Strength Training in Children

Strength Training in Children: Should They “Weight”?

SARAH ZIRKLE HALL, MD and LINDA S. NIELD, MD—Series Editor

Dr Hall is a pediatric resident and Dr Nield is associate professor of pediatrics at West Virginia University School of Medicine in Morgantown.

A MOTHER ASKS:

My 10-year-old son plays soccer and basketball and wants to work out with me. Is it safe for him to start a weight-lifting program?

THE PARENT COACH ADVISES:
Children aged 10 years can begin a weight-lifting program, but it must be done correctly. More than 40 million children in the United States participate in sports.1 Soccer, football, basketball, and baseball are the most popular sports among children. Physical activity should be encouraged for obvious health reasons. Major medical associations agree that strength training can be safely incorporated into a child’s overall sports training program at age 7 to 8 years.2,3 The overall sports training program includes exercises to improve cardiovascular fitness, stretching and flexibility, and sport-specific drills. Strength training, also known as resistance training, refers to the use of gradually increasing forces exerted on the body to improve the strength of the musculoskeletal system.2,4 Although the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness is supportive of strength training as an adjunct to sports participation, it does not advocate the sport of competitive weight lifting for the skeletally immature child.2The sport of weight lifting includes technically difficult lifts known as the “clean and jerk” and “snatch,” which should not be a part of strength training for a 10-year-old child.

Strength training can be a very positive experience for the young athlete, but there is the potential for serious adverse consequences when rules are not followed. If proper supervision and technique cannot be guaranteed, then strength training should not be part of the child’s exercise program.

Should children pump it up? Whether strength training at a young age provides significant benefits is a topic of on-going research. The benefits of strength training for young children may include the following:
•Increased muscular strength and endurance.
•Prevention of injuries.
•Enhancement of bone metabolism.
•Improvement in sports performance.
•Improvements in self-esteem, self-confidence, and body image.5,6

A literature review by Faigenbaum and colleagues6 indicates that resistance training, when performed appropriately, does not appear to lead to growth plate injuries or interfere with physical maturation.

Parents must be made aware of the potential adverse effects of weight lifting on the musculoskeletal system. Sprains, strains, tears, joint dislocations, and spinal injuries are some of the reported risks. Injuries are most likely to occur with improper lifting technique and training, excessive loads and maximal lifts, poorly designed equipment, and lack of qualified adult supervision.5,6 The medical literature is scant concerning fatalities associated with improper weight lifting. George and colleagues7 reported on a 9-year-old boy who died after a 23-kg barbell fell on his chest and ruptured his right atrium at the junction of the superior vena cava.7

The 2 most important components for youth strength training. The policy statement of the AAP Council on Sports Medicine and Fitness contains detailed recommendations for supporting strength training in young children.2 For the child with certain medical conditions (ie, cardiac disorders, hypertension, seizure disorders, history of chemotherapy with adverse cardiac effects), consultation with a pediatric subspecialist may be necessary to determine the appropriateness and safety of strength training. After the child is determined to be medically fit to participate in this type of training, the 2 most important components for a successful strength training program are: close supervision and proper technique (Box).

Close supervision. It cannot be overemphasized to parents that before they allow their 10 year old to participate in strength training, they must guarantee that the child will have qualified adult supervision 100% of the time. “Qualified adult supervision” may not necessarily be the parent but should be someone who is appropriately trained. Parents should only supervise if they are qualified to do so.

Proper technique. The person providing the strength training instruction must ensure that the child learns proper technique and use of equipment. Children who participate in strength training may use their own body weight, free weights (barbells and dumbbells), rubber stretch bands, medicine balls, and some exercise machines.4,5 Faigenbaum and Westcott4 emphasize that the training environment must be kept safe and that the child must be able to follow directions and have a positive attitude toward the training; the child’s program must also be individualized based on his or her abilities. No matter what type of resistance is used in the training, each workout must begin with a 10- to 15-minute warm-up that includes proper stretching and end with a cooling-down period.

Other components of a good workout. Children should pay attention to all major muscle groups and perform exercises initially with no resistance until they achieve proper form.2 If free weights will be used, the young athlete should start with small loads, perhaps with as low as 1-lb weights for arm exercises. Exercises performed in 2 to 3 sets of 8 to 15 repetitions, 3 times per week, can be beneficial. Kraemer and Fleck5 recommend limiting the amount of weight for prepubescent children to only that which they can lift for at least 6 or more repetitions.5 When a certain amount
of weight has been mastered for a particular exercise, the resistance can be increased minimally, such as by 10%.

The reader can consult expert trainers and coaches of young athletes for detailed training programs. Helpful publications, which describe age-specific and sport-specific exercises, are listed in the reference section.4,5

Acknowledgments: Dr Nield would like to thank Jane Rossi and Matthew W. Lively, DO for their expert review of this feature. Ms Rossi is a physical therapist and Dr Lively is a sports medicine physician at West Virginia University.