Understanding Contact Risks of Pediatric Physical Activity: Video Analysis to Inform Decisions for Children at Risk of Bleeding Injuries

INTRODUCTION: Physical activity guidelines for children with inherited or acquired bleeding disorders are largely based on expert opinion rather than objective measures of injury exposure, making evidence-based participation recommendations challenging. AIM: To evaluate physical activity injury exposure by objectively measuring physical contact characteristics during childhood physical activity using video analysis. METHODS: An observational video analysis was conducted across five childhood physical activities representing varying perceived risk levels (high/moderate/low): Ball hockey, ice skating, karate, swimming and physical education. Physical contacts were identified and categorized by sex, age, contact type, intentionality, readiness, movement preceding contact, and injury outcome. RESULTS: A total of 2976 contacts were identified in 2013.5 minutes of recorded activity. Contact frequency ranged from 0.66 contacts/minute in swimming to 5.50 contacts/minute in ice skating, despite its classification as a moderate-risk activity. Contact type varied by activity, with person-ground impacts predominating in physical education and skating and person-person contacts more common in swimming and karate. Over half of all contacts (58%) were unintentional. Only 11 of 2976 contacts (0.4%) resulted in injury. CONCLUSION: Objective analysis of childhood physical activity recordings provides evidence regarding contact-related injury risk and may inform participation recommendations for children at risk of bleeding. Observed contact frequencies and patterns suggest that current activity risk classifications may not accurately reflect real-world exposure during childhood physical activity. Expanding objective assessment of childhood physical activities may improve injury prevention strategies and support evidence-based guidelines for at-risk populations.