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Consensus statement

International Olympic Committee consensus
statement on youth athletic development
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For numbered afﬁliations see
end of article.
Correspondence to
Dr Michael F Bergeron, YouthSports of the Americas; Lemak
Sports Medicine, 500 Ofﬁce
Park Drive, Suite 200,
Birmingham, AL 35223 USA;mbergeron.phd01@gmail.com
Accepted 18 May 2015

Michael F Bergeron,1,2 Margo Mountjoy,3,4 Neil Armstrong,5 Michael Chia,6Jean Côté,7 Carolyn A Emery,8 Avery Faigenbaum,9 Gary Hall Jr,10 Susi Kriemler,11Michel Léglise,12 Robert M Malina,13,14 Anne Marte Pensgaard,15 Alex Sanchez,16Torbjørn Soligard,17 Jorunn Sundgot-Borgen,18 Willem van Mechelen,19,20,21
Juanita R Weissensteiner,22 Lars Engebretsen17,23
ABSTRACTThe health, ﬁtness and other advantages of youth sports
participation are well recognised. However, there areconsiderable challenges for all stakeholders involved—
especially youth athletes—in trying to maintain inclusive,
sustainable and enjoyable participation and success for all
levels of individual athletic achievement. In an effort toadvance a more uniﬁed, evidence-informed approach toyouth athlete development, the IOC critically evaluatedthe current state of science and practice of youth athlete
development and presented recommendations fordeveloping healthy, resilient and capable youth athletes,
while providing opportunities for all levels of sportparticipation and success. The IOC further challenges all
youth and other sport governing bodies to embrace andimplement these recommended guiding principles.

INTRODUCTION

To cite: Bergeron MF,
Mountjoy M, Armstrong N,
et al. Br J Sports Med
2015;49:843–851.

The goal is clear: Develop healthy, capable andresilient young athletes, while attaining widespread,inclusive, sustainable and enjoyable participationand success for all levels of individual athleticachievement. Yet, this is a considerable challenge
for all stakeholders in youth sports—parents,
coaches, administrators, sport governing bodies
and, especially, youth athletes.
The process begins with a subjective assessmentof potential talent, followed by a structured programme of training in a speciﬁc sport. However, thelimited success of talent identiﬁcation and athlete
development programmes is not surprising, as themodel of athlete development is built on an indi­vidually unique and constantly changing base,including the demands of normal physical growth,
biological maturation and behavioural development,
and their interactions.1 2 Athletic development isalso multidimensional and difﬁcult to assess inyouth, and the trajectories from the novice to elitelevels can vary greatly among athletes. Adding to thecomplexity, the demands of speciﬁc sports are super­
imposed on this dynamic integrated scheme.
Moreover, the development of sport-speciﬁc skills,
motivation and behaviours in an integrated learning
culture is not well characterised; and, given theselectivity and exclusivity of sport, it is the choice
athletes who generally receive the most attention in
research. Accordingly, less is known about those
who are systematically excluded (cut), who drop out(voluntarily withdraw) or are injured, along with

contributing factors such as overuse, overtraining
and burnout.
There is also an urgent need to extend our viewsof youth athlete development to include the ‘culture’of speciﬁc sports and youth sports in general, includ­ing the underlying philosophy for developing youth
athletes, the systems of speciﬁc sports and interac­tions between athletes, coaching styles and practices,
the effects on youth athletes from parental expecta­
tions and the view of youth athletes as commodities,
which is often intrusive with a ﬁne line between
objectivity and sensationalism.
In an effort to advance a more uniﬁed, evidenceinformed approach to youth athlete development,
the IOC convened a consensus meeting of experts
in the ﬁeld in November 2014. The group was
charged with two tasks:
1. Highlight key considerations and challenges incompetitive youth sport, and critically evaluate
the current state of science and practice ofyouth athlete development;
2. Create guidelines for a sustainable model todevelop healthy, resilient and capable youth ath­
letes, while providing opportunities for all
levels of sport participation and success.

MATURATION
Assessment of biological maturity
status and timing
Biological maturation is an ongoing process thatbegins prenatally and continues through approxi­
mately the ﬁrst two decades of postnatal life.
Outcomes of the underlying biological processes
are observed, assessed and/or measured to provide
an indication of maturity status (ie, the status of
the youngster at the time of observation), com­monly speciﬁed by skeletal age (SA) and secondary
sex characteristics. Maturity timing refers to thechronological ages when speciﬁc maturational
events occur, frequently assessed by age at peakheight velocity (PHV) and age at menarche. For
accuracy, both require longitudinal data that spanadolescence, as recalled age at menarche has error
associated with memory and a tendency for report­
ing in whole years.2–6
SA is the most useful estimate of maturity status
and can be used from childhood into late adoles­
cence.2 7 It can also be used with current bodyheight and/or mid-parent height to predict matureheight, which is of interest in some sports. Radiation

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Consensus statement
exposure with hand-wrist radiographs is minimal; although,expert interpretation is required. SA and fusion of the distal
radius based on MRI are periodically used for chronological age
veriﬁcation, especially in some male youth sport competitions.7–9
Given the maturity-related gradient in selection favouring earlymaturing males in many sports, the likelihood of false negatives isincreased.7 Ethnic variation in skeletal maturation is also a related
consideration.2 7 As such, SA and fusion of the distal radius
should not be used for age veriﬁcation purposes in sport.
Secondary sex characteristics (breasts, genitalia, pubic hair)
are useful only during the pubertal interval. Assessments indi­cate stage of puberty at the time of observation, but provide no
information on age at entry into and duration of a stage.
Moreover, for some, assessment of secondary sex characteristics
can be invasive; and accuracy of assessment can be signiﬁcantly
discordant among physicians, and between physicians and youth
in self-assessments.10 11
Percentage of predicted mature (adult) height at the time ofobservation provides an estimate of maturity status.12 The
method has moderate concordance with classiﬁcations of matur­
ity status, based on SA in youth American football and soccer
players.13 14 Predicted time before PHV (maturity offset) and, inturn, predicted age at PHV provide an estimate of maturity
timing.15 However, validation studies indicate several limita­
tions.16–18 Predicted offset and age at PHV increase withchronological age at prediction; predicted ages at PHV have a
reduced range of variation (SDs ∼0.5 year); and predicted age at
PHV is affected by actual age at PHV in both sexes, and age at
menarche. Also, height prediction equations are available pri­marily for European ancestry, which limits their global applic­ability. Maturity offset was suggested as a categorical variable,
pre-PHV or post-PHV;15 as such, it is most useful close to thetime of actual age at PHV in average (on time) maturing boys
within a narrow age range, 13.00–14.99 years, which limits its
utility with elite male athletes who tend to be early maturing.7
The trend is more variable in girls, as the protocol overestimatesage at PHV more than in boys. Ethnic variation in sitting heightand estimated leg length is also a confounder in the prediction
equations. Moreover, identiﬁcation of the ethnicity of youth isnot permitted in some countries.19

Physiological and performance changes across maturation
Muscle metabolism
Muscle biopsy studies indicate that resting muscle ATP concen­
tration is invariant with age; but phosphocreatine (PCr) andglycogen concentrations increase with age, at least in boys aged
11–15 years. Glycogen depletion with exercise is greater inolder boys and is reﬂected by increased muscle lactate accumula­tion with age. Children and adolescents accumulate less blood
lactate than adults during exhaustive exercise, and there is anegative relationship between the percentage of peak VO2 at thelactate threshold and age. However, sex and/or maturation
effects on blood lactate accumulation remain to be proven.20 21
Sparse data indicate enhanced oxidative enzyme activity in chil­dren and adolescents compared with adults and lower glycolytic
enzyme activity in pre-pubertal children than in adolescents oradults; though, differences in glycolytic enzyme activity between
adolescents and adults are less clear.21–23
During submaximal exercise, children’s enhanced ability tooxidise lipids, and therefore spare glycogen, means that they are
well-equipped for long-term moderate intensity exercise. Youngpeople have higher rates of exogenous carbohydrate oxidation
than adults; but, the optimal carbohydrate supplementation tosustain endurance performance during youth is unknown.24 25
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Muscle strength
The development of muscle strength is dependent on a combin­
ation of muscular, neural and biomechanical factors. Strength
increases with few sex differences in a relatively linear manner
through childhood. During puberty, however, sex differences
emerge with boys demonstrating accelerated increases instrength, while girls continue to develop at a similar rate as
during pre-puberty. Sex differences in strength are bothmuscle-group and muscle-action speciﬁc; but, on average, bylate puberty, there is a sex difference in the expression ofstrength of ∼50%.26 27

Aerobic and anaerobic ﬁtness/performance
There is an almost linear increase in boys’ peak VO2 from 8 to
18 years, with a similar but less consistent trend in girls’ values,
which tend to plateau in the mid-teens. Peak VO2 increases by∼80% in girls and by ∼150% in boys from 8 to 16 years of age,with the sex difference increasing from ∼10% at age 10 to∼35% by age 16 years. Increasing muscle mass is the dominant
inﬂuence on peak VO2 during adolescence; but, maturation has
a signiﬁcant positive effect on peak VO2, independent of age
and body size and composition.28 The time constant of the
exponential rise in the pulmonary ( p) VO2 kinetic response to
exercise above the lactate threshold increases with age fromchildhood through adolescence. The pVO2 slow component
also increases with age. Pulmonary VO2 kinetics studies provide
compelling evidence that, at the onset of exercise above thelactate threshold, children and adolescents have an enhanced
potential for oxidative metabolism compared with adults.29
In the absence of intra-muscular data, research on anaerobic
performance has focused on the assessment of external cycling
peak power output (CPP), using variants of the Wingate anaer­
obic test. There is an almost linear increase in CPP in both sexes
from ∼7 to 12 years and then a more marked increase in boys’
CPP through to young adulthood. Girls often outscore boys
until ∼12 years of age, due to their more advanced maturation;but, by age 17 years, the sex difference in CPP is ∼50%.30
There is an asynchronous increase in anaerobic and aerobic per­formance with age and maturation. From ages 12 to 17 years,
girls increase their CPP by ∼65% compared with boys, who
experience a ∼120% increase in CPP. Both sexes experience a
more marked improvement in CPP than in peak VO2 during
maturation, with peak VO2 increasing by ∼70% and ∼25%,
respectively, in boys and girls aged from 12 to 17 years.31 32

Fatigue resistance and recovery
Resistance to fatigue and recovery from high-intensity intermit­
tent exercise undergo a gradual decline from childhood to adult­
hood in males. In females, the adult proﬁle appears to beestablished by mid-puberty. The distinction has been attributed
to children having more rapid cardiorespiratory recovery
kinetics, enhanced oxidative activity, faster PCr re-synthesis, dif­ferent motor unit recruitment, better acid–base regulation andlower production and/or more efﬁcient removal of metabolic
by-products, than adults.33 34

Responses to exercise training
Evidence-based IOC recommendations for muscle strength, andaerobic and anaerobic training programmes are documented.35
Pre-pubertal children beneﬁt from resistance training; but, thetrainability of muscle strength increases with age. There is aminor sex-effect during pre-puberty, which increases with age
and maturation. It is, however, unclear which maturationalchanges account for the enhanced strength trainability of boys.

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Consensus statement
There is no compelling evidence to suggest that, after adjustingfor initial ﬁtness, aerobic or anaerobic responses to training are
related to sex, age or maturation during youth.36–38

Sleep
Several hormonal and neurological changes occur duringpuberty, affecting the homoeostatic and circadian regulation of
sleep.39–41 Adolescents have later bedtimes and wake times,42
with a recommended optimal level of sleep of 8.5–9.5 h.43
However, international trends indicate a prevalence of insufﬁ­
cient sleep among adolescents,44 often prompted by earlyschool-start times, academic demands, social activities andevents, caffeine consumption and screen-time at night.43 45 46
For youth athletes, the training and competition schedule
further exacerbates the deﬁciency of sleep,47–50 with preliminary
evidence indicating an increased likelihood of injury with insuf­
ﬁcient sleep.51 Given the potential consequences of insufﬁcient
sleep on health, behaviour, attention, and learning and athletic
performance, interventions (eg, tailored training and evenperhaps schooling schedules) to support adequate sleep in youth
athletes should be implemented.40 52

Growth, maturation and performance on the ﬁeld
Sport performance during youth is underpinned by a range ofphysical and physiological variables that are governed by thetiming and tempo of growth and maturation. Youth sport,
however, is highly selective,53 54 with a maturity-associated selec­tion/exclusion process commonly occurring during the intervalof puberty and the adolescent growth spurt, which covers theperiod between 9 and 15 years of age.7 55–58 Sport performance
progressively improves with growth and maturation, and appro­
priate aerobic, anaerobic and resistance training further enhance
performance; but there is asynchronous development throughchildhood and adolescence into young adulthood. Thus, initial
selection, long-term athletic/sport performance prediction andoptimal athlete development remain a challenge. Research hasdeveloped a sound scientiﬁc foundation to inform decisionmaking; but those involved in youth athlete development must
nurture talented individuals, and appreciate that both positive
and negative changes in performance might be more related tobiological clocks than to coaching and training.

CHALLENGES TO HEALTH, WELL-BEING ANDPERFORMANCE
Specialisation
Children are increasingly specialising in a sport at an early age,beyond the customary early specialisation seen in gymnastics,
swimming, diving and ﬁgure skating. Various factors account forthis contemporary phenomenon, including investment by the
myriad stakeholders involved in sports, as well as incentives for
Olympic and other athletic success. This has led to the develop­
ment of talent identiﬁcation and development schemes, aimed
to identify and guide youth athletes towards professional sports,
and/or Olympic achievement. The result has been an increase incompetitiveness and professionalisation within youth sport
itself, intensiﬁed and expanded physical training and increased
competition volume and frequency with insufﬁcient allocationof time for rest and recovery. One consequence is an ongoing
escalation in sport-related injuries and health problems at alllevels of youth sports,59–62 including overuse injury, overtraining
and burnout.
In contrast to premature emphasis on a single sport, researchsuggests that youth should avoid early sport specialisation, as
diverse athletic exposure and sport sampling enhance motor

development and athletic capacity, reduce injury risk andincrease the opportunity for a child to discover the sport(s) thathe/she will enjoy and possibly excel at.61 63–66 Numerous suc­cessful elite athletes participated in several sports before specia­
lising.54 60 61 63 67–69 However, the message would be
reinforced with more deﬁnitive evidence indicating that children
who participate in a variety of sports and specialise only after
reaching the age of puberty, for example, tend to be more con­sistent performers, have fewer injuries and adhere to sports play
longer than those who specialise early.59 66

Injury and health concerns of systematictraining and competition
Musculoskeletal injury
The competitive careers of youth athletes across all sports are
too often temporarily halted or permanently derailed byoveruse injuries that are the consequence of disproportionate
training and repetitive homogenous loads, hastened and exacer­bated by insufﬁcient rest and recovery.70 71 This scenario is
notably pervasive with youth athletes transitioning too rapidly
to higher levels of training and competition demands duringadolescence.60 70 However, certain aspects of growth (eg, linearrate) and maturation may predispose some youth athletes to spe­
ciﬁc injuries involving the immature spine (eg, spondylolysis,
spondylolisthesis), joint surfaces (osteochondritis dissecans)and traction apophysitis (eg, Osgood-Schlatter disease, Sever’s
disease).60 72–75 Because of potential growth disturbances, injur­
ies to epiphyseal growth centres are of particular concern.

Growth and sexual maturation
There has been a long-standing concern that extensive highintensity sports training can alter growth rates; however, resultsfrom cross-sectional and longitudinal studies do not support thisspeculation.2 56 57 76 The short stature of youth athletes in artis­
tic gymnastics is often cited in the context of potential negative
effects of training. Nevertheless, current consensus is that
regular gymnastics training does not attenuate pubertal growthand maturation or compromise adult stature.58 Youth gymnasts
of both sexes have the growth and maturity characteristics ofshort, normal late-maturing children with short parents.58 It
should also be noted that youth ﬁgure skaters and divers also,
on average, present with shorter statures, though not as short as
gymnasts. Likewise, evidence indicates no effects of systematictraining and competition during childhood and adolescence on
the sexual maturation of either sex. Although menarche occurs,on average, at a later age among participants in some
sports,55 57 77 close scrutiny of the data indicates overlap with
the normal range of variability in the general population.78 79

Cardiac
Despite the well-documented beneﬁts of regular physical activity
in promoting cardiac health,80 81 unsuspected cardiovasculardisease represents the most common cause of sudden death incompetitive youth athletes.82 Accordingly, careful assessment torule out hypertension, congenital heart disease, dysrhythmia,
heart murmur or structural/acquired heart disease, is impera­
tive.83 However, the utility of pre-participation cardiovascular
screening in reducing the (already very low) prevalence ofsudden cardiac death (SCD) remains contentious,84 85 and there
is no consensus for screening youth athletes. While there has
been some evidence indicating features of the ‘athlete’s heart’with pre-pubertal children involved in intensive endurance train­
ing, these structural changes are mild and may simply represent
adaptive responses versus pathological conditions.86–89

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Consensus statement
However, given the nature and grave consequences of potential
negative cardiac adaptations and dysfunctions, closer longitu­
dinal study of the cardiac characteristics and health proﬁles ofyouth training at elite levels is recommended.

Injury rates and prevention strategies
Injury rates in youth sport
An estimated injury incidence proportion in athletes aged 11–­18 years has been reported as 35 injuries/100 youth annuallyrequiring medical attention.90 91 Lower extremity injury andconcussion accounted for over 60% and 15% of the overall
injury burden, respectively.90 91 The highest sport-speciﬁc injury
incidence rates for boys are in ice hockey, rugby, basketball,
football (soccer) and American football, along with wrestling,running and snowboarding. For girls, the highest injury inci­
dence rates are in basketball, football, ice hockey, gymnastics,
ﬁeld hockey and running.92 93 The combination of highsport-speciﬁc participation rates in those sports with high injury
rates leads to the highest burden of injury in youth sport.

Injury prevention in youth sport
It is impossible to eliminate all injury in youth sport; however,injury prevention strategies can reduce the frequency and sever­
ity of injuries. Multifaceted neuromuscular training and programmes focused on intrinsic factors such as strength,
endurance and proprioception/balance, have been shown to
reduce injury incidence in youth football, handball, basketballand multisport by between 28% and 80%,94–106 with speciﬁc
efﬁcacy in reducing lower extremity, knee and ankle
injuries.94 96 100 101 104 107 108
Prevention strategies have also been developed to address
extrinsic risk factors via the use of protective equipment (eg,ankle bracing and taping,109 mouth and wrist guards,110 111 andhelmets112), and implementing rules and regulations.113 114
Unfortunately, without policies to enforce the implementation of
prevention strategies, the uptake may not be optimal.94 97 Rulechanges in some sports have often not been rigorously evaluated;
however, meta-analysis and cohort evidence demonstrate thatpolicy allowing body checking in youth ice hockey increases therisk of injury and concussion twofold to fourfold,114 115 which
has led to national policy changes in Canada and the USA.
Effective and sustainable implementation of injury prevention
research into practice is context-speciﬁc (eg, sport, age, level andorganisational structure).116 117 There are also evident deﬁciencies
in coach, athlete and parent knowledge and behaviours regarding
injury prevention programmes in youth sport populations, despite
the evidence to support their implementation.118–120 Accordingly,
there is a need to focus on effective evidence-informed injury pre­vention strategies in all youth sports, with special attention tosports with a high risk of injury and a paucity of research (eg,rugby, ﬁeld hockey, football, volleyball, ﬁeld hockey, running,lacrosse, gymnastics, martial arts, tennis and wrestling).

Chronic and acute clinical health conditions
While many clinical health conditions (CHCs) are not compat­
ible with high-level sports participation, numerous youth athleteswith asthma, attention deﬁcit-hyperactivity disorder, insulindependent diabetes, iron deﬁciency or certain orthopaedic mal­formations train and compete. However, special considerations
for youth athletes with these and other CHCs are essential toascertain and optimise well-being and minimise the risk of
injury.83 A break in training and competition is often therapeutic­
ally essential, and ultimately more beneﬁcial to the athlete, thantrying to maintain the usual routine and consequently inhibit
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recovery of an injury or acute illness. The responsible physician
must assure that individual-speciﬁc health-related risks fromtraining and competing are minimised, including proper instruc­tion for the athlete, parents and coaches, especially regarding
detection and management of potential life-threating conditions,such as seizures in epilepsy,121 hypoglycaemia in insulindependent diabetes,122 123 or SCD.124
Prior to sport participation, as part of the pre-participation
examination, the following should be considered for any athletewith a CHC: (1) evidence-based diagnosis, severity and progres­sion of the CHC; (2) CHC burden to the athlete; (3) potential
performance limitations by the CHC or its treatment; (4) healthrisks for the athlete from the CHC or its treatment and (5) appli­
cation for a Therapeutic Use Exemption for the treatment of theCHC, if required by WADA. Antidoping rules generally do notpose a major problem for the elite young athlete with a CHC, solong as team physicians are knowledgeable of the Therapeutic
Use Exemption programme of the World Anti-Doping Code.125
Over-reporting or overdiagnosis is sometimes motivated by a
medical treatment having a purported potential of performanceenhancement, as in asthma or attention-deﬁcit hyperactivity disorder;126 127 although performance-enhancing effects at thera­
peutic doses are often unremarkable.128 129 Moreover, at theelite level, athletes need to meet strict diagnostic criteria, so overdiagnosis is less likely.

Psychological overload from excessive demands andexpectations
Psychological stress can have both training and straining effects
on the individual.130 Psychological overload, however, occurs
when the level of stress becomes excessive, no longer affecting a
positive response. Youth athletes are increasingly being exposed
to inappropriate and unrealistic demands and expectations, andconsequent psychological overload (self or coach/parent
induced).54 60 How youth athletes perceive and cope with thesestressors is neither predictable nor benign,131 with athlete
burnout and subsequent related drop-out from sport being arecognised part of competitive youth sport.132 Use of
performance-based ﬁeld criteria (eg, resting cortisol levels andProﬁle of Mood test) may facilitate early detection of youth atrisk of burnout.133 There is also the potential for developing
maladaptive perfectionistic tendencies, prompted by elevatedparental expectations and criticism.134
Widespread (often unrecognised) depressive disorder is espe­
cially prevalent in adolescent girls,135 and the psychosocial
stress of an unhealthy youth sports environment or an injury
could exacerbate the risk and levels of depression andanxiety.135 136 Providing youth athletes with speciﬁc coping
skills through mental training seems promising,137 and goal
setting can have a positive effect in reducing fear of failure
among young elite athletes.138 Coping effectiveness speciﬁc to
the competitive level and the demands of the sport can also be
directly related to athletic achievement.139 140 Potential interac­tions between sport-related stressors and those associated withnormal adolescence must also be recognised and addressed.
Coaching education should emphasise the importance of cre­ating autonomy-supportive, mastery-oriented sporting climatesthat result in less stress and more intrinsic motivation,141 142
which is especially important in elite youth sport where thepressure to perform is often overwhelming and can evenincrease the risk of injury.143 144 By focusing on a mastery devel­
opmental climate, a positive (sporting) community canevolve.145 Parent supporting involvement is also important in
mitigating dysfunctional and/or destructive responses. Indeed,

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Consensus statement
parents reportedly welcome advice on how to become a better
sporting parent;146 147 although implementation is a challenge.

Safeguarding the youth athlete from abuse in sport
While sexual abuse and harassment in sport is one of the moreconcerning threats to children,148 other forms of relational abusehave also been identiﬁed involving emotional and physical abuse,including forced physical exertion.149 The scope of threats to theyouth athlete, however, extend beyond relational abuse to include
organisational threats, such as systems that promote over­training,150 the endorsement of abusive hazing rituals151 and theutilisation of selection procedures that promote eating disorders
or competing with an injury.152 Medical mismanagement isanother organisational threat for the child athlete. In particular,
the excessive and often systematic use of analgesic medication byteam physicians in elite youth football is reported.153 As indicatedin selected study settings and populations, almost 25% of youth
athletes have admitted to misuse of their prescribed medication(pain, stimulant, sleep, antianxiety),154 and 13–68% have admit­
ted to anabolic androgenic steroid abuse in the sport context.155
Insufﬁcient medical coverage during training and competition, by
relying on insufﬁciently trained coaches to manage medical issues,
is another recognised threat to youth athletes.156
The prevalence of various forms of abuse, associated risk
factors and consequences for the athlete need to be moreclosely examined. Moreover, an organisational approach beyond
the perpetrator and the victim is essential to reveal how theculture of an organisation can facilitate or prevent abuse. Thereis also a need for research exploring the efﬁcacy and effective­
ness of speciﬁc strategies that can protect and promote the well­being of youth athletes.

Nutrition: energy and nutrient needs and dietary
supplements
Owing to metabolic variability within and between indivi­
duals,157 and methodological difﬁculties in estimating energy
intake and expenditure,158 it is difﬁcult to deﬁne the precise
energy requirements of youth athletes. Carbohydrate needs andfat intake should be in accordance with established guidelines,159
and youth athletes do not need protein supplements to meet ele­
vated protein needs, as these can be readily met by appropriate
and well-timed eating patterns.159 As many youth athletes are at
risk of low vitamin D status, correction of insufﬁciency throughsupplementation may be necessary to ensure optimal bone healthand mitigate injury risk.159 160 Dietary iron intake ( particularly
for girls) should be consistent with the Reference Daily Intake,with only medically warranted supplementation.159 Increased
calcium intake, especially in adolescent female athletes, is often
needed to meet the recommendation of 1300 mg daily. Not sur­prisingly, poor nutrition knowledge among elite coaches161 andadolescent athletes162 has been reported.
Supplement use (including energy drinks) and muscleenhancing behaviours (eg, excess protein intake) are common,
especially among male adolescents.163 164 Factors inﬂuencing
supplement use include pressure to perform, physical ideals andavailability of dietary supplements targeting youth athletes.
However, it is recognisably considered inappropriate andunacceptable to encourage dietary supplements for performanceenhancement with youth athletes.159 165 166 Athletes who takesupplements are also at risk of violating antidoping rules.167

Eating disorders in adolescent athletes
Weight and body composition are crucial performance variables
in some sports. Unfortunately, in an attempt to conform tovarious self-imposed expectations, demands from others orcompetition regulations that might be ill-suited to their
physique, many youth athletes develop the Female Athlete
Triad,168 recently termed ‘Relative Energy Deﬁciency in Sport’(RED-S),169 with or without disordered eating (DE) or eating
disorders (EDs). The prevalence of DE is high in competitive
youth sports, with the peak onset of EDs170 coinciding withsport specialisation and increases in demanding competition.
A high prevalence of EDs exists in male (3%) and female (14%)
elite adolescent athletes, compared to non-athletic male (0%)
and female (5%) controls.171 DE and an ED can lead to adverse
short-term and long-term effects on health and performance.172
The pathogenesis of EDs is multifactorial. Cultural, individ­
ual, family and genetic/biochemical factors are involved,173–175
in addition to sport-speciﬁc factors, such as dieting to enhance
performance, personality factors (such as perfectionism, obses­
siveness), pressure to lose weight, frequent weight cycling, pre­mature sport-speciﬁc training, overtraining, recurrent andnon-healing injuries, inappropriate coaching and parental behav­
iour, and regulations in some sports.172 The potentially grave
health consequences related to RED-S and EDs underscores theimportance of early screening, during the annual Periodic
Health Examination.169 176 The diagnosis of RED-S and an ED,
however, is challenging, as symptomatology can be subtle.
Athletes in judged, weight category and endurance sports are
particularly at risk, so that early detection is crucial to prevent
long-term health consequences and to improve performance.
Investigation and treatment should be initiated when an athlete
presents with unexpected weight loss, lack of normal growthand development, recurrent injuries and/or illnesses, moodchanges and/or unexpected decreased performance.169
Very few studies have examined EDs prevention in youth ath­
letes. However, a recent randomised controlled trial demon­
strated that it is possible to prevent new cases of EDs andassociated symptoms in adolescent female elite athletes.161

Environmental challenges
All stressful environmental conditions, including heat andhumidity, cold and altitude, can pose particular health and per­formance challenges for youth athletes.177 With the cold, ele­
vated metabolic heat production from physical exertion, andbehavioural and physiological responses acting to minimise
exposure and preserve body temperature, are generally sufﬁcient
to mitigate cold-related health risk during sport; although,inhalation of cold air during sport can have adverse healtheffects for asthmatic and healthy athletes. Moreover, cold accli­
matisation efforts provide little, if any, practical advantage interms of preserving normal body temperature. With respect toaltitude, youth athletic events are held at elevations that pose
little-to-no health risks. While even modest altitudes can affectsport performance, any decrement in performance is subject toa high degree of sport- and event-speciﬁc variation, with inﬂu­
encing factors often being mutually offsetting. Arriving at alti­
tude in advance of competing (∼3–5 days) is sufﬁcient for
altitude acclimatisation; though, it is not advisable for youth totrain at altitude or use passive exposure to hypoxia.
Training or conditioning for, or playing, sports effectively andsafely in the heat, is distinctly challenging, especially when par­ticipating multiple times on the same day.178 Notably, the health,safety and performance challenges from sweat-prompted body
water and exchangeable sodium losses can be increasingly greater
as youth athletes grow, physically develop and mature.179
Anticholinergic drugs or other medications that affect hydrationor thermoregulation (eg, a dopamine reuptake inhibitor to treat

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attention-deﬁcit/hyperactivity disorder or enhance perform­
ance126 or diuretics), or current or recent illness (especiallyinvolving vomiting, diarrhoea and/or fever), can also contributeto decreased exercise-heat tolerance and increased exertional
heat illness risk. However, with sufﬁcient preparation (including
progressive heat acclimatisation), ample hydration, appropriate
modiﬁcation of known contributing risk factors and close moni­
toring, thermal and cardiovascular strain can be minimised, andexertional heat illness is usually preventable.180–183

YOUTH ATHLETIC DEVELOPMENT
Athlete development frameworks
Despite a predominance of popular frameworks, gaps in the
youth athletic development pathway prevail.184–187 At the initialsports participation stage, inappropriate guidance and develop­
mental activities contribute to compromised fundamental skill
acquisition, injury, burnout, dropout and unrealised talentpotential of youth athletes.185 187–190 Furthermore, individual
athletic performance and achievement is based on a complemen­tary, and sport-speciﬁc, mix of athletic attributes and skills (tech­nical, perceptual, neurocognitive, psycho-social and physical)
that are, in turn, altered by environmental, system and chancefactors.68 184 191–194 Because of this complexity and low rate ofconversion from youth sport to elite sport success, development
frameworks should be inclusive in considering the complementof sports participation, as well as pre-elite and high-performanceelements. Athlete development frameworks should also be holis­
tic in embracing the multidimensional nature of athlete develop­
ment, and predicated on recognised ‘best practice’ for eachdevelopmental phase, rather than age-related prescription basedon physical and maturational factors, and ﬂexible to embrace
the inherent complexity and non-linearity of athlete develop­
ment.185 187 195–197
An effective integrated approach to athlete development high­lights the changing elements of the personal, social and physicalfeatures of different activities in sport throughout develop­
ment.185 187 196 When overall youth development and skill
acquisition are considered as integrated, many personal andenvironmental factors interact to affect sport involvement. In
this integrated approach, the activities of youth in sport become
the developmental environment that incorporates speciﬁc social
relationships and physical features of the setting. The develop­
mental activities of youth in sport can be categorised along two
continuums: ﬁrst, the social structure of the activity (adult-led
to youth-led) and second, the personal value the activity pro­vides to the participants (extrinsic to intrinsic).198 When com­bined, these two continuums form a matrix in which thedifferent activities of youth sport can be located, resulting in an
integrated learning approach. Accordingly, the different activ­
ities of this integrated approach offer unique interactions, learn­ing opportunities and potential for growth. A diversity of sport
activities during childhood allows young athletes to experience a
range of opportunities and then select (or be selected to) a spe­
ciﬁc path of more targeted training activities during adolescenceand young adulthood. Empirical evidence shows that a diversityof activities (including variations of play and practice) in early
development is an indicator of continued involvement in more
intense activities later in life, elite performance and continued
participation in sport.199

Talent identiﬁcation and development
The search for talent in sport at relatively young ages is far moreprevalent and systematised than in the past. Formal talent identi­
ﬁcation programmes can be traced to the former socialist East
6 of 14European countries, often labelled as ‘scientiﬁc selection’.200
However, success of these systems predicated on physical para­
meters and juvenile levels of performance has been
limited.53 54 201–205
Effective sport talent identiﬁcation and development in youth
for achieving elite performance remains a fundamental challenge
for sports institutions, with the allocation of limited resources forthe uncertain probability of future international sporting achieve­
ment. However, sport is extremely selective; and the probability ofelite success is highly unlikely for most. Moreover, accurate talent
identiﬁcation and appropriate athletic development of potentiallygifted youth athletes is far too complex to be distilled into a singu­
lar, universally accepted process, especially since this is greatly
dependent on country, culture and context. The difﬁculties in
effectively utilising valid performance measures (eg, physiological,
cognitive, functional motor, psychosocial etc), as well as the inter­actions from unknown inﬂuencing variables, further complicate avery complex task.206 Elite athletic success is also vulnerable todeviations in sport focus, as well as the impact of normal behav­
ioural development and interactions with adults, which can alter
the sport-life balance. Not surprisingly, therefore, there exists anapparent disconnect with discordant results between advocatedtalent development systems and the evidence of actual
outcomes.66 205 207
The efﬁcacy of early talent identiﬁcation predicated solely on
physical factors and juvenile levels of athletic performance inpredicting future elite sport performance is confounded by mat­urational factors, which often exclude late developers in demon­
strated athletic capacity and sport skill.208 209 Moreover, whenchildren or adolescents are grouped by age, older individuals
generally outperform younger ones. Research speciﬁc to elite
athletes from multiple sports and in different countries repeat­
edly revealed that sampling of sport during childhood is not
detrimental to adult elite levels of sport achievement in sports
where peak performance is achieved during adulthood.63 190
Data speciﬁc to professional German football players afﬁrm thata more inclusive, long-term approach to athlete development,
involving recurrent selection and de-selection of athletes, could
address the uncertainty involved in and shortcomings of earlytalent identiﬁcation.202
Success at the elite level of sport performance stems from a
combination of factors that vary based on the sociocultural andpoliticoeconomic context of a country. Intrinsic (eg, body heightand rate of maturation, aptitude, adaptation to training, motiv­
ation, psychological skills) as well as extrinsic (eg, environment,
access and opportunity, athlete development pathway, coaches,family, educators) factors work in synchrony to determine anathlete’s success in sport, with the interactions between heritablecharacteristics and environments thought to be the primary
determining factors.210

Coaching education and effectivenessCoaches of youth athletes play a pivotal role in determining
whether sport systems provide opportunities for peak athlete
performance, promote lifelong participation and shape personal
development. Therefore, coach education and mentoring todevelop coach competencies should be a priority of sport orga­
nisations. Contemporary coaching theory211 indicates that coacheffectiveness should be driven by an understanding that (1)coaching knowledge is multidimensional, (2) there are key
athlete assets and several related athlete outcomes and (3) that
effective coaching is inﬂuenced by the coaching context. It isalso essential that coaches understand physical growth,

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Consensus statement
biological maturation and behavioural development, as theyaffect performance and injury risk.

Coaches’ knowledge
Although a major component of coaching effectiveness resides in
one’s ability to teach sport-speciﬁc skills, coaching effectivenessis also reﬂected in the ability to create and maintainrelationships with others, and the ability to learn from one’s own
practice.212–214 Therefore, coaches’ effectiveness encapsulatescoaches’ ability to access and use a combination of professional
knowledge (eg, sport-speciﬁc content, paediatric exercise science,
injury prevention and pedagogical knowledge), interpersonal
knowledge (eg, relationships with athletes, parents and local com­munity) and intrapersonal knowledge (eg, reﬂection andintrospection).

Athletes’ assets and outcomes
The four Cs—Competence, Conﬁdence, Connection andCharacter—is a set of athletes’ assets that should become
the focal point of coaching practice.211 It is the coaches’
responsibility to establish positive training and competitiveenvironments, and to create relationships that focus on indi­vidual athletes’ needs in addition to the long-term objectivesof performance, participation and personal develop­
ment.215 216 Repeated positive developmental experiencesin sport that result from regular engagement in fun andchallenging activities that focus on athletes’ four Cs are
known to have long-term positive effects on performanceand participation.217–219

Coaching contexts
The Developmental Model of Sport Participation65 66 wasused220 to propose a typology of four different categories ofcoaches, based on contrasting competitive demands (ie, perform­
ance vs participation) and for developmental level (eg, age ormaturation). The four categories include participation coachesfor (1) children and (2) adolescents and adults; and performancecoaches for (3) young adolescents and (4) older adolescents andadults. This and other similar typologies identify appropriate anddiffering criteria and expectations for coaching effectiveness.

Coaching effectiveness deﬁnition
The integration of these three components (coaches’ knowledge,
athletes’ assets and outcomes and coaching contexts) led to adeﬁnition of coaching effectiveness:
The consistent application of integrated professional, interper­
sonal and intrapersonal knowledge to improve athletes’ compe­
tence, conﬁdence, connection and character in speciﬁc coachingcontexts.211

Accordingly, coaches across the continuum of youth athletic
progression require a unique mix of professional, interpersonaland intrapersonal knowledge to effectively cultivate athletes’
competence, conﬁdence, connection and character (4 Cs).
Although all effective coaches require a high level of profes­
sional, interpersonal and intrapersonal knowledge, there will begreat variation between each context as to the nature of theknowledge and strategies required to appropriately nurture ath­
letes’ assets respective to their developmental and competitive
levels. Ultimately, this deﬁnition of coaching effectiveness pro­vides the foundation to develop coaching education programmes speciﬁcally emphasising sport-speciﬁc coachingknowledge, a coach’s ability to maintain high-quality relation­
ships with athletes and coaching peers, and reﬂection on

personal experiences. Coaches who are able to improve theirathletes’ four Cs are making an enormous contribution to thedevelopment of sport and society.

Developing ﬁtness, athleticism and a functional foundation
Despite a compelling body of scientiﬁc evidence that supports
regular participation in age-related strength and conditioning
activities,27 221 222 secular declines in measures of muscularstrength, fundamental movement skills and neuromuscularﬁtness in the general population of youth have beenreported.223–227 The observed regressions in muscular ﬁtness
may be, in part, due to worldwide reductions in frequent varied
exposure to moderate-to-vigorous intensity physical activity inschool-age youth.228 229 Participation in organised sports,
however, does not ensure a suitable level of integrated strength,
neuromuscular ﬁtness and other essential characteristics (eg, bio­
motor abilities, including coordination and balance) toadequately meet the physical and functional demands of sportconsistent with elite, and sustainable, athletic performance. In
contrast, sports participation with appropriate preparatory
strength and ﬁtness conditioning decreases the risk of sportsrelated injuries, and enhances the likelihood of achieving andsustaining an enjoyable, high level of performance.230–232
Muscular ﬁtness and effective movement skills serve as thefoundation for achieving optimal and sustainable long-term ath­
letic performance; accordingly, a suitable emphasis on develop­
ing muscular strength, power, speed and agility of young
athletes with appropriate age-related interventions is essen­tial.233 234 Early exposure to strength and conditioning can
improve markers of health, enhance physical performance, andreduce injury risk in children and adolescents.27 231 235 Indeed,
the IOC encourages early identiﬁcation of individual deﬁcits inphysical ﬁtness in young athletes and the qualiﬁed prescriptionof training programmes speciﬁcally designed to address individ­
ual limitations.236
To optimise training adaptations and manage fatigue, youth
conditioning should be considered a long-term process thatinvolves the sensible integration of different training methods
and the periodic manipulation of programme variables (eg,training intensity and volume) over time, while providing
regular opportunities for rest and recovery. Integrative neuro­
muscular training is speciﬁcally designed to improve essential
athletic elements for sport, and foster positive skill developmentwith the intent to make organised youth sports more engaging,enjoyable and safe for all youth athletes.237 238 Extensive evi­
dence suggests that young athletes who are not exposed to thistype of strength and conditioning early on in their athletic
careers will inevitably need to address neuromuscular deﬁcien­
cies to enhance athletic development or in rehabilitation follow­
ing an injury.94 97 104 239 The desired result encompasses having
sufﬁcient physical capacities of balance, coordination, ﬂexibility,
agility, strength, power, endurance, variable speed and theability to read (through various senses and experiences), inte­
grate and interpret a wide range of athletic scenarios and chal­lenging situations, and respond efﬁciently and effectively with
conﬁdence, anticipation and optimal decision-making.

Physiological monitoring and sport-speciﬁc performance
testing
A rationale for the assessment and monitoring of youth athletes
might include purportedly identifying talent, predicting future
performance, determining strengths and weaknesses, informing
the selection process, evaluating the effectiveness of training
programmes, monitoring current health and performance,

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Consensus statement
motivating the athlete, enhancing the athlete’s (and coach’s)understanding of the demands of the sport, and improving
present and future performance.240 241 The sport physiologist,as a member of the athlete-integrated science and medical
support team ( psychology, biomechanics, medicine, nutritionand physiotherapy) works collaboratively to choose appropriate
testing, and to interpret and communicate test results and theirapplication to performance to the coach and athlete. Those whowork with youth athletes (coaches, physiologists, physicians, die­ticians, etc) should also be knowledgeable of methods for asses­
sing and interpreting the growth and maturity status of youth
athletes.

Ethics of testing youth athletes
The ethics of non-therapeutic testing of minors are well­
documented.242 243 Sport physiologists should also be aware of
power differentials and coercion in the recruitment process, as
it is unlikely that a youth athlete will refuse to participate if thecoach gives proxy permission on his/her behalf. To protect all
parties, written informed consent (or parental/guardian consent
and child assent for children <18 years) should be obtained fol­lowing an explanation, appropriate to the athlete’s level of com­prehension, of the purpose, procedures and potential beneﬁts
and risks of the tests. It is advisable that a contract clearly out­lining the role the sport physiologist is signed by all parties.

Testing youth athletes
Clear rationales and guidelines for the physiological assessment
and interpretation of, for example, young people’s body com­position,244 muscle strength,245 aerobic ﬁtness20 and anaerobic
performance246 are well-documented. A body of knowledge on
assessing the kinetic responses to rapid changes in exercise
intensity is also emerging.247 As well, the interpretation of exer­
cise testing data in relation to body size has been comprehen­sively addressed.248 To be effective, physiological testing ofyouth athletes should be as sport-speciﬁc as possible. Several
well-documented sport-speciﬁc tests for adult athletes249 can beapplied to youth athletes. A number of sport-speciﬁc ﬁeld tests
designed for youth athletes have recently emerged; but, more
research is required to establish their effectiveness.250–252
The precise inﬂuence of a change in a laboratory or ﬁeld test
outcome on sport performance during youth is unknown. A
single change in a physiological variable may have little effecton subsequent performance, as it is often an accumulation ofrelated changes that enhance performance. Moreover, it may
take several years of training for some factors related to per­formance (eg, running economy) to signiﬁcantly improve, andthis is compounded during youth by the asynchronous develop­
ment of aspects of physiology (eg, the interplay of anaerobic
and aerobic metabolism). Although laboratory testing provides agold standard for physiological variables and enables close
control over extraneous factors, sport-speciﬁc ﬁeld tests havegreater speciﬁcity and ecological validity. Laboratory and ﬁeld
tests can both play valuable roles in monitoring progress, andthe balance of use and frequency is best made on a
sport-by-sport basis.

IOC RECOMMENDATIONS FOR YOUTH ATHLETIC
DEVELOPMENT

While the ﬁeld of youth athletic development has advanced con­siderably, new research and validated practical solutions toeffectively improve current practices are of paramount import­
ance. There is also an urgency to address the ‘culture’ of speciﬁcsports and youth sports in general, which have become
8 of 14disproportionately both adult and media centred. The muchmaligned ‘specialisation’ in youth sports is a related recognised
concern that also needs to be addressed appropriately and realis­tically. Appropriate diversity and variability of athletic exposure
within a single sport, while supporting sufﬁcient learning offoundational skills and sport-speciﬁc technique and biomechan­
ics to minimise injury risk and optimise performance, alongwith consistent adequate rest and recovery and a balanced
emphasis on other priorities (eg, family and school, life skills
and social development), can be acceptable and healthy, so longas the youth athlete is enjoying and beneﬁtting fully from theexperience.
While recognising the broad challenges, and lack of sufﬁcientsport-speciﬁc and athletic development stage-speciﬁc data, evi­
dence-informed best practices should be emphasised to minimise
illness and injury risk, enhance well-being and promote sustain­
able, enjoyable, long-term athletic development, performanceand success in all youth athletes. To this end, the IOC authors
recommend these guiding principles:
General principles▸ Youth athlete development is contingent on an individuallyunique and constantly changing base of normal physicalgrowth, biological maturation and behavioural development,
and therefore it must be considered individually.
▸ Allow for a wider deﬁnition of sport success, as indicated byhealthy, meaningful and varied life-forming experiences,which is centred on the whole athlete and development of
the person.
▸ Adopt viable, evidence-informed and inclusive frameworks
of athlete development that are ﬂexible (using ‘best practice’for each developmental level), while embracing individual
athlete progression and appropriately responding to the ath­
lete’s perspective and needs.
▸ Commit to the psychological development of resilient
and adaptable athletes characterised by mental capability
and robustness, high self-regulation and enduring personal
excellence qualities—that is, upholding the ideals of
Olympism.
▸ Encourage children to participate in a variety of different
unstructured (ie, deliberate play) and structured age-appropri­ate sport-related activities and settings, to develop a wide rangeof athletic and social skills and attributes that will encouragesustained sport participation and enjoyment.
▸ Make a commitment to promote safety, health and respect
for the rules, other athletes and the game, while adopting
speciﬁc policies and procedures to avert harassment andabuse.
▸ Across the entire athletic development pathway, assist eachathlete in effectively managing sport-life balance to be better
prepared for life after sport.
Coaching▸ Provide a challenging and enjoyable sporting climate that focuseson each athlete’s personal assets and mastery orientation.
▸ Coaching practices should be informed by research-based
developmental guidelines that promote ﬂexibility and innov­
ation, while accommodating individual skills and athletic
development trajectories.
▸ Coaching should be context-speciﬁc (eg, participation vs per­formance focus) and aligned with individual athletic
readiness.
▸ Coaching education programmes should assist coaches inestablishing meaningful relationships that enrich the personal
assets of their athletes and foster their own intrapersonal andinterpersonal skills (eg, reﬂection and communicative skills).

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Consensus statement▸ Coaches should seek interdisciplinary support and guidancein managing a youth athlete’s athletic development, ﬁtness
and health, and mental and social challenges and needs.
Conditioning, testing and injury prevention▸ Encourage regular participation in varied strength and condi­
tioning programmes that are suitably age based, quality tech­nique driven, safe and enjoyable.
▸ Design youth athlete development programmes comprising
diversity and variability of athletic exposure, to mitigate therisk of overuse injuries and other health problems promptedby inappropriate training and competition that exceed safe
load thresholds, while providing sufﬁcient and regular rest
and recovery, to encourage positive adaptations and progres­sive athletic development.
▸ Maintain an ethical approach to, and effectively translate,laboratory and ﬁeld testing to optimise youth sports partici­
pation and performance.
▸ Develop, implement and continue to evaluate knowledgetranslation strategies and resources that will enhance injury
prevention and promote health in youth athletes, such as the
Get Set—Train Smarter injury prevention app developed by
the IOC for the 2014 Youth Olympic Games.253▸ Promote evidence-informed injury prevention programmes,
protective equipment legislation and rule changes that arecontext speciﬁc, adaptable and consistent with maintaining
the integrity of the sport and participation goals.
▸ Strictly adhere to a “No youth athlete should compete—ortrain or practice in a way that loads the affected injured area,interfering with or delaying recovery—when in pain or notcompletely rehabilitated and recovered from an illness or
injury”.
Nutrition, hydration and exertional heat illness▸ Dietary education for young athletes should emphasise
optimal eating patterns to support health, normal growthand sport participation demands, with emphasis on abalanced intake of nutrient-dense carbohydrates, high-quality
protein and sufﬁcient dietary calcium, vitamin D and iron.
▸ Youth athletes and their support personnel should be edu­
cated on the risks associated with dietary supplements andenergy drinks.
▸ Emphasise and mitigate the risks of sport-related EDs, DE
and RED-S, by raising awareness through education, improv­
ing screening and treatment, and implementing applicable
rule modiﬁcations.
▸ Education and training on exertional heat illness risks andeffective prevention and risk-reduction strategies (including
practical preparation, offsetting measures and management
and immediate response protocols) and policies should be
regularly provided and emphasised to youth athletes, coaches
and staff, and others overseeing or assisting with children
and adolescents participating in outdoor sports.
▸ A written emergency action plan and effective response pro­
tocols should be in place and practiced ahead of time withtrained personnel, as well as readily available facilities on-site
for managing and treating all forms of exertional heat illness
and other medical emergencies, for all youth athletic activ­
ities, especially in the heat.
Sport and sports medicine governing bodies and organisations▸ Sport and sports medicine governing bodies and organisa­
tions should protect the health and well-being of youth in
sport by providing ongoing education, and fully implement­
ing and monitoring practical, and effective, athlete safeguard­
ing policies and procedures in all youth athlete
programming.254–256▸ Youth athlete selection and talent development philosophies
should be based on the physiological, perceptual, cognitive
and tactical demands of the sport, and a long-term, individu­
ally variable developmental context.
▸ Diversiﬁcation and variability of athletic exposure between
and within sports should be encouraged and promoted.
▸ Competition formats and settings should be age and skill
appropriate, while allowing for sufﬁcient rest and recovery
time between multiple same-day contests.

A CALL TO ACTION
We challenge all youth and other sport governing bodies toemphasise awareness, education and implementation of these
IOC recommendations and to support the promotion ofevidence-informed perspectives to coaches, the athlete entou­
rage, medical providers and administrators involved in youth
sports to ensure an enjoyable, safe, healthy and sustainable
experience for all participants.
Author afﬁliations
1
Youth Sports of the Americas, Birmingham, Alabama, USA2
Lemak Sports Medicine, Birmingham, Alabama, USA
3
Department of Family Medicine, Michael G DeGroote School of Medicine,
McMaster University, Hamilton, Ontario, Canada
4
IOC Medical Commission—Games Group5
Children’s Health and Exercise Research Centre, St Luke’s Campus, University of
Exeter, Exeter, UK
6
Physical Education & Sports Science, National Institute of Education, Nanyang
Technological University, Singapore
7
Queen’s University, School of Kinesiology and Health Studies, Kingston, Ontario,
Canada8
Alberta Children’s Hospital Research Institute for Child and Maternal Health
Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta,
Canada9
Department of Health & Exercise Science, The College of New Jersey, Ewing, New
Jersey, USA
10
Hallway Consulting, Los Olivos, California, USA
11
Institut für Epidemiologie, Biostatistik und Prävention, Gruppe Children, Physical
Activity and Health (CHIPAH), Universität Zürich, Switzerland
12International Gymnastics Federation (FIG), Paris, France
13
University of Texas at Austin, Austin, Texas, USA
14
Tarleton State University, Stephenville, Texas, USA
15
Department of Coaching and Psychology, Norwegian School of Sport Sciences,Oslo, Norway
16
International Basketball Federation (FIBA), Switzerland
17
Medical & Scientiﬁc Department, International Olympic Committee, Lausanne,
Switzerland
18
Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo,
Norway19
Department of Public & Occupational Health and EMGO+ Institute, VU University
Medical Center Amsterdam, Amsterdam, The Netherlands
20
School of Human Movement and Nutrition Sciences, University of Queensland,
Brisbane, Australia
21
Division of Exercise Science and Sports Medicine, Department of Human Biology,
University of Cape Town, Cape Town, South Africa
22
Athlete Pathways and Development, Australian Institute of Sport, Bruce, Australia
23
Orthopaedic Center, Ullevaal University Hospital, Oslo, Norway
Acknowledgements The group acknowledges the contribution and support of
IOC Medical and Scientiﬁc Director, Richard Budgett, during the IOC Youth Athletic
Development Consensus Meeting.
Contributors MFB and MM made substantial contributions to overall and detailed
conception, planning, design and coordination of the paper, drafting and criticallyrevising the manuscript, and approval of the ﬁnal version to be published. NA, MC,
JC, CAE, AF, SK, RMM, AMP, TS, JS-B, WvM and JRW made substantial
contributions to drafting and critically revising the manuscript. GH, ML and AS
contributed to conceptual and content development. LE made a substantial
contribution to overseeing manuscript development and overall ﬁnal approval of the
ﬁnal version to be published.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.

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Consensus statement
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International Olympic Committee consensus
statement on youth athletic development
Michael F Bergeron, Margo Mountjoy, Neil Armstrong, Michael Chia, Jean
Côté, Carolyn A Emery, Avery Faigenbaum, Gary Hall, Jr, Susi Kriemler,
Michel Léglise, Robert M Malina, Anne Marte Pensgaard, Alex Sanchez,
Torbjørn Soligard, Jorunn Sundgot-Borgen, Willem van Mechelen,
Juanita R Weissensteiner and Lars Engebretsen
Br J Sports Med 2015 49: 843-851

doi: 10.1136/bjsports-2015-094962
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