It is no secret that children often have minor injuries while playing. Skinned knees and scraped elbows are part of growing up. But it is important to remember that recreational injuries can have a lasting impact on a child's health and development, even into adulthood.

A study published in the November/December 2001 issue of the Journal of the American Academy of Orthopaedic Surgeons identified four activities with the most injuries to bones and muscles. These are bicycle riding, basketball, football, and roller sports.

They cause about 1.5 million medically treated bone and muscle injures among children 5 to 14 years of age. And this number only includes injuries that require a doctor's care! The most costly injuries are broken bones (fractures). You cannot avoid every injury, but following current safety guidelines and using protective equipment can help.

The greatest number of recreational injuries to children occur while the child is riding a bicycle. Most of these 415,000 injures are bruises (contusions). Broken arms and wrists are also common. There are more than 125,000 fractures among bicycle riders. Falling off the bike and colliding with a fixed object such as a wall or with another bicycle are the most common causes of injuries.

To reduce your chances of being injured while riding a bicycle:

• Take a riding skills course. Most injuries resulted from rider error. Knowing what to do can help you avoid accidents.
• Don't ride on uneven or slippery surfaces.
• Don't ride at night. It's harder for you to see what's ahead and it's harder for motorists to see you.
• Wear a properly fitted bicycle helmet.

Basketball is the most popular team sport in high schools. It is also the leading cause of all sports-related injuries. Each year, children aged 5 to 14 years have more than 407,000 muscle and bone injuries while playing basketball. Although boys and girls at this age have similar injury rates, the rate for knee injuries increases significantly for young women aged 15 years and older. Girls also have more ankle sprains than boys.

To reduce your chances of having a basketball-related injury:

• Wear protective equipment. This may include mouth guards, eye protection, ankle braces, strapping, or taping.
• Take time to warm up and stretch. Initially stretch the spine and legs in a relaxed but thorough fashion. Warm up with jumping jacks, stationary cycling, or running or walking in place for 3 to 5 minutes. This should be followed by slow and gent stretching, holding each stretch for 30 seconds.
• Practice good technique. For example, when you jump for the ball, land on a bent knee rather than a straight knee.

Football is a collision sport. Each year, doctors treat an estimated 389,000 musculoskeletal injuries due to football in children 5 to 14 years of age. More than 100,000 injuries involve a fracture, although sprains, strains, and bruises are also common. Head and neck injuries can be especially serious. An athlete who exhibits any of the signs or symptoms of a concussion should be taken out of the game until a physician has conducted a thorough examination and approved a return to play.

Signs of a possible concussion include:

• Headache
• Dizziness
• Confusion
• Unsteadiness
• Ringing in the ears
• Loss of consciousness
• Amnesia
• Vomiting
• Nausea
• Visual disturbances
• Light-headedness

To reduce the risk of incurring a football-related injury:

• Wear the proper protective equipment, including a helmet, face mask, mouth guard, proper pads in the uniform, and proper shoes or foot wear. Because spikes on shoes should be different lengths on different surfaces, don't wear shoes designed for one surface while playing on different type of surface.
• Learn the proper technique for tackling an opponent. "Spearing," or tackling with the head-neck, can result in concussions as well as injuries to the nerves in the neck and shoulders.
• Drink plenty of fluids during practices and competitions. Proper hydration and frequent breaks are also necessary to avoid heat-related illnesses.

Roller sports include inline skating, skateboarding, scooters, and roller skating. This category accounts for 297,000 medically treated musculoskeletal injuries among 5- to 14-year-olds each year. More than 125,000 of these injuries involve broken bones, primarily among children younger than 10 years of age. Fractures due to skateboarding are more common among older children (11 to 14 years old). The forearm and the wrist are the most common fracture sites.

To reduce the risk of injury from a roller sport:

• Wear the proper protective equipment. Wrist guards and helmets are especially important. Wrist guards can help reduce the risk of fractures; helmets protect against head injury. Protective knee and elbow pads are also helpful.
• Ride on smooth surfaces away from traffic.
• Don't let a young child go unsupervised. Younger children don't have the experience or skills necessary to avoid accidents.
• Older children who plan to practice tricks and trick jumps should only do this in a controlled environment, such as a skate park, with adult supervision and appropriate access to emergency medical care.

Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)