Baseball and softball are among the most popular and safest sports in which children and adolescents participate in the United States, says an updated policy statement from the American Academy of Pediatrics.1
"The rates of injury for baseball and softball are low in comparison with the other sports, the combination of relatively high severity of injuries that do occur and the very large number of participants in these sports produces a substantial number of individuals with significant injuries each year," the AAP report noted, with "[f]ocused media attention on these cases often produc[ing] a groundswell for action, even when the scientific evidence is lacking."
Participation
The total annual participation over a dozen youth baseball organizations is nearly 5 million
- Little League Baseball:
- Baseball: 2.3 million
- Softball: 400,000
- Babe Ruth (and its 12-and-under Cal Ripken Baseball Division): more than 1 million
- Fast-pitch softball for girls between ages 12 and 18: over 2 million
- High school baseball (as reported by the National Federation of State High School Associations): 473,503
- High school softball (as reported by NFHS): 393,578.
Injuries
Based on an extrapolation of data collected by the Consumer Product Safety Commission (CPSC) from U.S. emergency departments through its National Electronic Injury Surveillance System (NEISS), there were in 2007:
- an estimated 109,202 baseball- and softball-related injuries among 5- to 14-year-old children treated in US emergency departments;
- the highest number of injuries clustered in children 11 to 14 years, a group that represents the majority of participants;
- nearly half (44%) involved the head:
- 25% to the face, including eyes and nose;
- 14% to the head and neck; and
- 5% to the mouth.
- approximately one quarter to one-third of all youth baseball injuries are to the upper extremities, including:
- the fingers (10% to 13%)
- wrists (4% to 5%)
- hands (4% to 5%).
- just under 20% of injuries were to the lower extremities, including
- knees (5%) and ankles (6%-7%)
- injuries to the trunk and pubic area accounted for approximately 6% to 10% of all injuries.
- for girls:
- the highest number of injuries clustered in children from 13 to 16 years of age;
- the distribution of injuries for body region was more evenly distributed, with
- 28% of girls' softball injuries involving the head and neck;
- 35% involving the upper extremities;
- 31% involving the lower extremities; and
- 5% involving the trunk and pubic area.
- The five most common areas of injuries:
- face (14%)
- ankle (14%)
- finger (13%)
- knee (11%)
- and head and neck (11%)
- 39% of injuries were classified as contusions, abrasions, lacerations, or hematomas/hemorrhages;
- 31% were classified as sprains or strains;
- 21% were classified as fractures, dislocations, or avulsions;
- 4% were classified as internal organ injuries; and
- 4% were classified as concussions.
High school baseball
Baseball, says the AAP, is "one of the safest high school sports in the United States."
- Baseball athletes have the third lowest rates of injury lasting longer than 1 week among 18 different sports played at the high school level;
- Although the overall injury rate is low, however, the degree of injury severity is relatively high, with fractures representing a larger percentage of total injuries than in other sports.
- Baseball also ranks second highest for the percentage of injuries resulting in a time loss from sport participation longer than 7 days.
- In high school baseball, most injuries are to the head and face (48%) and mouth and teeth (16.0%) as a result of being hit by a batted ball. More of these head and facial injuries also required surgery (18%), compared to other baseball-related injuries (6.8%).
- Baseball had the lowest rate of concussions among the nine high school sports surveyed, while softball was seventh,
- The top two activities associated with concussion in high school baseball were batting (36.7%) and running the bases (21.5%).
- The top two activities associated with concussion in high school softball were catching (33.3%) and fielding (25%).
Injury patterns
According to a 2008 report by a USA Baseball:
- Across all age groups, pitchers, catchers, and fielders have a relative frequency of injury in a season comparable to batters and base runners, except, as age increases, the proportion of injuries to catchers increases (which USA Baseball attributed to the greater muscle power and body size increasing injury forces), while the proportion of injuries to fielders decreases (because injuries to younger players are more often associated with lack of skill);
- The younger the age group, the more frequently injuries occur during practices, not games. Note to youth baseball coaches: The study found relatively higher frequencies of injuries among the younger age groups from "before/after" baseball play, such as warmups or post-game horseplay);
- Pitching injuries are also age-related, with noncontact overuse injuries increasing in each older age group, while younger pitchers are more likely to be hit by a batted or thrown ball. [Note to youth baseball pitchers: Given the small, but ever present risk of commotio cordis to younger pitchers, teaching them how to react quickly to a batted ball hit at them is critical).
- Catchers principally are injured in catching a pitch, getting hit by a foul tip, or tagging a base runner. Younger catchers are more frequently injured trying to catch a pitched ball, while older catchers are more likely to be injured by foul tips. Home plate collisions produce a greater risk to the older catcher.
- Batters are most frequently injured by a pitched ball (and by a fould ball as they get older). Youth coaches take note: The younger the batte, the more likely they are to be injured by a swung bat of another player while getting into position.
- Baserunner injuries occur almost equally on the bases, with slightly more injuries at home plate than at first-base. Two-thirds of these injuries occurred from sliding, and one-third occurred from base running.
- Fielders are injured at the base (33%), in foul territory (10%) and in the field (57%). Younger fielders are more likely to be hit by a batted ball, whereas older fields are more likely to be injuried by colliding with a sliding opponent.
Catastrophic injuries
The rate of castrophic injury in baseball is very low (approximately 1 injury per 1 million participants annually).
- Between 1996 and 2006, deaths in youth baseball averaged just over 2 per year, resulting from impact to the head resulting in intracranial bleeding and from blunt chest impact, likely prompting ventricular fibrillation or asystole (commotio cordis)
- Another study, based on statistics from the CPSC, reported 88 baseball-related deaths (approximately 4 per year) to children 5 to 18 years old between 1973 and 1995:
- 38 (43%) from direct-ball impact with the chest (commotio cordis);
- 21 (24%) from direct-ball contact with the head;
- 13 (15%) from impact with a bat;
- 9 (10%) from direct contact with a ball impacting the neck, ears, or throat; and
- 7 (8%) from unknown causes.
- In high school baseball, there have been, between 1982 and 2008:
- 10 "direct" deaths;
- 14 "indirect" deaths;
- 17 nonfatal catastrophic injuries;
- 22 serious catastrophic injuries.
- In high school softball, there has been 1 direct death, no indirect death, 2 nonfatal catastrophic injuries, and 1 serious catastrophic injury in the 15 seasons from 1983 to 2008, a rate approximately one-tenth that of high school baseball.
1. American Academy of Pediatrics Council on Sports Medicine and Fitness, Baseball and Softball Policy Statement. Pediatrics 2012;128(3):842-856 (doi 10.1542/peds 2011-3593)(www.pediatrics.org/cgi/doi/10.1542/peds2011-3593 (accessed February 27, 2012).
