In recent years, there has been a surge in the participation of children in distance running. It is not unusual for an aspiring prepubescent athlete to run 10 to 15 miles daily and to participate in distance races, including marathons (26.2 miles).

Although running is a natural activity that can maintain and improve aerobic fitness, racing and particularly training for long distances have their risks. Distance running may induce musculoskeletal, endocrine, hematologic, thermoregulatory, and psychosocial damage. Most reports on such potential damage have not been evaluated with proper epidemiologic scrutiny. It is unknown whether the risk is greater for children than for adults. Nevertheless, the American Academy of Pediatrics wishes to alert the physician to the presence of such risks. Even without established guidelines and extensive documentation, physicians can give children, parents, and coaches advice that fosters healthy physical and psychosocial growth.

The most common musculoskeletal problems in the young runner are overuse injuries (ie, those that result from a mechanical stress repeated during a long period). These include epiphyseal plate injuries, stress fractures, patellofemoral syndrome, and chronic tendonitis.1-4 The incidence of such injuries seems to be related to the total distance covered in training and competition.4 Such overuse injuries may lead to a chronic disability (eg, chronic arthritis and growth deformity). Therefore, early medical intervention is important.

Female distance runners often experience delayed menarche.5 Its etiology and relevance to health have yet to be established. In most cases, menarche will occur several months after cessation or reduction in volume of training.

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