Introduction

The 2008 International Olympic Committee (IOC) Consensus Statement on Training the Elite Child Athlete states “The entire sports process for the elite child athlete should be pleasurable and fulfilling.”1 Vanden Auweele,2 however, believes that, when considering child participation in sport, a balanced approach is needed that is neither hypercritical or cynical nor too romantic about the positive outcomes associated with it. While it is known that participation in sport has positive health benefits for children,3 Fraser-Thomas and Cote4 recognise that the benefits of sport are not automatic, and that the well-being of a person cannot be guaranteed within the sporting domain simply through their active participation. Despite the many potential positive health and social benefits for child athletes in a healthy sporting environment, sport participation may have inherent underlying threats or dangers in an unhealthy sport culture where abuse and harassment occur.5

The IOC has developed two documents which illustrate the rationale for athlete protection in sport. The Olympic Charter (2013), which outlines the key principles of Olympism, discusses the role of the IOC in protecting the health of the athlete and acting against any form of discrimination.6 The second document is the Olympic Movement Medical Code (2009) which underscores that all stakeholders “should take care that sport is practiced without danger to the health of the athletes and with respect for fair play and sports ethics … [and should take] measures necessary to protect the health of participants and to minimize the risks of physical injury and psychological harm.”7 With these two guiding documents, the IOC has been active in its mission to protect the health of the athlete—and in particular the child athlete. The IOC has published consensus statements on “Training the elite child athlete,”1 “Sexual harassment and abuse in sport,”5 “Age determination,”8 “Fitness and health of children,”3 and most recently, “Youth athletic development.”9 Additionally, the IOC's commitment to protect the health of the athlete10 has been manifest by its development of athlete and coach educational tools on injury prevention,11 sexual harassment and abuse in sport,12 and healthly body image.13

In the creation of the Youth Athletic Development Model for the IOC Consensus Statement,9 there was unanimous consensus of the invited expert scientists, physicians and youth athlete sport specialists that safeguarding the child athlete within sport should be incorporated as an integral component of the model. This paper serves as the basis for the recommendations included in the IOC Consensus paper on Youth Athletic Development. The aim of this narrative review is to (1) present a summary of the current body of scientific literature as it pertains to the threats to children within sport; (2) introduce a framework to clearly define and categorise these threats; (3) identify research gaps in the field and (4) provide safeguarding recommendations for sport organisations.

In this paper, the range of the various forms of physical, sexual and psychological abuse in sport will be referred to as ‘violence’, to be consistent with the terminology used by other child advocacy agencies in the field of safeguarding the child athlete including Unicef14 and Safe Sport International.15 According to WHO,16 the definition of ‘violence’ refers to The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.

While this global definition of violence is applicable in many contexts, it is potentially problematic in sport. The definition is broad and neglects to point out that many actions in sport, while not violent per se, could be construed as violent in many ways and for many reasons. As such, in many instances within the sporting context, violence becomes normalised in sport.17 ,18 Thus, we discuss clear definitions of what ‘is’ and ‘is not’ acceptable behaviour in the sporting milieu below.

Scope of the review In its early phases, work on safeguarding focused on practices within sport. As the field has grown, its remit has broadened to encompass a much wider conception of the ways in which sport may foster harm and abuse. Brackenridge and Rhind19 have recently identified research and advocacy as focusing on three key domains: safeguarding in, around (eg, associated with a major sporting event or child trafficking), and through sport (eg, educating children about sex and relationships, or teaching life skills through a sport-based programme). The scope of this review is limited to the safeguarding of athletes ‘in’ sport. This review focuses on athletes under the age of 18, which is in line with the definition of a child used within the United Nations’ Convention on the Rights of the Child.20 All competitive levels are considered from initial participation within a recreational context, through training to compete, and on to the elite level.

Review of the scientific literature on child protection in sport Research interest in the safeguarding of child athletes from violence in sport has increased over recent years. A key trend has been the broadening of this body of work in terms of three important considerations: who is involved in the violence, the context in terms of where it occurs, and what forms of it are studied. Who: Research has demonstrated that anyone can be a perpetrator of violence in sport including coaches, parents and peers.21 Traditionally, research focused on the coach as the perpetrator and the athlete as the victim. Recent research has revealed that in a significant number of cases the perpetrator is a peer athlete. Indeed, for some forms of violence, such as bullying and hazing, peers are most often the perpetrators.21 Although some athletes may be more vulnerable, these safeguarding concerns are relevant to all athletes, irrespective of their personal characteristics, such as gender and age. Raakman et al22 have highlighted the need to also consider indirect abuse which occurs when children witness the abuse of others within the sport context. Where: Research indicates that preventing violence is important for all sports.23 The context in which the violence can take place has expanded beyond the environment of training or competition. Recent research has highlighted that athletes are subject to online abuse via social media.24 Furthermore, it is important to recognise that child athletes may disclose to someone within sport negative experiences which take place outside of sport.21 As a result, sport organisations need to be prepared to provide the appropriate advice and support. What: Perhaps the most significant broadening in terms of scope has taken place with regards to the range of safeguarding concerns that have been studied. This body of research attempts to better define violence in sport by clarifying unacceptable behaviours which harms athletes. The forms of violence can be grouped with reference to their focus at the individual, relational or organisational level (table 1). In terms of the individual athlete, participating in sport can be associated with a range of safeguarding concerns regarding an athlete's health and well-being. These include depression, self-harm and disordered eating.21 Acts of omission, such as neglect, or failure to take action to prevent injury from training/competing are also individual threats that can be as harmful as acts of commission. Table 1 Categorisation of the various forms of violence which threaten child athletes There are a range of potential threats or forms of violence to child athletes which concern the critical relationships which are developed with other key individuals in sport. Sexual abuse and harassment in sport were the first relational threats to children identified in the literature.25 ,26 Studies have reported prevalence rates of sexual abuse between 2% and 22%.27 Physical abuse includes the infliction of physical injury, whether through contact (eg, hitting an athlete) or non-contact (eg, forced physical exertion).28 Emotional abuse may be the most prevalent safeguarding concern within youth sport.29 ,30 Indeed, Alexander's, et al18 study highlighted that of a sample of over 6000 young people in the UK; 75% had experienced emotional abuse within organised youth sport. Athletes’ needs can also be neglected in terms of their physical, educational, psychological or social development.28 The nature of violence to the child athlete expands beyond relational abuse to include organisational threats. These include systems which promote over-training,31 the endorsement of abusive hazing rituals,32 the use of selection procedures which promote competing with an injury,33 and age cheating.8 Age cheating refers to the athlete's legal documents being altered to officially change the date of birth to enable an athlete who is either too young, or too old for an age category sport, to compete unethically. It has been reported in both gymnastics and football at the elite level.8 The use of systematic doping is another serious threat to the child athlete. Historical examples include systematic institutionalised doping as seen in the former East German regimen in sports, such as athletics and swimming in the 1970s and 1980s. In some weight category sport cultures, it is an accepted and often imposed behavioural expectation to ‘make weight at all costs’. Examples of this form of violence in youth athletes have also occurred at the elite level. For example, during the 2010 Singapore Summer Youth Olympic Games (ages 14–18 years), there were two antidoping rule violations for diuretics used to reduce weight in order to make a weight category in wrestling.34 In the 2014 Nanjing Summer Youth Olympic Games, one antidoping rule violation was reported also for a diuretic in the weight category sport of Taekwondo.35 Finally, in the 2014 Glasgow Commonwealth Games, there was another diuretic antidoping rule violation for a 16-year-old weight lifter.36 Doping can also be categorised as a relational form of violence if the junior athlete is forced into the act of doping within a power structure by either a coach, a member of the athlete entourage, or a senior team mate. Medical mismanagement is another organisational threat for the child athlete. In particular, the excessive and often systematic use of analgesic medication by team physicians in elite youth football is reported.37 Additionally, almost 25% of youth athletes have admitted to misuse of their prescribed medication (pain, stimulant, sleep, antianxiety),38 and 13–68% have admitted to anabolic androgenic steroid abuse in the sport context.39 Provision of insufficient medical coverage during training and competition, by relying on insufficiently trained coaches to manage medical issues, is another organisational threat to the child athlete.40 With the commodification of sport, and therefore athletes, there are some new integrity threats, such as match fixing, trafficking of athletes, and gene doping41 to add to cheating through the use of systematic organisationally endorsed performance-enhancing drugs.

Identification of research gaps Despite this growing body of evidence, there remains clear scope for research in this domain. Studies are required to quantify the prevalence of the various forms of violence as well as the ways in which abusive practices are developed and maintained. While the potential impact of these safeguarding concerns for the individual and the organisation is acknowledged,5 research is required to determine the extent of this impact for the athlete (eg, performance and well-being) and the organisation (eg, reputation). There is also merit in adopting an organisational approach which moves beyond the perpetrator and the victim to reveal how the culture of an organisation can facilitate or prevent violence. There is a need for systematic research which explores the efficacy and effectiveness of strategies which could protect and promote the well-being of child athletes. Additionally, objective evidence from a cost/value analysis of prevention initiatives would be useful data to encourage sport governing bodies of the need to take action on these problems.