As seen within this thematic issue on children’s and youth sports, sports medicine has a complex relationship with child health. On the one hand, much of the world is experiencing an epidemic of childhood obesity. The physical activity inherent in sports is viewed as a means of combating this epidemic. However, sports also lead to injuries which can cause short and long-term disabilities. With homage to legendary UCLA basketball coach John Wooden, the role of sports medicine in promoting the health of children fits within the construct of a pyramid. Coach Wooden used a pyramid to describe the qualities necessary for success. A pyramid depends upon symmetric strength, a firm foundation, and a solid heart at its center. Its peak is the goal, which in this case is child health. The pyramid of sports medicine and child health is shown in Figure 1 and described below.