In general, children and youth sports are safe. The great majority of injuries which are sustained are minor and self-limiting. Fortunately, catastrophic acute injuries such as paraplegia, quadriplegia and major limb insults are rare. The 2 mechanisms of injuries at these age groups are acute traumatic insults and unresolved sequelae of repetitive microtrauma. The latter usually results from inappropriate training and coaching techniques. In the United States, adolescents and children are becoming involved in sport at earlier ages and with higher levels of intensity and competition. Factors which lead to injury include the athlete and his/her own psychobiology, inappropriate equipment, the sports environment (playing surfaces, temperature), training and coaching errors, and parental influences. Preparticipation assessment usually reveals extremely healthy children with rare factors which contribute to non-sports participation. Preventative efforts must be made to provide these children with the appropriate equipment and coaching to limit the number of overuse injuries. Management of acute sports problems and rehabilitation of significant injuries are as important in childhood and youth sports as in those of their older sibs in order to prevent lifelong sequelae of musculoskeletal injury. The appropriate goal of children and youth sports must remain one of enjoyment with acquisition of sport-specific skills.