September 2000, Vol. 106, pp. 610-613
Summary version at www.aap.org/advocacy/archives/septath.htm
With all the concern about couch potatoes, let's start by emphasizing that exercise is good for children and adolescents, and girls are more actively participating in sports than ever before. However, with many youth workers becoming more involved in girls' athletic activities, they need to be aware of research about the possible health problems that can arise.
The American Academy of Pediatrics Committee on Sports Medicine and Fitness published a review of the research and information about female athletes. The article summarizes information about eating disorders, menstrual problems, and bone mineral density.
Eating disorders are more common in sports such as swimming, diving, gymnastics, dancing, and figure skating. Girls are sometimes encouraged by their coaches or teammates to lose weight to improve their appearance or their performance. Binge eating followed by intentional vomiting or use of laxatives are two of the commonly used dangerous weight loss strategies, but compulsive exercise is another form of purging. Despite the use of purging strategies to improve performance, they can impair performance and increase the risk of injury.
When athletic activity results in less body fat, it can cause a delay in puberty in girls, and increase the risk of menstrual problems. If breast development has not begun by age 13, and menstruation has not occurred by age 16, a medical exam should be considered. In addition to how these problems affect a girl's self-esteem, they may have implications for later osteoporosis, breast cancer, or other health problems.
The pediatricians' recommendations are intended for other pediatricians, but have implications for youth workers. Exercise and sports should be encouraged in girls, but youth workers should also encourage a reasonable approach to diet and nutrition, and discourage excessive, compulsive exercising. Menstrual problems should not be considered "normal" for female athletes and efforts should be made to encourage weight gain and modify exercise if menstrual problems persist. In this time of increasing pressure on female athletes, we will need more than recommendations from pediatricians to make that happen.