As can been seen in Table 16.1, scientific investigation of injuries in children’s sport has an uneven history. For the first half of the twentieth century there was virtually no interest from researchers or administrative organizations supervising youth sport (whether school or clubs) in investigating the scope, mechanisms, or implications of sports-related injury. However, from the late 1950s there was a slow but steady increase in publications related to injuries in children’s and youth sport leading to a sharp increase in the number of peer-reviewed publications from the early 1990s to the mid-2000s. A similar exponential increase in the literature has occurred in the past 10 years (January 1, 2005–December 31, 2014). Of particular interest, in addition to the geometric increase in publications in general, is the concomitant increase in the number of review articles and the subsequent emergence of systematic reviews to provide more stringent filters through which to evaluate the myriad of descriptive, and to a lesser degree, analytical, studies. Overall, the annual rate of publications for both articles and reviews increased by at least 250 % in each subsequent era.

The rising interest in pediatric and adolescent sports injuries can also be judged by the origins of the published research. Overall, the vast majority of the literature arises from the USA, which accounted for 38.5 % of the total in this analysis; in the past decade its contribution has risen to 41 %. The next four major contributors combined (Canada, United Kingdom, Germany, Australia) account for 19.5 % overall and 24 % over the past 10 years. However, the internationalization of the field may be illustrated by the fact that in the 48 years from 1957 to 2004, only four countries outside the top five produced at least ten papers each, with an additional 28 countries being attributed with at least one publication. In the past 10 years, 14 different countries outside of the top five have at least ten papers with an additional 33 countries providing at least one peer-reviewed manuscript (Europe: 10; Asia: 8; Middle East: 7; Central/South American: 4; Africa: 3; Oceania: 1).

It is not clear what prompted these radical shifts in research interest but it may be argued that factors such as the growing professionalization of children and adolescent sport, litigation, media coverage of the increasing number of youth athletes who were qualifying for national teams for World Championships and Olympic Games, and a “trickle down effect” from the interest in injury prevention in elite/professional adult sport have all played a role. This last point is an important one to consider as injury research in children’s and youth sport is still overshadowed by work on college, adult, and professional sports even though the total number of participants under the age of 18 in organized competitive sport is significantly greater than the number aged 19 and older. Despite the participation disparity, there is 8–10 times more peer-reviewed sports injury research on adults than on children and adolescents. However, the growing “acknowledgement” that children are not little adults and have physical, psychological, and emotional characteristics that have been shown to place them at increased risk of harm in both daily life and sociocultural activities such as participation in organized sport [5] may also be helping move the research momentum to specialized study of risk in pediatric sports.

Despite differences such as the magnitude of research interest, sports injury research with children and adults shares a common quality, that is, as discussed previously, the generally ad hoc nature of the work. The vast majority of injury research in both children’s and adult’s sport consists of “one-off” studies, of varying quality, that investigate the idiosyncratic interests of individual researchers utilizing widely divergent research designs, operational definitions, sample sizes, study lengths, and outcomes.

The lack of an over-arching research philosophy in children and adolescent sport can be indirectly gaged from an analysis of the 97 systematic reviews published in the past 10 years. Systematic reviews stand as a useful proxy for the state of research in a field as they are evidence of both the maturity of the field (i.e., there are a sufficient number of papers on a topic to warrant a summary) and its disorder (i.e., the available studies are so disparate that there is a critical need for synthesis to bring some coherence to the available information). Additionally, the focus of systematic reviews reflects the research priorities across an area of interest. For example, the 97 papers retrieved in this analysis can be grouped into six topic categories: Central Nervous System (25 systematic reviews; 26 % of the total), epidemiology (8; 8 %), injury prevention (13; 13 %), growth-related (12; 12 %), specific sports (18; 18.5 %), and miscellaneous (21; 21.5 %). The topic with the greatest number of systemic reviews relates to central nervous system injuries, primarily concussion. Although brain injuries are cause for concern and may have significant ramifications, given the vast range of unexplored or underexplored issues in pediatric and adolescent sport, especially the development of prevention protocols, from a scientific standpoint it’s not clear why so much emphasis should be placed on concussion. It may be argued that the number of sports in which this is important, or even relevant, is a very small proportion of all of the youth sports available. Caine at al. [14] perhaps inadvertently touch on the answer when they note that it is “probably the hottest topic in sports injury”. Such an observation points to an undue influence of media playing into an opportunistic mindset of many researchers seeking funding. While this pragmatic approach to research is understandable, it is not conducive to ensuring cohesive research programs that ultimately aim to produce cost-effective prevention program and ensure the well-being of youth in sport.

The topic area with the second highest number of systematic reviews in this analysis related to specific sports. However, these 18 reviews covered 13 different sports, only five of which rated two reviews (American football, ice hockey, Australian Rules football, soccer, weight training). Other sports represented by one review each, such as snowboarding, cheerleading, and judo, have been shown to be high-risk activities but the amount of research attention shown in this sampling seems to indicate a problematic hierarchy of importance. Finally, it is interesting to note that the purported “end-game” of sports injury research, that is, prevention, was the focus of only 13 % of these systematic reviews. Within this pool, only four reviews used meta-analytical approaches to provide a rigorous evaluation of the disparate findings of individual studies [11, 15–17], emphasizing considerable variation in the quality of the work even within what is supposed to be the highest level of evidence. Two interesting facts emerge from these analyses: (a) that exercise-based injury prevention programs appear to demonstrate beneficial effects in youth sports, and (b) there is little data on injury prevention available for children younger than 14 years of age.