By
Dev K. Mishra, M.D., President, Sideline Sports Doc
In the adult sports world much attention is focused on the use of steroids or other performance enhancing drugs used illegally to gain an edge on the competition. In youth 
sports there’s an additional method used sometimes to gain an edge, or sometimes just to become eligible for competition: age fraud.
Age fraud simply means that the athlete (or more commonly the athlete’s parents) lies about the true age in order to either gain a competitive edge, seem more attractive to professional scouts, or sometimes to become eligible for competition. Age fraud is relatively easy to do when paper records are used to provide a birth date. The paper records can be changed, they can be “lost”, or they are unreadable.
Let’s take a look at how age fraud is used in different ways.
Age fraud allows older athletes to compete against younger kids
This is probably the most common reason for age fraud. Older athletes are often physically more developed than younger athletes, particularly on the edges of puberty. For boys, for example, 14 or 15-year-old boys would have a considerable physical advantage over a 12 year old. The most famous examples of this type of age fraud include the Little League pitcher Danny Almonte in the 2001 Little League World Series (Almonte, later proven to be 14 years old, struck out 18 of the 21 twelve-year-old batters he faced), and many Nigerian youth national team soccer players.
Age fraud can make players more attractive to professional scouts
Let’s say you’re a professional baseball scout and you come across two players: a 17 year old who throws in the mid-80s and a 20 year old who throws in the mid-80s. Which one is more attractive to you? Probably the 17-year-old player, since their upside is considerably higher given additional physical maturity. There are examples of several famous baseball players who lied about their ages, appearing younger to scouts than they actually were including Rafael Furcal and Miguel Tejada.
Age fraud to allow underage athletes to compete in age-restricted sports
This is a widely used tactic in “women’s” gymnastics. The current minimum age to compete in women’s gymnastics Olympic competition is 16, and the reason given is to protect very young athletes from physical abuse due to overtraining. But many female gymnasts reach physical peak as young as age 12, thus birth and age records are altered to make the young athletes appear older.
Efforts to verify true age use imaging: x-rays, mri, or ultrasound
How then do we verify an athlete’s true age? X-rays of either the wrist or the elbow can be used to estimate a young athlete’s age, and some organizations such as FIFA are requiring imaging to confirm eligibility. A recent study in the British Journal of Sports Medicine has shown however that X-rays can overestimate age, perhaps by as much as 6-12 months. MRI could be more accurate and have the advantages of no radiation to the young athlete. Disadvantage of MRI however is cost and availability, with MRI often not available in developing countries. Ultrasound is being investigated for this and could turn out to be a simple low-cost alternative. Whatever the method used, expect to see age verification based on something other than a piece of paper to become the norm very soon.