This systematic review found 48 studies that quantified the risk of injury from physical activity in children aged 5–15 years. Thirteen different sports and activities were represented, with soccer the game studied most often.
The magnitude of injury risk varied across sports: the highest injury rate per hours of exposure was reported for ice hockey, and the lowest was for soccer. However, it appeared that injury rates were greatly influenced by the definition of injury used and the age of participating players.
What is already known on this topic
- Children receive many physical and psychological health benefits from participating in regular physical activity, but these must be weighed against the risk of injury.
- A vast amount of literature exists on the risk of injury in various sports and activities.
What this study adds
- This systematic review provides a concise summary of the literature detailing the risk of activity‐related injury per an objective exposure denominator for children aged 5–15 years.
- The review allows comparison between different sports and activities and highlights the methodological shortcomings and current gaps in the literature on this topic.
The highest injury rates expressed as injuries per player season were also reported for ice hockey. Direct comparison between injury rates per player seasons may be problematic, however, if the duration of the playing season varies between sports or organisations such that players are exposed to different numbers of games of practice sessions. This information was not provided in all of the studies.
Comparison between sports using a measure not based on hourly exposure is more difficult. However, some authors contend that such exposure measures may be inappropriate.49
For example, it has been argued that the constant interruptions that characterise a game of American football mean that players are inactive during a significant proportion of game time, rendering a time‐based exposure measurement meaningless. Stuart and colleagues49
therefore expressed injury rates for American football in terms of player plays. A similar approach was adopted by Hale,55
who expressed injury rates in terms of balls pitched during football, and by Kujala and colleagues,56
who reported injuries per bicycle riders and bicycle uses.
Although a wide number of different sports were represented by the included studies, the current knowledge of physical activity‐related injury risk in young children remains limited. Except for one study which reported cycling injury rates, all the studies were conducted in organised sports. There were no studies that reported injury rates for unorganised, daily activity.
In addition, very few children at the lower end of the age spectrum were included in the studies, with only seven including children aged less than 8 years.21,29,36,38,47,50,52
The study results indicate that injury incidence increases with age, but the magnitude of injury risk in very young children remains unknown.
The risk of physical activity‐related injury must be considered within the context of the substantial benefits that children gain through participation in sports and activities. In general, the overall injury risk may be considered to be quite low compared with the opportunities for improving physical, psychological and mental health that many activities offer.
At some point, however, questions will be asked about sports and activities for which a higher injury risk is consistently demonstrated. Discouraging children from participation in such activities is undesirable. However, anxious parents may not permit children to participate if they believe their safety is compromised.
Modification of rules for younger players is one approach that has met with previous success in reducing injuries in some sports. Such approaches are being explored for many activities and coupled with improvements in coaching techniques, equipment safety and maintenance of playing fields may improve the safety of childhood sports and activity without reducing the associated enjoyment and health benefits.