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Concussions

Concussions & Young Athletes

Daily Dose

Over-scheduling Your Kids

1:30 to read

Are your kids busy with activites this weekend?  Is your child going to be over or under scheduled?  It is sometimes difficult to find a happy medium.

 

I am still a big believer in the “one sport” per season rule and one other activity..maybe two if the third activity does not require a weekend game or practice.  So, what does this look like for a child in elementary school….soccer, fall baseball or football for the fall season, as well as girl scouts, boy scouts, debate team, chess team, and then maybe piano or flute lessons?  You can change that up in anyway and substitute dance, gymnastics, volleyball, a foreign language class…but you get the picture. In this way your child should have several days a week with “NOTHING” to do after school…except go outside and play!  This gives the parent or caregiver a break as well from driving all around to transport to the venue for the practice or game.

 

I hear so many complaints from parents who are in a constant state of stress from trying to figure out transportation for their child to the soccer practice that conflicts with the football practice and the lacrosse practice. This also requires trying to  juggle the multiple games on the weekend that go on for hours one after the next, and even on Sunday mornings.  When I hear the parents complain about this ridiculous schedule I am also seeing the children who are over tired, burnt out and may even have stomach aches and headaches due to the stress of being over scheduled.

 

While every parent is well intended and wanting their child to have as many opportunities as possible in both athletic and other extracurricular activities, a parent also needs to sometimes say “no”.  Discussing the logistics as well as the time commitment for each activity, in an age appropriate manner, may help a family decide which activity stays and which one is “punted”.

 

So….sit down before you and your child are overwhelmed and pick the activities that you will do this fall…but leave some room for being bored. Boredom is a noun that we need to hear more often.

 

Your Child

Sports Variety Recommended to Avoid Overuse Injuries

1:45

Kids who participate in a variety of sports are more likely to benefit from lifelong physical activity according to a clinical report from the American Academy of Pediatrics (AAP).

Researchers also noted that children, who specialize in a single sport at a younger age, are at a higher risk for overuse injuries from training as well as increased stress and burnout.

In its report, “Sports Specialization and Intensive Training in Young Athletes, “the AAP reviewed patterns of youth sports and found the culture has changed dramatically over the past 40 years.

"More kids are participating in adult-led organized sports today, and sometimes the goals of the parents and coaches may be different than the young athletes," said lead author Joel S. Brenner, MD, FAAP, past chairperson of the AAP Council on Sports Medicine and Fitness.

"Some are aiming for college scholarships or a professional athletic career, but those opportunities are rare," Dr. Brenner said. "Children who play multiple sports, who diversify their play, are more likely to enjoy physical activity throughout their lives and more successful in achieving their athletic goals."

The AAP suggests that kids participate in several sports and delay specializing in one particular sport until late adolescence.  The academy also advocates banning the practice of ranking athletes nationally and recruiting for college before they reach their late high school years.

About 60 million children age 6-18 participate in organized sports annually, according to the 2008 National Council of Youth Sports. Of those, about 27 percent participated in only one sport, the council found. Increasingly, children specialize in one sport early and play year-round, often on multiple teams. By age 7, some participate in select or travel leagues that are independent of school-sponsored programs.

About 70 percent of children drop out of organized sports by age 13, research shows.

While there are a variety of reasons why kids may choose to drop out of sports, Brenner believes stress may play a role.

"One reason could be pressure to perform better and lack of enjoyment due to a variety of reasons, including a lack of playing time," Dr. Brenner said.

During the recent Olympic games in Rio, sports such as figure skating, rhythmic gymnastics and diving gained international attention and praise. There is no doubt that these remarkable athletes have been training diligently since they were children. While few will achieve the kinds of success these athletes have, it hasn’t stopped them from trying.

Youth athletes often begin their competitive sports careers as early as age seven, with some youth participating in organized sports activities as early as age four, if not sooner. With an estimated 25 million scholastic, and another 20 million organized community-based youth programs in the United States, the opportunity for injury is enormous.

That is not to say that children should avoid sports, in fact, physical activity is necessary for normal growth and good health. However, when young children specialize in one particular sport and the activity level becomes too intense or too excessive in a short time period, tissue breakdown and injury can occur.

These overuse injuries used to be seen frequently in adult recreational athletes, but are now being seen in children. The single biggest factor contributing to the dramatic increase in overuse injuries in young athletes is the focus on more intense, repetitive and specialized training at much younger ages.

The AAP has these recommendations for young athletes and their parents:

•       Delay sports specialization until at least age 15-16 to minimize risks of overuse injury.

•       Encourage participation in multiple sports.

•       If a young athlete has decided to specialize in a single sport, a pediatrician should discuss the child's goals to determine whether they are appropriate and realistic.

•       Parents are encouraged to monitor the training and coaching environment of "elite" youth sports programs.

•       Encourage a young athlete to take off at least three months during the year, in increments of one month, from their particular sport. They can still remain active in other activities during this time.

•       Young athletes should take one to two days off per week to decrease chances of injury.

"The ultimate goal of sports is for kids to have fun and learn lifelong physical activity skills," Dr. Brenner said. "We want kids to have more time for deliberate play, where they can just go out and play with their friends and have fun."

The AAP report was published online in the journal Pediatrics.

Story sources: https://www.healthychildren.org/English/news/Pages/AAP-Clinical-Report-Young-Children-Risk-Injury-in-Single-Sport-Specialization.aspx

http://www.nationwidechildrens.org/kids-sports-injuries-numbers-are-impressive

 

Daily Dose

Busy Sports Schedules

1:30 to read

I can’t get over how many of my young patients who play sports tell me that they are up late at night during the school week due to their soccer schedule, or who miss church on Sunday due to a soccer or baseball game. Not only are kids starting organized sports at younger and younger ages (soccer for 3 year olds, flag football at 5?), the commitment to practice or play at what I would term “inappropriate” times seems to be more prevalent and absurd to me.

The mother of a 10 year old boy called me recently to discuss how upset and tearful her son had been since school has started.  Upon further questioning it seems that he had joined a fall baseball team and some of their games are scheduled on school nights at 8 pm....which means they don’t even get home until 10:30 or 11:00 pm?  When my own sons were playing high school sports I was not thrilled about Thursday evening JV games and how late we got home....but elementary school?  Of course, her son was exhausted and then he would get anxious about getting his homework done before hand and getting to bed so late and then being able to get up in the morning etc. etc.  She said that he now wanted to “quit playing baseball”, and cried every time he had to practice.

She was trying to explain to him that he had made a commitment to his team and needed to finish out the season, which I agree is an important life lesson about following through.  At the same I totally understand how upset he is that he has to stay up past his usual school night bedtime. It is not uncommon for some children to get very tearful when they are just exhausted...same for adults.

So how do you rationalize teaching your child about loyalty to their team and commitment when adults make up crazy schedules requiring young kids to stay up past an appropriate bedtime, or forgoing Sunday school if that is what they typically do on Sunday morning rather than going to a scheduled soccer game?

Hard for me to figure out how to “fix” this situation until enough parents say..”we will not let our children participate on the team unless the schedule is appropriate for their age”.  

Have you had any similar experiences? What do you think?

 

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Prevent a Concussion!

Prevent a Concussion!

Daily Dose

Concussion Update

1.30

Football has started and cheerleaders are back flipping and flopping and unfortunately that means concussion “season” is beginning as well.  Concussions are also seen during soccer which has geared up for select teams, fall lacrosse, and many other contact sports.  

There is more and more data being published about concussions in children and adolescents, and most of the studies are showing that concussions are serious brain injuries and therefore needed to be treated appropriately.

A new study out of Boston Children’s Hospital showed that children and teens take longer to recover from a concussion if they have had one before.  For the study, a concussion was defined to include any altered mental status within 4 hours of the injury, and headache, nausea, vomiting, dizziness and or balance problems, fatigue,drowsiness, blurred vision, memory difficulty or trouble concentrating.  The most common symptoms noted were headache, fatigue, and dizziness. Of note, 20% of the kids in the study had neuroimaging, and all were negative. 

While 5-7 years ago it was previously thought that kids recovered from a concussion within a week, we now know that recovery time for preteens and teens is longer than previously expected.   Other risk factors for a prolonged recovery were being 13 years of age or older, not losing consciousness, and having a higher “post concussion symptom questionnaire score (RPSQ).  

So, what does this all mean? It means both doctors and parents need to be very conservative in making sure that any athlete who has sustained a concussion has both physical and cognitive rest.  In the study only 92% of people who had sustained a concussion were told to refrain from athletics. That number needs to be 100%.

There will be more and more studies on the way looking at whether there is a gap between when kids “feel better” and when they are truly physiologically recovered. Once again, this study verifies that a recurrent concussion is even more serious.

If ever in doubt that your child might have sustained what used to be called a “mild concussion”, be conservative and keep them out of play. That is never the wrong call.

Your Child

Young Baseball Pitchers Playing With Pain

2:00

It’s that glorious time of year when pitchers pitch; batters swing and outfielders reach out to catch a fast and furious white leather-bound ball. Yep, it’s baseball season!

While the pros start their 162 game regular season, school teams and Little Leagues are suiting up and hitting the fields as well.

Although typically in good physical shape, professional players are not immune to injuries – just ask the Texas Rangers.

Kids on the other hand, play long and sometimes double games at tournaments on the weekends. Many of these kids are weekend warriors that love the game, but aren’t always in the best physical condition.

According to a pair of recent studies, young baseball pitchers are playing with arm and shoulder pain because they feel pressured by their parents or coaches. Playing through the pain may lead to injuries that won’t heal.

"Kids are playing harder and longer in more leagues than ever before," said Dr. Paul Saluan, director of pediatric and adolescent sports medicine at the Cleveland Clinic. "Kids also are not getting enough rest in between episodes of pitching, which may lead to insufficient time to heal smaller stress injuries. Over time, these smaller injuries add up."

Kids explained why they kept playing even though they were in pain.  "Players who experience pain often felt their parents and coaches were frustrated with them," said Dr. Christopher Ahmad, professor of orthopedic surgery at Columbia University Medical Center in New York City.

"Throwing with pain is a signal that injury is occurring," added Ahmad, who is the New York Yankees' head team physician.

In Ahmad's study, he and his colleagues surveyed 203 healthy players, aged 8 to 18. Just under one-quarter of them had experienced a prior overuse injury, they found.

Almost half of the players -- 46 percent -- said they had been encouraged to continue playing with arm pain, and 30 percent said their arm pain sometimes made playing less fun.

Those most likely to report being encouraged to play despite pain had a previous overuse injury. They were also more likely to report feeling arm pain while throwing and to experience arm fatigue during games or practice.

The second study looked at whether parents were monitoring their child’s pitch count during a game. Sixty parents of baseball pitchers were surveyed and just over half of the parents were not aware of safe pitching guidelines and did not actively monitor their child's pitch count.

The most important aspects of safe pitching guidelines are a maximum number of recommended throws based on a child's age and the number of days of rest needed between throwing stints, said Saluan.

"The focus has been on creating a better athlete who can throw harder, faster and more accurately than ever before," Saluan said. "Injury prevention has taken a back seat."

One in five parents did not know how many pitches their child threw in a typical game, but 64 percent recalled that their child had experienced pain in the upper extremities because of pitching, the survey found. For one-third of the pitchers, the pain required a medical evaluation.

"Kids who continue to pitch through pain end up with significant injuries that may have lifelong consequences," Saluan said. "Younger pitchers who are still growing are much more vulnerable than adults to sustain an injury to the growth plates around the shoulder and elbow.”

Injuries to the growth plates usually heal with rest, Ahmad said. But he noted that more young pitchers are also damaging their ulnar collateral ligament, an important ligament in the elbow.

"Unfortunately, these injuries do not always heal and often require surgery," he said.

Most of the injuries are caused when kids are playing too many games, specializing in one aspect of the game, using poor pitching mechanics and throwing too hard.

In the pitching study, half the young pitchers threw in at least two leagues at a time, one-quarter pitched more than nine months of the year, and just over half participated in extra showcase situations.

"We have fallen into the trap of 'too much too soon,'" said Saluan. "This has resulted in a rise in injury rates in kids whose bodies are not prepared to handle the stresses that are encountered."

If you’re unsure of how to monitor your child’s pitching, the Major League Baseball website has a “Pitch Smart” guidelines page for young and adolescent pitchers listed at the end of this article.

The studies were presented at the American Academy of Orthopaedic Surgeons' annual meeting in Las Vegas. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

Sources: Tara Haelle, http://consumer.healthday.com/fitness-information-14/baseball-or-softball-health-news-240/young-pitchers-often-pressured-to-play-despite-pain-study-says-697197.html

http://m.mlb.com/pitchsmart/pitching-guidelines

Your Child

More Kids Suffering ACL Injuries

2:00

Kids involved in sports like soccer, basketball and football are increasing their odds of damaging their knees, according to a new study.

A common knee injury — an anterior cruciate ligament (ACL) tear — has steadily increased among 6- to 18-year-olds in the United States, rising more than 2 percent a year over the last two decades, researchers report.

These injuries peak in high school, said lead researcher Dr. Nicholas Beck, an orthopedic surgery resident at the University of Minnesota. Girls have a higher rate of ACL injuries, Beck added.

Sports like soccer and basketball often require the child to pivot or cut back and forth, putting stress on their ACL and risking a tear.  Contact sports like football can further increase the risk. But ACL tears can occur in tennis and volleyball, too.

The study didn’t look at why the injuries are on the rise, but co-author, Dr. Marc Tompkins, an assistant professor of orthopedic surgery at the University of Minnesota, has a theory.

“One potential cause is the year-round sports specialization that is occurring in kids at an earlier age,” Tompkins said.

Instead of playing a variety of sports and using different muscle groups, many kids are focusing on just one sport creating muscle fatigue and an increase for injury, Tompkins explained.

“Another potential cause is that children as athletes play with more intensity and force than 20 years ago, which may put the body at increased risk of injury,” he added.

The numbers of girls experiencing ACL tears are rising because their sports participation numbers are up.

Beck hopes this study will increase awareness of ACL tears in young athletes and promote interest in prevention programs or developing athletic participation guidelines.

The anterior cruciate ligament sits in the center of the front of the knee. It’s one of the ligaments that holds the knee bones together. When it tears, the ligament splits into two, causing knee instability, according to the American Academy of Orthopaedic Surgeons.

“ACL injuries are serious in the short term because they generally require six months’ to a year’s worth of hard recovery work before going back to sports. And even then it often takes longer to get back to pre-injury function,” Tompkins said.

“ACL injuries are serious in the long term, too, because we know that even if they recover well with or without surgery, the risk of developing arthritis in the injured knee is higher than before the injury,” he added.

Some sports medicine specialist say there are ways to reduce injuries among young athletes, by having coaches teach good running techniques that promote improved function and agility.

Children participating in sports can also benefit from flexibility and stretching programs.

The researchers found that girls of all ages experienced a significant increase in the incidence of ACL tears over 20 years. In boys, however, only those aged 15 to 16 showed such an increase.

The report was published online journal Pediatrics.

Story source: Steven Reinberg, http://www.cbsnews.com/news/acl-tears-on-the-rise-among-kids-especially-girls/

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Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

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Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

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