Updated July 2010
It isn’t surprising that children who play contact sports are at a greater risk for injury than children who don’t play them. Baseball players in particular risk several types of injuries. These can result from “overuse” or a single incident where a player gets hurt.
An overuse injury is damage to a bone, muscle or tendon that happens after it has been repeatedly stressed without enough time to heal or repair itself. To recognize these often quiet injuries, look for a progression from pain in the affected area after physical activity, to pain during the activity without any effects on performance, to pain during the activity that does affect performance, and finally to pain in the affected area that does not go away-even at rest. Among the most common overuse injuries in baseball are injuries to the shoulder and elbow. These injuries are most common in pitchers, but are found in other positions that require frequent and forceful throwing. 
Prevention is possible. For example, to reduce the number of overuse injuries to the shoulders and elbows of young baseball pitchers, it is important to teach players how to pitch correctly. It also helps to give players enough rest time between pitching outings, since players who throw a higher number of pitches and pitch more frequently are at greater risk for overuse injuries. In addition, pitchers should rest their arms for 3 months of the year, avoiding activities that cause stress to the arm, like football quarterbacking, competitive swimming, and playing softball.
Young baseball players are also at risk from injuries that happen suddenly, often without warning. One study, published in Pediatrics in 2009, looked at all baseball injuries that resulted in trips to the emergency room over a 13 year period. This study found baseball players under age 18 were most likely to be injured when hit by a ball, hit by a bat, or sliding into base.
Fortunately, there are safety devices available to players. Safety balls, face shields, mouth guards, and safety bases top the list of products that help to make baseball a safer sport for kids.
Face shields are effective in reducing injury to the face, for example when a player is at bat or running the bases.
Safety balls are baseballs made with rubber centers instead of the normal cork and twine found in other balls. All types of safety balls, but especially “reduced impact” balls, reduce the risk of injury. Safety balls are especially useful in preventing a rare, but deadly, baseball injury: commotio cordis, Latin for “agitation of the heart.” This injury is the cause of 3% of sudden deaths in young athletes, and unfortunately baseball is the sport that sees this tragic injury most frequently. This event is caused by a blunt, non-penetrating, blow to the chest that does not cause damage to the ribs, sternum or heart. Often the accident does not appear serious until the athlete suddenly collapses.
Some say that safety balls bounce differently than traditional balls when they are batted. While it’s true that the softest variety used for T-Ball by kids 7 and under are bouncier, bounce less predictably, and are slower leaving the bat, the harder (intermediate) variety perform almost identically to regular baseballs.2 When a safety ball hits a player’s body, there is less impact, thus reducing the risk of commotio cordis. Safety balls can help reduce the number of deaths in youth baseball if used in lower leagues where younger players are at greater risk of commotio cordis because their bodies are not fully developed,
The risk of commotio cordis for baseball players is relatively low, and gets even lower as an athlete gets older. Overall injury rates for young people who play baseball range from 2%-8% of participants per year.2 It’s important that parents, schools, and baseball leagues take the necessary precautions to prevent these injuries.. Most of the measures to reduce the risk of baseball injuries-whether from overuse or from sudden impact-are simple and inexpensive.
 Brenner JS, Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics. 2007;119:1242-1245
 Committee on Sports Medicine and Fitness. American Academy of Pediatrics: risk of injury from baseball and softball in children. Pediatrics. 2001:107:782-784
 Krajnik S, Fogarty KJ, Yard EE, Comstock RW. Shoulder injuries in tUS high school baseball and softball athletes, 2005-2008. Pediatrics. 2010:125;497-501
 Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: Clinical results and injury risk factors. American Journal of Sports Medicine. 2004;32:1158-1164
Lawson BR, Comstock, RD, Smith GA. Baseball-Related Injuries to Children Treated in Hospital Emergency Departments in the United States, 1994-2006. Pediatrics. 2009;123: 1028-1035
 Marshall SW, Mueller FO, Kirby DP, Yang JY. Evaluation of Safety Balls and Faceguards for Prevention of Injuries in Youth Baseball. Journal of the American Medical Association. 2003;289:568-574
 Maron BJ, Doer JJ, Haas TS, Tierney Dm, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation. 2009;119:1085-1092
 Maron BJ, Estes M. Medical progress: commotio cordis. New England Journal of Medicine. 2010;362:917-927