If you have young children who play soccer, watch them closely.
That's the message from a team of Ohio researchers who found that children ages 2 to 4 are the most likely group to be hospitalized for soccer injuries.
Reviewing thousands of emergency room records, health experts at Children's Hospital in Columbus discovered that 5.2 percent of the youngsters ages 2 to 4 treated for soccer injuries were admitted to the hospital for treatment, compared with only 1.5 percent of players ages 5 to 18.
The researchers used records from 1990 to 2003, part of a national injury surveillance system set up by the U.S. Consumer Product Safety Commission at 100 U.S. hospitals.
The report, published yesterday in the American Journal of Sports Medicine, is the first study to comprehensively document soccer- related injuries among children nationwide, according to the journal's editors.
Previous studies were limited to specific types of injuries, age or gender groups, or focused on injuries among professional players, they said.
Soccer injury rates remain relatively low, especially when compared with heavy contact sports such as football, the researchers say. The same researchers concluded in another report last fall that football players were almost twice as likely to be injured as soccer players.
"One thing we want to emphasize is that soccer is a relatively safe sport," said Christy L. Knox, a co-author and researcher at the hospital's Center for Injury Research and Policy.
The researchers have no explanation for why the youngest children are most likely to be hospitalized. It could be a lack of supervision during backyard play, or that physicians are more likely to admit very young patients as a precaution because at that age, children can't articulate their symptoms, the researchers said.
Or it could be the nature of the injuries. The researchers found that 41 percent of the children ages 2 to 4 seen in emergency rooms were treated for face, head and neck injuries, while only 15.5 percent of the older children suffered face, head and neck injuries.
"We really don't know why it's happening," Knox said.
The researchers recommend that parents more closely supervise youth soccer matches - particularly if the players are very young.
Still, soccer players and coaches say the risk of injury is part of a sport in which players constantly run at each other, engage in frequent contact, kick a ball that moves at high speed and wear little protective equipment.
"Soccer is a very, very, very physical game," said Gary Lynch, girls coach at John Carroll High School.
Senie Mentis, 28, of Lutherville, knows that from experience. She's played since she was a toddler and is recuperating from her second soccer injury: a torn quadriceps muscle in her right thigh. That happened three months ago when her cleats stuck in some muddy turf during a match at Centennial Park in Howard County.
"It had been a while since I played, and I wasn't really in the shape I should've been in," she said.
But her first injury, as a 12-year-old playing in a Tennessee tournament, was more serious - a concussion that sent her to an emergency room. "There was a power shot to the goal and I plucked it with my head - and then I went down. It might've been the contact with the ground that did it," she said.
Researchers found that concussions were diagnosed in 2 percent of the emergency room cases, which means that about 30,286 children nationwide suffered concussions playing soccer between 1990 and 2003.
Concussions are more likely when players are hit on the head unexpectedly - and not when they deliberately use their heads to strike the ball, a common technique called "heading," said Dr. James P. Kelly, a neurologist at the University of Colorado medical school who wrote the guidelines that physicians use to treat sports concussions.
Knox said soccer's rise in popularity during the past 25 years portend an increase in injuries.
The number of high school soccer players rose from 305,102 in 1990 to 659,000 last year, according to the National Federation of State High School Associations, which writes the soccer rules for the nation's high schools. No one keeps track of the number of players in adult and youth recreation leagues.
The researchers examined 41,278 emergency room injury reports, representing an estimated 1.6 million pediatric soccer injuries treated nationwide during the 14-year period.
The injuries were sustained in both organized and informal backyard soccer matches, the researchers said.
The researchers found that wrists, fingers and hands were the most commonly injured body parts, accounting for 20 percent of soccer-related emergency room treatments. They were followed by injuries to ankles (18 percent) and knees (11 percent).
Some coaches and players were surprised by those results. "I can't remember a finger injury," said Maurice Boylan, who coaches girls' soccer at the McDonogh School as well as boys' youth soccer teams.
The researchers also found that boys of all ages were more likely to have face, head and neck injuries (accounting for 18 percent of their injuries), while girls were more likely to injure their ankles (22 percent) and knees (13 percent). About 58 percent of the soccer players treated in emergency rooms were boys.
At least some of those differences may be rooted in different styles of play, players and coaches say. "Girls can get pretty aggressive, but I think the boys get in the air more," Mentis said.
"Boys play with reckless abandon. Boys are going up for head balls; there's elbows flying to the face," added Boylan.
Others say the statistics may be misleading because many soccer injuries don't send players to a hospital.
"Someone with a knee injury isn't as likely to go to the ER right away. They're more likely to see an orthopedist, maybe the next day when the knee is swollen up," Lynch said.
Shin guards are mandatory in organized soccer leagues, including high school play. But head protection and mouth guards are more matters of personal choice.
Jeff Skeen, a San Diego businessman who began marketing a padded headband in 2003 after his daughter suffered three concussions playing soccer, argues that the risk of concussion is grossly underestimated by many of the coaches, trainers and others involved in the sport.
He's sold 300,000 of his head guards. He insists that they absorb the impact from other players, the ground or a goal post, but says many in the sport are reluctant to accept them.
"It's like people who say that motorcycle helmets aren't necessary," he says.
In their report, the authors recommend additional research to see whether helmets or headgear decrease the risk of head injuries. They also recommend funding for a national database to track pediatric soccer injuries.
"What we really need is a good surveillance system," Knox said.
dennis.obrien@baltsun.com