such as raking leaves or walking the dog are effective ways to increase activity.
• Designate indoor areas for physical activity.
• Select physically active-oriented toys and gifts.

References

1. National Center for Health Statistics, National Hospital Discharge Survey, 2003.
2. National Center for Health Statistics, National Ambulatory Medical Care Survey, 2003.
3. National Center for Health Statistics, National Health and Nutrition Examination Survey, 1999-2002.
4. Centers for Disease Control and Prevention (CDC) Report, 2000.

©March 2006 American Academy of Orthopaedic Surgeons

This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons®.

Document Number: 1170

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