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.