Little League Safety: How to Protect Our Future All-Stars on the Field

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Parsing the new policy statement released by the American Academy of Pediatrics for keeping kids safe while playing baseball.

Image: Heather Renee/Shutterstock

Every spring millions of American children ages five to 18 participate in baseball and softball programs throughout the country. To help prevent injuries, the American Academy of Pediatrics (AAP) has produced a policy statement aimed at increasing safe play.

Children understand and play the game differently and sustain different types of injuries at different ages and stages of cognitive and physical development. The new guidelines are meant to make coaches and parents aware of this so they can tailor rules, equipment, and expectations to the ages and stages of the children involved to make playing softball and baseball safer and more enjoyable. Here are some highlights.

OVERUSE AND REPETITIVE STRESS INJURIES

Overuse injuries in baseball and softball are common, particularly among pitchers. The AAP recommends that in addition to taking precautions to limit the number of throws, "Parents, coaches, and players should be educated about the early warning signs of elbow and shoulder overuse injuries.... [A]thletes should cease pitching immediately when signs of arm fatigue or pain occur...."

Little League shoulder and Little League elbow are both overuse injuries that result from the repetitive stress of throwing which can cause muscle fatigue, and damage muscles, tendons, and ligaments This, in turn, can lead to chronic pain, joint instability, and degenerative arthritis. Proper conditioning, proper throwing mechanics, enforced limits on daily, seasonal, and yearly pitches thrown, and enforced rest periods are all considered keys to prevention.

In 2006, the Medical and Safety Advisory Committee of USA Baseball set pitching limits for the season and calendar year based on the pitcher's age. Similarly, Little League has guidelines for the number of pitches to be thrown in a day and the number of rest days required between pitching assignments based on pitches thrown and the age of the pitcher. They also demand that each league designate a scorekeeper or official to track pitch counts as the official pitch-count recorder. A violation of the rules can result in a protest of the game in which it occurs.

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The Little League's own pitching guidelines state that a manager must remove the pitcher when a pitcher reaches the limit for his/her age group (they may remain to complete pitching to the batter at bat). The pitcher may remain in the game at another position. However, if a pitcher delivers 41 or more pitches in a game, he or she cannot play the position of catcher for the remainder of that day. When young pitchers are on multiple teams, it is important that the guidelines must be enforced across all teams, taking into account the sum of pitches among them, so that pitchers do not overstress their elbows and shoulders.

Rest Requirements for Young Shoulders, Backs, and Arms

Giving young bodies time to recover is as important to protecting pitchers' shoulders and arms -- and backs -- as limiting pitches. The Little League's rest requirements also take into account a pitcher's league age and the number of pitches thrown and stipulate that a player may not pitch in more than one game in a day.

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The AAP guidelines note that young pitchers should not pitch competitively for more than eight months in any 12-month period, and they recommend three consecutive months of complete rest from pitching each year. Additionally, it is recommended that pitchers not serve as catchers, since catchers throw even more often than pitchers.

The kinds of pitches being thrown make a difference, too. The curve ball and the slider are considered to be too stressful for the immature joints of young players. It is recommended that these pitches not be introduced until the pitcher has reached skeletal maturity, around age 14 to 16. Keep in mind that children mature at different rates, so some may still be growing at age 16 and beyond.

Special Softball Issues

Softball pitching has similar musculoskeletal challenges to baseball but softball pitchers throw underhand (windmill pitch) and the hips and legs are more involved in the supportive mechanics. Thus, weak gluteal muscles and poor pelvic stabilization may contribute to shoulder pain and overuse injury. Accordingly, injury rehabilitation and preseason conditioning for softball pitchers should include attention to the gluteal and pelvic muscles in addition to the shoulder.

Image: JustASC/Shutterstock

PROTECTIVE EQUIPMENT AND BASEBALL-SPECIFIC RISKS

The AAP guidelines stress that "serious and potentially catastrophic baseball injuries can be minimized by the proper use of available safety equipment." This includes batting helmets with face protection for hitters; helmets, masks with throat guards, chest protectors and shin guards for catchers; hard plastic athletic cups for all players to prevent testicular injury; and rubber spiked shoes for all players. Other available protective equipment includes padded sliding pants, to reduce bruising during sliding into base, gloves to reduce hand abrasions and blisters, and behind-the-knee pads for catchers to minimize strain on the knee joint while squatting.

Chest and Heart Injuries

Commotio cordis is one of the most catastrophic of baseball injuries and occurs when young players receive a direct ball to their chest right over their hearts. The heart rhythm is disrupted, often fatally. It is the second highest cause of death in athletes under age 14. It only occurs in children under 16, most likely because their chests are more elastic than older children and more easily compress, leaving the heart vulnerable to impact.

Chest protectors have not been shown to be effective in preventing this injury and are not routinely recommended for all players, although catchers must wear approved chest protection. Teaching players proper positioning relative to the oncoming ball and helping them learn to recognize and react to a threatening ball throw can prevent the problem.

Commotio cordis is one of the most catastrophic of baseball injuries and occurs when young players receive a direct ball to their chest right over their hearts. It is the second highest cause of death in athletes under age 14.

If a player sustains a chest injury and goes into cardiac arrest, an appropriate response with a defibrillator can save his/her life. For this reason, the Academy recommends that coaches and officials be fully prepared to initiate an emergency response and have ready access to an Automated External Defibrillator or AED, a device that can treat life threatening heart arrhythmias at the scene.

Head Injuries

The sports world has increasingly recognized that concussions, even mild ones, need to be treated and followed up carefully. The Academy guidelines emphasize that: "Coaches, parents, umpires, and league officials need to be knowledgeable regarding the causes, prevention, recognition, and response to concussion. "

In baseball, as in other sports, when a player sustains a concussion, it is recommended that they be removed from the game with no return allowed on the day of the injury. The best recovery is dependent on resting the brain from physical, cognitive, and social activity. Prompt medical attention is key and the player must not return to play until cleared by a knowledgeable physician. There should be a slow, graduated return to practice and play to ensure safety.

Baseball has the highest rate of sports-related eye injuries. Thirty percent result from being struck in the face by a pitched ball. The incidence is highest in the five to 14 year old group. The policy paper recommends that baseball and softball players wear "polycarbonate eye protection guards or shields or metal cages on their batting helmets" to reduce the risk of eye injury. Children who have only one good eye, have had eye surgery, or had previous severe eye injuries, should wear eye protection at all times during play whether batting or fielding.

BALLS AND BATS ... AND THE WEATHER

Since the ball is the cause of most baseball injuries, equipment manufacturers have developed balls with varying hardness and compressibility for use by children of different ages. The intent is to lessen the impact of the ball while maintaining its performance. Research has supported the assumption that lower impact balls are less likely to cause injury.

Standards were developed by the National Operating Committee on Standards for Athletic Equipment, grading the balls 1, 2, 3 with the lowest impact balls being recommended for players 10 and younger, moderate for 10 to 12 year olds and level 3 being reserved for youths older than 12 or for 10 to 12 year olds with advanced skills. The academy supports the recommendation that children with the lowest skill level should use the lowest impact NOCSAE-approved balls.

There has been a shift from wooden bats to composite metal, but there is no consensus regarding the safety of the composite over wood. The AAP calls for continued research into this issue.

The physical environment and the weather can also pose risks to baseball players The new policy statement discusses how important it is for coaches and officials to be aware of heat and lightning safety. Many fields have automatic lightning detectors and alarms. It is also important that players be dressed appropriately for the temperature, maintain adequate hydration in hot and humid weather, and use sun protection including sunglasses, hats, and sunscreen. It is strongly recommended that the physical environment, including the field, fences, bases, and dugouts be regularly inspected for safety hazards.

Because the ages of baseball and softball players span such a broad range of physical and cognitive developmental stages, the American Academy of Pediatrics recommends parents and coaches be sensitive to these age-related differences. Younger players are less coordinated, react more slowly, have reduced ability to pitch accurately, and fear being hit by the ball more than older children. The injuries of younger players are more likely to be related to their lack of skill than those of older players.

To meet these challenges, the AAP recommends that rule modifications taking into account developmentally appropriate risks and differences should "continue to be implemented when indicated." For example, the youngest players will benefit from a batting tee or an adult pitcher and the use of softer balls. Depending on the age of the players, the distance between bases and from the pitcher's mound to the home plate must be modified, with the shortest distances for the younger players and the longest for the oldest. Similarly, The length and width of the bats increase as the players increase in size and ability.

The main message behind the AAP Guidelines is this: Coaches and parents would do well to take a developmental approach to their young athletes and have age-appropriate expectations of their players with respect to their physical as well as cognitive and emotional capabilities. With proper conditioning, equipment, and rules, baseball and softball are safe and enjoyable pastimes.


This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

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Esther Entin, M.D., is a pediatrician and clinical associate professor of Family Medicine at Brown University's Warren Alpert School of Medicine. She writes for TheDoctorWillSeeYouNow.com.

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