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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

Daily Dose

Over-use Injuries in Kids

1.45 to read

It seems that more and more kids are participating in organized sports at even younger ages. I now have many 3 year olds who are already playing on a soccer team, and kindergartners in football and lacrosse.  They are also “specializing” in a sport at younger ages as well. With the focus on one sport at even earlier ages the risk of overuse injuries seems to be greater.

While many kids play multiple sports, maybe a different one each season, there seem to be more and more who are deciding at an earlier age that they prefer one sport and therefore “specialize”. This seems to be more common in those children who participate in dance, soccer, gymnastics and tennis.

While I have been noticing more and more over-use injuries in younger aged children, a recent sports medicine study supports this. A preliminary report from the sports medicine department at Loyola Univ. School of Medicine found that “kids are twice as likely to get hurt if they play just one sport than those who play multiple sports.”  It seems that those children who participate in multiple different sports are actually “cross-training” and are using different muscle groups and different movements.. The children who are playing just one sport are typically playing or competing for over 10 hours a week (more than those in multiple sports) and this requires repetitive use of the same muscle groups.

Added on to this repetition is the stress that is incurred to a growing body. 8-16 year old bodies are still in the throes of major developmental changes and growth spurts and are more vulnerable to injury.  Their bodies are just not ready to perform at this level every day, year round. They truly have so little down time that their bodies just “tire out” and overuse injuries occur. This is seen with stress fractures in the back, feet, lower legs, as well as with tennis elbow, and knee problems, just to name a few. I have seen stress injuries in almost every area of the body!

The mainstay of treatment for overuse injuries is REST! But there are children as young as 9-10 in my practice who become anxious and guilt ridden when told that they may not participate (in whatever sport that got them to this place) for 4 – 6 weeks so that their body may heal itself. You can’t rush rest and the “body is a temple” that needs time to repair, especially in pre-pubertal children.

It would seem that parents should encourage their children to play/experiment with many different activities during their formative childhood years in hopes that injuries will be fewer and that their bodies will have time to grow before specializing in a sport. By high school the body has matured, there is less risk to growth plates while there is still plenty of time to become a “single sport” jock. 

That’s your daily dose for today.  We’ll chat again tomorrow.

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.

 

Daily Dose

Sports Drinks or Water?

2.00 to read

Does your child need a sports drink or water to hydrate? A new study reveals the best practices for your kids. The AAP Committee on Nutrition and the Council on Sports Medicine and Fitness released a report outlining the use and misuse of sports drinks and energy drinks among children and adolescents.

While pediatricians have been effective in discouraging families from drinking full calorie carbonated beverages, and schools have phased out full-calorie soft drinks in cafeterias and vending machines, there has been huge growth in the sports and energy drinks market. It seems that these sports drinks are now the third fastest growing beverage category in the US, after energy drinks and bottled water. Many of these beverages are being marketed towards children and teens for a big variety of inappropriate uses. To begin with, sports drinks and energy drinks are really very different products. Sports drinks are flavored beverages that contain carbohydrates, along with minerals, electrolytes, and they should be used specifically for hydration in athletes. Advertisements would suggest that these products may optimize athletic performance and replace fluid and electrolytes lost in sweat during exercise. For the average child who is engaged in routine physical activity, the use of sports drink is really unnecessary, good old water will do the trick. It is important to teach children to hydrate with plenty of water before, during and after regular exercise. If doctors and parents are encouraging exercise as a means of improving overall health and wellness, providing sugary sports drinks seems counter intuitive. Some kids may not even burn as many calories with their exercise as they may receive from one bottle of a sports drink. In other words a child’s overall daily caloric intake may increase without any real nutritional value provided by a sports drink. Back to reading labels! For athletes who are participating in vigorous exercise, or in conditions of prolonged physical activity, blood glucose is an important energy source and may need to be replenished; in which case sports drink providing additional carbohydrate may be appropriate. But, different sports drinks contain differing amounts of carbs, anywhere from 2-19 grams of carbohydrate per 8 oz serving. The caloric content of sports drinks is 10 – 70 calories per serving.  You must look at the labels and judge the intensity and duration of exercise to decide which drink to use. With summer approaching, it is good to know that sports drinks really are not indicated for use during meals or snacks, and are not a replacement for low fat milk or water. Turn on the faucet and cut down on calories and cavities! That’s your daily dose for today.  We’ll chat again tomorrow. How do your kids stay hydrated? Let me know!

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Your Child

Pre-teen Football Linked to Brain Changes in NFL Players

2:00

The start of a new school year also brings after-school sports programs. Late summer and fall is prime football season for many middle and high schools. In some states, it’s a hallowed tradition that boys and girls look forward to participating in whether it’s running down the field or cheering on the team.

While school football doesn’t typically offer the same ferocious body beating and brain –rattling that are seen in the National Football League (NFL), a new study shows that brain development can still be affected by playing football at a young age.

The study looked at the possible connection between a greater risk of altered brain development in NFL players who started playing football before the age of twelve as opposed to those players who began playing later in life.  The study is the first to show a link between early repetitive head trauma and future structural brain variations.

The study was small but interesting. It included a review of 40 former NFL players between the ages of 40 and 65 who played over 12 years of structured football with a minimum of 2 years at the NFL level.

One half of the players took up football prior to the age of 12 and half started at age 12 or later. The number of concussions suffered was very similar between the two groups. All of these players had a minimum of six months of memory and cognitive issues.

"To examine brain development in these players, we used an advanced technique called diffusor tensor imaging (DTI), a type of magnetic resonance imaging that specifically looks at the movement of water molecules along white matter tracts, which are the super-highways within the brain for relaying commands and information," study author Dr. Inga Koerte, professor of neurobiological research at the University of Munich and visiting professor at Harvard University, said in a press release.

The researches believe their findings add to the growing amount of scientific evidence that shows the brain may be especially vulnerable to injury between the ages of 10 and 12.

"Therefore, this development process may be disrupted by repeated head impacts in childhood possibly leading to lasting changes in brain structure," said study author Julie Stamm, currently a post-doctoral fellow at the University of Wisconsin School of Medicine and Public Health.

Despite finding a link to the brain development window where kids are more likely to suffer brain injury by repeated head impacts, the small size of the study means the results may not necessarily apply to non-professionals.

"The results of this study do not confirm a cause and effect relationship, only that there is an association between younger age of first exposure to tackle football and abnormal brain imaging patterns later in life," said study author Martha Shenton, a professor of psychiatry at Harvard Medical School.

Because of the intense publicity about and the findings of many studies on the short and long-term dangers of concussions, many school sports programs are looking at changing how they allow students to play in games associated with head injuries.  Where it was once common for coaches to let players continue playing after a particularly rough tackle or head butting, they are more likely now to insist that a field medical professional examine the child. Some schools are also implementing no tackle policies to protect very young players.

While traditional football isn’t likely to become extinct, parents and coaches can educate themselves about brain injuries and learn how to best protect young players from the chances of long and short-term disabilities.

Source: Brett Smith,  http://www.redorbit.com/news/health/1113407634/pre-teen-football-linked-to-more-severe-brain-changes-in-nfl-players-081115/

 

 

Daily Dose

Keep Your Athletes Hydrated On and Off the Field

1:30 to read

With summer heat all across the country and kids heading back to school athletics, band practice, drill team and the like it is a good time to discuss heat related illnesses and their prevention.

It is always at this time of year that I begin worrying about heat exhaustion and heat stroke and I find myself re-emphasizing the importance of maintaining hydration, even before you start back to outside activities. The Centers for Disease Control and Prevention reported 129 deaths while playing sports due to heat and exposure to elevated temperatures.

Among high school athletes, exertional heat stroke is the third leading cause of death and is often related to lack of acclimation to the heat and dehydration. You can’t just head out to run three miles in the heat or work out in pads or march in the band on the hot field without preparing ahead of time. Heat exhaustion occurs when the core body temperature is elevated between 100.4 and 104 degrees. This is different than having a fever secondary to illness. Symptoms are typically non-specific but include muscle cramps, fatigue, thirst, nausea, vomiting and headaches. The skin is usually cool and moist from sweating and is indicative that the body’s cooling mechanism is working. The pulse rate is rapid and weak and breathing is fast and shallow. Coaches, athletes and others should all be aware of these symptoms. This is the body saying, “I am overheated” and don’t keep going! (You would not drive your car when overheated; you pull over, and at least add water.)

The mainstay of treatment is to prevent progression to heat stroke by moving to a cooler place, in the shade, air conditioning etc. Remove as much clothing as possible (uniforms, pads, helmets etc) to help heat dissipation. Water misting fans may be helpful. Begin rehydration with appropriate oral electrolyte solutions and water. When treated quickly and appropriately, symptoms usually resolve in 20 -30 minutes. The child should not return to activities that day, and should avoid heat stress for several days. Heat stroke is a MEDICAL EMERGENCY and will require transportation to the ER for aggressive treatment. In this case the previous symptoms have been missed and the core body temperature rises to 104 degrees or greater. The skin is flushed, hot and dry from lack of sweating. The athlete is confused, or even unconscious. The heart rate is fast and there is hyperventilation. The blood pools away from vital organs and can result in encephalopathy, liver, kidney and multiple organ failure. While awaiting transportation to the ER the athlete should be moved to a shaded area, clothing removed and ice packs may be applied to surface areas overlying major vessels, (i.e. the neck, beneath the arm pits, and the groin). Cooling and misting fans may also be used.

Continue to educate your children about the need for hydrating the evening prior to events, and for continuous hydration while exercising in the heat. They should know to drink fluids even when not thirsty, as once you become thirsty you are already behind in your fluid intake. With good education, and recognition of early signs over overheating heat related illnesses are preventable.

That’s your daily dose, we’ll chat again soon! Send your question to Dr. Sue!

Daily Dose

Too Much Pressure to Play Sports?

1:30 to read

Does your child play a sport “after school”?  It seems children as young as 3-4 years of age are now involved in soccer and even football.  Some children are barely walking before they are signed up for a team.  Parents tell me various reasons for this including, “if they don’t start young they will be at a disadvantage athletically”, “if we don’t get on a team now, there will not be room for our child once they start kindergarten or first grade”,  and “our child wants to play and wear a uniform”. I just see lots of issues with burn out.

It seems awfully early to start “team sports” to me. I am a huge advocate of families and children playing together and learning all sorts of games and sporting skills. Kicking a soccer ball in the yard, or hitting the wiffle ball off of the tee, or having Dad throw a pass with the football all seems pretty “normal” to me. But organized sports with a 3 year old who is still in diapers….really?  Maybe one of the “guidelines” should be you have to be potty trained.  Yes, this is true, I see children in diapers who “will not pee or poop in the potty” according to their parents, but they go to soccer practice?  What is wrong with this picture?

So, while some of these well intentioned parents have told me that they are having fun being the coach, or attending games with other friends, their pre-school children “don’t have time to be potty trained”. They are too busy going to school, followed by organized activities that “it is just easier to let them stay in diapers”. I was even with a 4 year old at a football game and she was still in diapers?

At some point these children and parents will need to skip a practice or two and stay home long enough to get potty trained.  I am noticing that children are getting older and older before they are potty trained. I know there are books written on this topic with the philosophy that “the child will ultimately train themselves”, or “ how to potty train in 3 days, with a child who shows no interest”…or something along those lines.  But really, in my experience, if you watch your child’s cues, spend the time to “talk bathroom habits” and have the “time” to be home to potty train most children are potty trained between 24-36 months of age.  Yes, there are occasional children (none of my own) that just show interest earlier and say things like “I go potty now” and really do it on their own. There are also some who are more difficult to get interested and may be harder to potty train…but again, which is probably a more important life time skill…..getting out of a diaper or trying to figure out how to line up for a soccer game? I’m just saying.

Daily Dose

No More Energy Drinks for Your Kids

New guidelines from the AAP states your tweens & teens should not be using enery drinks. Dr. Sue weighs in.Last week, we discussed the new report from the American Academy of Pediatrics outlining the use of sports and energy drinks.  So, what exactly is an “energy” drink?

As you know from previous post, a sports drink is a flavored beverage that contains carbohydrates, mineral and electrolytes and sometimes other vitamins and nutrients. In contrast, an “energy” drink typically contains a stimulant such as caffeine or guarana with varying amounts of carbs, protein, amino acids as well as other minerals and/ or vitamins. In the recently published new guidelines by the AAP they state “stimulant containing energy drinks have no place in the diets of children or adolescents”. Many of the so called energy drinks contain substances that are non-nutritive stimulants such as caffeine, guarana, taurine, ginseng, L-carnitine, creatine and/or glucuronolactone.  All of these substances are purported to provide performance enhancing effects. While “energy” drinks often provide carbs, the primary source of “energy” is the stimulant caffeine. Many adolescents ingest large amounts of caffeine in a variety of forms. The new “energy” drinks contain varied amounts of caffeine, and are often more than a cola beverage. The caffeine content in these “energy” drinks is often not on the label and may exceed 500 mg (equivalent to 14 CANS of a carbonated cola drink), and is enough to result in caffeine toxicity. Did you know a lethal dose of caffeine is considered to be 200-400mg/kg?  In 2005 poison control centers reported more than 4600 calls for questions regarding caffeine ingestion and 2600 of these calls involved children less than 19 years of age. Caffeine has effects on both the cardiovascular and developing neurologic system of a child. There is also the risk of physical dependence and addiction. One study showed that children 6-10 years of age ingested caffeine on an average of 8 out of 10 days!  Another study showed that of 78 adolescents surveyed, 42.3% had consumed energy drinks in the 2 weeks prior to the survey. Symptoms of caffeine withdrawal include headache, fatigue, decreased alertness, difficulty concentrating, irritability and depressed mood. (Sounds like the complaints of many teens I see). If a child or teen is mistakenly buying an energy drink for use in re-hydration, they may be ingesting huge amounts of stimulants, especially if they are drinking one energy drink after the next. At the same time, some adolescents are intentionally buying energy drinks for the stimulant effects, in hopes of combating fatigue while at school and during sporting events.  The use of these energy drinks with underage alcohol ingestion is yet another topic. So, there is NO Place for the use of energy drinks among children and adolescents and this topic needs to be reiterated by parents, pediatricians, schools and coaches. What do you think? Will you talk to your kids about their use of energy drinks?  I would love your comments.

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