Competitive youth sport participation has been shown to benefit physical, psychological, and social development in children and adolescents. However, recent trends involving increased training volume, early sport specialization, and performance-based youth sport systems have elicited questions around youth biological maturation and skeletal development. These concerns include increased susceptibility to injury and overall athlete well-being later in life. This narrative review aimed to discuss sex-specific differences in growth and skeletal maturation as they relate to training load considerations in youth athletes. PubMed, Google Scholar, SPORTDiscus, and Scopus were used to search for peer-reviewed literature related to youth biological maturation, peak height velocity, skeletal development, training loads, risk of overuse injury, and sport participation. Results were synthesized according to themes including biological development and growth, injury susceptibility, training load considerations, and psychosocial implications of youth sport participation. Female athletes were found to mature earlier on average than their male counterparts, experiencing pubertal onset, peak height velocity, and subsequent skeletal maturation around 8-13 years of age. Compared to females, males experience this process later but over an extended period that can continue into late adolescence. Physiological changes during periods of rapid growth can temporarily alter coordination, movement efficiency, and injury susceptibility, especially under conditions of high training load and inadequate recovery. Failure to account for individual differences in training load relative to biological development may increase risk for overuse injury, growth plate injury, and psychological burnout. Researchers and coaches should be aware that training programs based on chronological age may not account for individual variability. Load management, movement competency, recovery, and long-term athlete development should be considered when developing training programs to reduce injury risk and promote healthy athletic development.
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