VANCOUVER, B.C. — Overtraining, disordered eating, and lower extremity injuries are some of the many health issues that physicians who care for young dancers may encounter, according to a pediatric sports medicine specialist.
Several factors increase young dancers' risk of health problems, said Dr. Chris G. Koutures, who is in private practice in Anaheim, California. These young athletes often put in long hours, and they have multiple instructors, so there is a lack of continuity in their training. “I tell the families—parents especially—you must be the arbiter for your child, because each instructor does not know what the previous one was doing,” he said.
In addition, dancers typically train in minimally supportive footwear and on unforgiving surfaces, he noted. Many of them now dance year-round between performances, recitals, and summer dance camps. The training can be intensive, pushing them past their abilities and experience.
Preparticipation evaluations and annual physicals provide good opportunities for anticipatory guidance on dancing and for early detection of health issues, Dr. Koutures said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics (AAP).
Dancers should be encouraged to perform different types of dance (in moderation) for variety, and to take 2–3 months off per year to allow their bodies to grow and recover.
Along those lines, Dr. Koutures said to be alert for signs of overtraining. Affected dancers may have declining dance performance, loss of interest in the activity, sleep and appetite disturbances, a flat affect, and little social interaction.
Considering growth periods also is important, according to Dr. Koutures. During the major growth period—which occurs during ages 10–14 years in girls and ages 12–16 years in boys—dancers may be less flexible, become uncoordinated, and experience anatomic changes, such as widening of the pelvis and lengthening of the limbs. “During this time, it may be more sensible in all activities to back off a little bit,” he said.
When it comes to developmental status, he pointed out that puberty and menarche may be delayed in dancers if their caloric intake does not meet their energy demands. “These are things we bring up with the family,” he commented. “It doesn't have to be this way if they get enough calories.”
Keep a close eye on body mass index. “When you see a young athlete starting to lose weight, really get aggressive in finding out what external factors may be making this occur,” he said.
In addition, in female dancers, menstrual status warrants close watching and prompt intervention in the case of amenorrhea. “The female athlete triad is unfortunately very common in the dance world, and this can give you issues—not just when you are a teenager, but for the rest of your life,” he said.
The female athlete triad is defined as the relationships among energy availability, menstrual function, and bone mineral density associated with athletic training that may manifest into disordered eating, amenorrhea, and osteoporosis, according to the American College of Sports Medicine.
Anemia and iron deficiency are particular concerns in this population because many dancers are vegetarians, Dr. Koutures noted. “If a young person comes in and says 'I don't eat meat,' especially if they are in an image sport, be very quick to screen them with a CBC, and ferritin and iron studies,” he advised.
Dancers also may be at increased risk for low bone mineral density because of some of the factors mentioned above, as well as inadequate calcium intake and inadequate exposure to the sunlight needed to produce vitamin D. He suggested considering a DXA scan in dancers who have stress or low-impact fractures, menstrual irregularity, or disordered eating.
Dr. Koutures reported that he had no disclosures in association with his presentation.
The female athlete triad is very common in the dance world. ©Andrew Ross/