Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Cognitive difficulties, such as learning new tasks or remembering previously learned material, may pose challenges in the classroom. The school environment may also increase symptoms with exposure to bright lights and screens or noisy cafeterias and hallways. Unfortunately, because most children and adolescents look physically normal after a concussion, school officials often fail to recognize the need for academic or environmental adjustments. Appropriate guidance and recommendations from the pediatrician may ease the transition back to the school environment and facilitate the recovery of the child or adolescent. This report serves to provide a better understanding of possible factors that may contribute to difficulties in a school environment after a concussion and serves as a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning.

The number of anterior cruciate ligament (ACL) injuries reported in athletes younger than 18 years has increased over the past 2 decades. Reasons for the increasing ACL injury rate include the growing number of children and adolescents participating in organized sports, intensive sports training at an earlier age, and greater rate of diagnosis because of increased awareness and greater use of advanced medical imaging. ACL injury rates are low in young children and increase sharply during puberty, especially for girls, who have higher rates of noncontact ACL injuries than boys do in similar sports. Intrinsic risk factors for ACL injury include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of knee motion. ACL injuries often require surgery and/or many months of rehabilitation and substantial time lost from school and sports participation. Unfortunately, regardless of treatment, athletes with ACL injuries are up to 10 times more likely to develop degenerative arthritis of the knee. Safe and effective surgical techniques for children and adolescents continue to evolve. Neuromuscular training can reduce risk of ACL injury in adolescent girls. This report outlines the current state of knowledge on epidemiology, diagnosis, treatment, and prevention of ACL injuries in children and adolescents.

Injury rates in youth soccer, known as football outside the United States, are higher than in many other contact/collision sports and have greater relative numbers in younger, preadolescent players. With regard to musculoskeletal injuries, young females tend to suffer more knee injuries, and young males suffer more ankle injuries. Concussions are fairly prevalent in soccer as a result of contact/collision rather than purposeful attempts at heading the ball. Appropriate rule enforcement and emphasis on safe play can reduce the risk of soccerrelated injuries. This report serves as a basis for encouraging safe participation in soccer for children and adolescents. Pediatrics 2010; 125:410-414 INTRODUCTIONSoccer (known as football outside the United States) is one of the most popular team sports in the world and continues to provide healthy exercise for many young people. Participation in soccer is an effective way for children to increase their level of physical activity and fitness, because it requires intensive physical effort over an extended period of time through practice and games. 1 In the United States, an estimated 15.5 million 2 people participate in soccer. Two national youth organizations have registered 650 000 3 and 3.2 million 4 participants younger than 19 years, with a 7% increase in female adolescent players from 2001 to 2007. 2 More than 700 000 girls and boys played soccer in US high schools in 2008 -2009, 5 placing soccer among the top sports for increased participation. 5 With this growing participation comes a greater number of injuries, leading to an increasing prevalence of soccer-related cases presenting to the pediatrician. INJURY RISKSoccer has a higher injury rate than many contact/collision sports such as field hockey, rugby, basketball, and football, although in 1 community study of 7-to 13 year-old players, football did have a higher percentage of serious injuries and higher frequency of injury per team per season. 6,7 The US Consumer Product Safety Commission (CPSC), through its National Electronic Injury Surveillance System, estimated that there were 186 544 soccer-related injuries in 2006. 8 Approximately 80% of these injuries affected participants younger than 24 years, and approximately 44% occurred in participants younger than 15 years. It is unfortunate that there is a wide variation in the reported incidence of soccer injuries as a result of study differences in factors such as level of competition, intensity of exposure, definition, classifications, and reporting of injuries. Because of difficulties with interstudy com-

Despite previous recommendations from the American Academy of Pediatrics discouraging home use of trampolines, recreational use of trampolines in the home setting continues to be a popular activity among children and adolescents. This policy statement is an update to previous statements, reflecting the current literature on prevalence, patterns, and mechanisms of trampoline-related injuries. Most trampoline injuries occur with multiple simultaneous users on the mat. Cervical spine injuries often occur with falls off the trampoline or with attempts at somersaults or flips. Studies on the efficacy of trampoline safety measures are reviewed, and although there is a paucity of data, current implementation of safety measures have not appeared to mitigate risk substantially. Therefore, the home use of trampolines is strongly discouraged. The role of trampoline as a competitive sport and in structured training settings is reviewed, and recommendations for enhancing safety in these environments are made.

The martial arts can provide children and adolescents with vigorous levels of physical exercise that can improve overall physical fitness. The various types of martial arts encompass noncontact basic forms and techniques that may have a lower relative risk of injury. Contact-based sparring with competitive training and bouts have a higher risk of injury. This clinical report describes important techniques and movement patterns in several types of martial arts and reviews frequently reported injuries encountered in each discipline, with focused discussions of higher risk activities. Some of these higher risk activities include blows to the head and choking or submission movements that may cause concussions or significant head injuries. The roles of rule changes, documented benefits of protective equipment, and changes in training recommendations in attempts to reduce injury are critically assessed. This information is intended to help pediatric health care providers counsel patients and families in encouraging safe participation in martial arts.