Children and sports – «Movement is essential for physical and mental development»

Children have a natural urge to move. For some, it diminishes a bit over time. For others, it leads to a career in competitive sports. It’s natural for kids to run riot and let off steam – and it’s just as natural for parents to worry about how they can best support their children and channel their energy in the right direction. It’s something I worry about, at least.

What does them good? When is it too much of a good thing? How varied should my kids’ exercise be? And what are some potential problems? Friederike Wippermann, MD, was kind enough to answer my questions. She’s a specialist in paediatric and adolescent medicine, sports medicine and works as a senior physician at the University Center for Prevention and Sports Medicine at Balgrist University Hospital. In December, she co-organised the 1st Zurich Sports Medicine Symposium titled «Child and Sport».

I’d like to start with a big societal issue. For what feels like decades, we’ve been told our children are becoming less athletic and more overweight. Is there something to that?
Dr Friederike Wippermann: There is indeed. Children and young people are moving less and less. This development has been evident for several years, and the trend is continuing. The causes are quite diverse. Media consumption and a less active lifestyle certainly play a role. Most recently, the Covid pandemic has also had a negative impact on children’s movement behaviour.

This is a problem, because lack of exercise is a significant risk factor for obesity. The World Health Organization (WHO) has responded to this development by formulating physical activity recommendations for different age groups. In general, it’s recommended that children exercise at least one hour a day. What’s meant aren’t everyday activities, but moderate to intense exercise. In other words, children and youths should work up a sweat.

You’re saying many of them don’t sweat enough?
Let’s rewind to the Covid pandemic example. Over the course of it, we saw significant changes manifest themselves. Children of all ages moved less. A number of studies have shown that younger kids have recovered quite well and have since gone back to their pre-pandemic movement behaviour. Teenagers, on the other hand, continue to exercise less.

You’ve implied that obesity and lack of exercise go hand in hand. At what point is a child too heavy?
In children, overweight isn’t defined with absolute values. Instead, BMI (body mass index) is assessed using so-called percentiles in conjunction with height and weight. This allows a child’s development to be assessed based on sex and age. A percentile curve (linked document in German) allows us to assess growth during development (i.e. from birth to age 18). A BMI between the 90th and 97th percentile is defined as overweight; above the 97th percentile is considered obese. This means that only three per cent of all children of the same age have a higher BMI.

Does the problem continue to worsen?
The first major increase in obesity in society was observed in both adults and children in the 1990s. There was quite a jump. In recent years, the figures in Switzerland and Germany have been relatively stable despite there being differences between age groups.

At the University Center for Prevention and Sports Medicine, do you see only the most athletic of individuals, that is, young top athletes?
No, we see the whole spectrum. Of course, we do also see many athletic children and adolescents, as we offer medical care for young competitive athletes – for example, as team physicians. I myself am the team physician for the Zurich gymnastics association (ZTV) and the under-17 women’s national football team (SFV). Many athletes come to us for annual check-ups. This isn’t limited to competitive athletes.

Our medical care mission lies in all aspects of health related to exercise. So, many children and adolescents also come to us with injuries or other problems related to exercise. For example, some of them experience shortness of breath when exercising. And young people with chronic conditions also come in for advice on how much they can exercise and what they can do. We’re also regularly faced with the question of how to use exercise as a therapeutic agent – in the sense of «exercise is medicine».

I’m imagining the perspective of a parent and coach, observing and guiding children through school and sports clubs. You’re quite sensitive to any complaints of pain or other problems. What are symptoms that need to be medically clarified?
They can vary greatly. For example, a check-up is recommended if you notice problems with the musculoskeletal system or a child repeatedly complains of pain. This may indicate overuse. We also have parents coming to us all the time who are concerned about their child’s growth. Other reasons include misaligned feet, recurring back or knee pain during growth or – as I just mentioned – shortness of breath or circulatory problems while doing sports. Some teens notice a dip in performance after an illness.

Back to the topic of pain. What’s the deal with growing pains? After all, it’s a term that comes up every now and then. I’ve seen kids who have diffuse complaints that aren’t really severe, but are still limiting.
I’d put the term «growing pains» in quotation marks. It’s a diagnosis of exclusion. Many children describe diffuse pain on and off during growth – often in the legs and at rest. It often goes away again, but you should rule out any serious problems that could be causing it.

Where do complaints typically occur in children?
Often, we see growing athletes have problems with their knees. They complain of pain during exertion, often around the kneecap and adjacent tendon. This often affects children who participate in sports involving a lot of jumping or start-stop elements. For example, football, basketball or gymnastics. In this case, these aren’t classic growing pains, but irritations of soft tissue structures or bones.

So, these are sport-specific problems. It’s often said that younger children should have as varied a range of movement experiences as possible. But if they show talent, they quickly end up in a single sport, being challenged accordingly. Is this too early to specialise?
The general recommendation is indeed that younger children in particular should move in as wide a variety of ways as possible and combine it with play. That’s why so many are in gymnastics clubs or track and field. It all depends a bit on the sport. In disciplines such as football or tennis, the development towards competitive sports comes somewhat later. In gymnastics, specialisation begins very early. The training intensity is high, so it becomes difficult to practise other sports. You should aim to find a good compromise in your child’s training and support them so that they move in diverse ways.

But gymnastics is a perfect full-body workout. In sports such as tennis or football, the dominant side of the body experiences greater load. Is that a risk if you do a lot of training early on?
If you were to train on one side only, you’d be at risk of overuse injuries. For example, in tennis, that’d be your hitting arm and that side of your body. It’s important to train in a versatile and even way to avoid imbalances. But even with gymnastics, you have to be careful not to stress just one side. This is something to consider in all sports when creating training plans.

I always fail to motivate kids to do stretching and mobility exercises. Even when I try to do introduce them in a playful way, it’s not very effective. In my experience, this is rarely incorporated into any children’s sports. Isn’t this a missed opportunity?
There’s something like an ideal time window in which certain skills can be trained particularly well. In the case of mobility, for example, the foundations are laid at primary school age. Children can be supported in their development well if you use these time windows for different skills. As they get older, endurance and strength training also become more important.

You perform many sports medicine examinations. What happens during such a check-up and how are any deficits recorded?
We start off with a detailed conversation. In this so-called anamnesis, we go over training volume and intensity, any previous illnesses, illnesses in the family, and so on. Next, we measure body height and weight, record vital data and measure pulse and blood pressure. During the medical examination, we perform a full-body check of the musculoskeletal system to recognise any issues such as postural defects, foot malposition or scoliosis. We also listen to the heart and lungs. It really is a head-to-toe examination. In addition, we take a blood sample and do a resting ECG.

Does the topic of nutrition also play a role? I assume if you’re growing and very active, you should pay even more attention to what you eat than usual. Many adults don’t manage to do this themselves, and it’s probably no easier for children. Are symptoms of a deficiency an issue?
Yes, they are. All the more so as the training load increases. A balanced diet is the most important foundation. During the blood test, we also determine iron and vitamin D levels, for example. Trace minerals and vitamins are important for children. If we detect low levels in the blood test, we can act before deficiency symptoms appear. Especially during growth, low vitamin D levels or iron deficiencies are more common. We have good treatment options for them.

Do you have to be even more vigilant during puberty?
In the course of development, all children go through a so-called growth spurt. During this time, they, of course, need more energy. And if they do a lot of sports, you have to take that into account. They need vitamin D for bone development. They also need iron – especially girls.

It’s not like you only deal with extremely athletic kids. On the other hand, there are patients with chronic diseases, heart problems or asthma complaints. Under what conditions can children with such problems participate in sports?
In principle, any child can do sports. Sometimes you have to accept a few limitations. Movement is essential for physical and mental development. So, it shouldn’t be forbidden, especially not for children with chronic diseases. Children who had frequent surgeries in infancy, for example, often have motor deficits due to spending too much time in hospital. They’re often a bit more sheltered, perhaps exempt from school sports. We examine these children with regard to their performance and possible deficits, which might be treatable with physiotherapy.

They can play sports just as well, but sometimes simply need a safe setting. We’re currently planning to create an interdisciplinary sports group for children and adolescents with chronic illnesses. The goal is to offer those with musculoskeletal disorders, heart disease or obesity a safe environment to exercise in. This is also reassuring for parents.

Going back to societal concerns: are we doing enough to teach children as early on as possible to lead an active lifestyle? That would be the most effective preventative measure, wouldn’t it?
There are support programmes and great offers in schools and clubs. But it’s at home that children learn how natural exercise is. If the parents are active, they’re likely to take their children along with them. All in all, there are many offers – and we all have to support children together in taking advantage of them.