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Your Teen

Preventing ACL injuries in Young Athletes

2.00 to read

A new report states that young athletes are more susceptible to serious and potentially debilitating knee injuries. 

An increasing number of American children and teens are tearing up their knees, particularly kids who are involved in sports such as basketball, soccer, volleyball and gymnastics.  The most dangerous injury is a tear in the anterior cruciate ligament (ACL), which provides stability to the knee.

Specific types of training can reduce the risk of an ACL tear by as much as 72 percent, the report from the American Academy of Pediatrics (AAP) says.

"Neuromuscular training programs strengthen lower-extremity muscles, improve core stability and teach athletes how to avoid unsafe knee positions," lead author Dr. Cynthia LaBella, medical director and associate professor of pediatrics at Northwestern University Feinberg School of Medicine, and a member of the academy's council on sports medicine and fitness, said in an academy news release.

The AAP recommends that coaches who run these types of sports programs should learn more about the exercises that can help athletes strengthen their muscles and encourage their athletes to use them.

The risk of ACL injury among young athletes increases at age 12 for girls and age 14 for boys. The largest numbers of ACL injuries occur in female athletes ages 15 to 20. After an ACL tear, girls are much more likely to have surgery and less likely to return to sports than boys, experts said.

"After puberty, girls have a 'machine motor mismatch,'" report co-author Timothy Hewett, professor and director of research at Ohio State University's sports medicine department, said in the news release. "In contrast, boys get even more powerful relative to their body size after their growth spurt. The good news is that we've shown that with neuromuscular training, we can boost the power of girls' neuromuscular engine, and reduce their risk of ACL injuries."

Before some of the newer less-invasive surgical treatments were available, surgery was often delayed until the child’s skeletal structure was fully mature. Now though, improved treatment can avoid impact to the developing growth plates, which means that they can have surgery to stabilize the knee.

Overall, ACL surgery is about 90 percent successful in restoring knee stability, according to the report published online April 28 and in the May print issue of Pediatrics.

"In many cases, surgery plus rehabilitation can safely return the athlete back to sports in about nine months," report co-author Dr. William Hennrikus, professor of pediatric orthopedic surgery at Penn State Hershey Bone and Joint Institute, said in the news release. "Parents who are considering surgery for their child should seek out a pediatric orthopedic surgeon with sports medicine training."

ACL tears can have long-lasting effects. People who suffer an ACL tear are up to 10 times more likely to develop early-onset degenerative knee osteoarthritis, which can lead to chronic pain and disability, the report said. "This is important, because it means athletes who suffer an ACL tear at age 13 are likely to face chronic pain in their 20s and 30s," LaBella said.

If your child participates in any of these sports, check with your child’s coach to see if they are providing the appropriate amount of muscle strengthening exercises to fortify your child’s knee support system.

If you feel they are not getting any or enough of these needed exercises, consider enrolling your child in a muscle strengthening exercise program or begin doing them together at home.

Source: Robert Preidt, http://www.philly.com/philly/health/topics/HealthDay687065_20140428_Training_Programs_Protect_Young_Athletes_From_ACL_Tears__Report.html#cPXEpJy1wK9xQl6s.99

Daily Dose

Make Sure Your Playground is Safe

This is the best time of year for children playing on playgrounds and in the front yard.I was outside with the neighbors and their children on this beautiful evening and realized that the longer days of spring are here. This is the best time of year for children playing on playgrounds and in the front yard. With those outside activities come concerns about safety for children of all ages. From falling off the slide to running into the street to chase a ball and being hit by a car, accidents and injuries are far too common.

Approximately 20 children under the age of 14 die each year from injuries sustained on playgrounds. Many of these deaths occurred on backyard playgrounds. Thousands of other kids will make trips to the E.R. for fractures and sprains, cuts that need stitching, and head and neck injuries. The best way to ensure safe play is to ensure that the equipment they are playing on is safe, and that there is good parental supervision. Swings may pose a choking and hanging hazard, so check out that home made rope swing. Check out the slide for sharp edges or hooks that may cause lacerations. Burns may occur from slides that heat up in the heat of the midday sun (that may only be a southern experience!) Another source of injury is due to inappropriate surfaces beneath the playground equipment. Look into installing a protective shock-absorbing surface beneath your swing set or fort. Make sure that the surface extends far enough in all directions to cover jumps from swings and slides. Playing outside is a rite of passage, and a great way for a both family and friends to have fun, and get exercise. Just make the experience as safe as possible. That's your daily dose, we'll chat again tomorrow.

Your Child

Are Playgrounds Too Safe?

1.45 to read

It takes a lot to bore a preschooler. They are so inquisitive that just about everything seems interesting. But, believe it or not, playgrounds may have become so “safe” that they bore even preschoolers. A new report suggests that may be one of the reasons these little ones are not getting enough exercise.

Researchers have found that strict safety rules for equipment and low budgets at childcare centers were largely blamed for playgrounds that don't make kids feel like playing,

Kristen Copeland, MD, of Cincinnati Children's Hospital Medical Center, and her colleagues wrote in the February issue of Pediatrics that fixed playground equipment that meets licensing codes is unchallenging and uninteresting to children.

Another reason kids may not be exercising enough is that schools are focusing on academics at the expense of recess and gym.

"Societal priorities for young children -- safety and school readiness -- may be hindering children's physical development," they wrote in the paper.

According to an online article in Medpagetoday.com, three-quarters of U.S. kids, ages 3-5 years, attend childcare and most of their time is spent being sedentary.

"Because children spend long hours in care and many lack a safe place to play near their home, these barriers may limit children's only opportunity to engage in physical activity," Copeland's group explained. "This is particularly concerning because daily physical activity is not only essential for healthy weight maintenance, but also for practicing and learning fundamental gross motor skills."

The investigators conducted nine focus groups with a total of 49 childcare providers taking care of preschool-age children at 34 centers in Cincinnati, which varied from inner-city to suburban locations and included some Head Start and Montessori centers.

The providers interviewed were nearly all women with at least some college education. These providers commonly expressed concern that the children they cared for had little chance of outdoor playtime when they went home, particularly those who were picked up late in the day or whose parents worked multiple jobs.

Many of the parents didn't have a dedicated room indoors where kids could be active during bad weather.

To prepare kids for grade school, an emphasis has been placed on teaching children shapes, colors, and skills that prepare them for reading, but not giving them time for outdoor and active play- both of which have been shown to increase a child’s learning ability.

That pressure came directly from parents -- both upper- and lower-income families -- as well as from state early-learning standards.

Some parents also told providers to keep their children from participating in vigorous activities so that they would not be injured.

Providers felt that the playground equipment was safe to let kids play on because of beefed up state inspections and stricter licensing codes, but all the safety measures sort of back-fired and kids just weren’t interested.

"To keep it challenging, teachers noted that children would start to use equipment in (unsafe) ways for which it was not intended," the researchers wrote.

They quoted one provider who explained that with new equipment fitting the tighter standards, "you see children trying to climb into places they're not supposed to climb in because it's just not challenging. They're walking up the slide much more than they ever did with the other one. You can see they are just trying to find those challenges."

Pediatricians may be able to help address this problem by emphasizing the learning and physical benefits of active outdoor play, encouraging parents to dress their child for it, and not suggesting that physical activity is inherently dangerous when giving injury prevention advice, the researchers noted.

Source: http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/30493

Daily Dose

Don't Let Your Child Become an Obesity Statistic

Healthy eating begins with the first foods that you feed your infant.An alarming statistic was released today which shows that one in five 4-year-old children are obese and these numbers are even higher in minority children. This study was just published in The Archives of Pediatric and Adolescent Medicine, and followed over 8,000 children looking at height and weight. The findings were quite concerning, showing a trend toward obesity at an age younger than predicted, and numerous long term health problems associated with obesity, such as heart disease, diabetes, high blood pressure and bone and joint problems.

This is a national health issue and a call to action for all families to teach and model healthy eating. One of the problems is that many of the government sponsored food programs provide foods high in carbohydrates, and low in fresh fruits and vegetables, and this promotes obesity. School lunches have also been found to be high in fat and carbohydrate and continue to promote poor food choices. With the bad economy and recession, families have cut back on groceries and may be eating more fast foods, breads and pastas, again providing more carbohydrate than protein. Healthy eating begins with the first foods that you feed your infant. A well balanced diet with grains, fruits, vegetables and meats begins in the high chair and should continue at the family dinner table. The meals may be simple and healthy. Being a short order cook, or providing your child's favorite pizza and fried food on a daily basis, even in a young toddler will have deleterious effects for the rest of their life. Don't let your child become a statistic heading toward lifelong health issues secondary to childhood obesity. Change your own eating habits, improve your children's and remain committed to family meals. We, as parents, cannot afford to raise a generation where obesity is the norm: the change must begin now. That's your daily dose, we'll chat again tomorrow. More Information: 1 in 5 Preschoolers Obese

Your Child

Exercise Boosts Kids’ Grades!

2:00 to read

We all know that exercise is good for the heart, lungs, weight-control and now a new study suggests that it’s good for increasing academic performance as well.

The Dutch researchers reviewed several prior studies conducted in the United States, one from Canada and another out of South Africa. What they discovered was that all the studies showed that the more physically active students are, the better they do in the classroom.

"We found strong evidence of a significant positive relationship between physical activity and academic performance," the researchers, led by Amika Singh of the Vrije Universiteit University Medical Center at the EMGO Institute for Health and Care Research in Amsterdam, the Netherlands, said in a journal news release.

"The findings of one high-quality intervention study and one high-quality observational study suggest that being more physically active is positively related to improved academic performance in children," the authors noted.

A total of 14 studies were reviewed. They involved students between the ages of 6 and 18. Some studies were smaller, working with 50 students, while another study had as many as 12,000 students. 

Researchers noted that students who exercised had increased blood flow and oxygen to the brain. These school-age children did better in the schoolroom. The analysis suggests that exercise also increases the levels of hormones responsible for curtailing stress and boosting mood, while at the same time establishing new nerve cells and synapse flexibility.

In recent years, there has been increasing evidence that has shown that many functions of the brain are highly dynamic, or “plastic”, meaning that the brain is able to continually change in response to stimulus and experience. This flexibility is thought to be a key property in allowing the nervous system to support short-term and sustained changes in output, associated with learning and memory.

Other studies have shown that people with early dementia benefit from exercise. Again, the increased blood flow and oxygen to the brain helps improve memory and learning function.

So, getting the kids off the couch and onto the playground (no matter whether it’s a public playground or the backyard) can help children stay physically fit and mentally alert.

The Dutch researchers would like to see more high quality studies conducted in this area of investigation.

"Relatively few studies of high methodological quality have explored the relationship between physical activity and academic performance," they acknowledged. "More high-quality studies are needed on the dose-response relationship between physical activity and academic performance and on the explanatory mechanisms, using reliable and valid measurement instruments to assess this relationship accurately."

It’s a pretty safe bet though, that the more a family exercises together, the healthier everyone will be.

The findings are published in the January issue of the Archives of Pediatrics & Adolescent Medicine.

Sources: http://consumer.healthday.com/Article.asp?AID=660288 / http://www.sussex.ac.uk/aboutus/annualreview/2011/mindandbrain

Daily Dose

Flu Season Isn't Over Yet

Just when you least expect it, those nasty viruses can rear their angry heads and guess what, they seem to be back.This has certainly been a weird end of winter and early spring in our office. I have always been very protective of my newborns and try to keep them "isolated" from all of those terrible winter viruses and germs for the first six to eight weeks of the infant's life. Especially for those newborns born during the winter months. Because we are fortunate to live in a temperate climate, we have lots of sunny days in the winter which allows for parents and babies to get out for walks in their neighborhood and even strolls in the park.

Even so, many of the parents (and they say their babies too) are getting a little cabin fever and are ready to head out to the mall, church and restaurants (the list seems endless). All of these venues are all full of crowds, so it is a given that germs are lurking there. By this time it had seemed that flu was long gone in our area and we had not seen RSV for months. Just when you least expect it, those nasty viruses can rear their angry heads and guess what, they seem to be back? I saw several cases of Influenza B last week, and yes they were documented! I was so skeptical that I had the lab techs pull out the boxes of flu tests to just check for checking sake and what do you know?! At the same time I saw several cases of RSV and even had to hospitalize one infant due to respiratory distress, the first child I had hospitalized all winter! Even the hospital was out of the rapid screening kits that had not been used recently, so it took us a day to document RSV. I am happy to report that both the your-baby with RSV and the adolescent with the flu are now doing well. I guess the moral of the story is, we cannot always predict the "official" end of the winter viral season. So keeping infants isolated seems like a good practice for at least several more weeks, until it is hard to find a coughing, sneezing, feverish, person among us. By June it will be a memory until winter of 2009 - 2010 and unfortunately the cycle begins again. That's your daily dose, we'll chat again tomorrow.

Your Child

Kids Who Specialize In One Sport Have More Injuries

Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries.Because a child’s body is still growing, children who specialize in only one sport suffer repetitive injuries more often, a new study says.

In fact, kids are twice as likely to get hurt –playing just one sport- as those who play multiple sports said Dr. Neeru Jayanthi, medical director of primary care sports medicine at Loyola University Chicago Stritch School of Medicine. "We saw a pretty significant difference with this intensity of training, along with specialization," said Jayanthi. The findings are slated to be presented Monday at the American Medical Society for Sports Medicine annual meeting in Salt Lake City. Research presented at medical meetings should be viewed as preliminary. "It's been accepted for the last five years or so that kids who are not super-specific do better. They're cross-trained, so they're conditioned for other movements," said Dr. Kory Gill, an assistant professor at Texas A&;M Health Science Center College of Medicine. Jayanith’s research team had done earlier studies on 519 junior tennis players and found that the kids who only played tennis were more likely to get hurt. Jayanthi wanted to see if the same findings extended to other sports. "As a physician, you get frustrated seeing kids come in with injuries that keep them out for two to three months. It's devastating," said Jayanthi, who recently saw a young gymnast with a knee injury that will keep her off the mat for at least three months. Here, the researchers looked at 154 young athletes, average age 13, who played a variety of sports. Eighty-five of the participants came to the clinic for treatment for a sports injury, while 69 were just getting sports physicals. The investigation ranked each athlete on how specialized they were, basing the score on factors like how often they trained in one sport, whether they had given up other sports to practice just one, and if they trained 8 months a year or more to compete more than 6 months a year on one sport. What they discovered was that 60.4 percent of the athletes who had been injured were specialized in one sport, compared with only 31.3 percent who came in for physicals. Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries. Why did these injuries occur? "One reason is repetitive use of the same muscle group and stressors to growing areas, for example, the spine," explained Jayanthi, who stressed that the findings were preliminary. His team, in collaboration with Children's Memorial Hospital in Chicago, plans to enroll more athletes in follow-up research, and those athletes will be evaluated every six months for three years, to look more closely at how intense training can affect a young athlete's body during growth spurts. "Second is exposure risk," he added. "If you're getting really good at one sport, the intensity increases because you are getting better. People are developing adult-type sports skills in a child's body. The growing body probably doesn't tolerate this." Younger children -- those who have not entered high school -- tend to be especially vulnerable as their bodies are still growing, said Gill, who recommended that kids cross-train and condition for other movements, or just play another sport. "I tell parents to let kids be kids and play multiple sports," he said. "See what they're good at and what they enjoy." By high school, when bodies are more mature, specializing is safer, he added. When children play different sports in different seasons, they are using a wide range of motions and muscles. But when they begin playing one sport year-round, the risk of overuse injuries increases.

Daily Dose

Did Your Child's Holiday Present Come With a Helmet?

I wonder how many children received bicycles, skateboards, or roller blades for gifts over the holidays? I always ask parents and children during the course of their annual exams about riding bicycles etc. and the use of protective gear. The answers I get from the kids at various ages really make me laugh, as they don't always know the word "helmet", but talk about "the thing that I wear on my head". But for the most part the younger children use helmets, wrist guards etc. They are rule followers.

What I do notice is that as the children get older they are less likely to wear their helmets and the use of a helmet while bicycle riding or roller blading, skate boarding or rip sticking is a must, and is as important as buckling your child in their car seat or using seat belts. It is therefore incumbent on the parent to lead by example as well as enforcing the family rules to wear helmets. Use of other gear is great, but we do a much better job as doctors in fixing bones and lacerations than we do head injuries. Head injuries are usually accidental and therefore kids of all ages think it won't happen to them. But, unfortunately, head injuries do occur and they may be deadly. Every time your child gets on their bike etc, they must wear a helmet, and I am adamant that if they "choose" not to wear the helmet, then they cannot ride the bike or use the skateboard. If parents put the bike in time out until the helmet gets back on the head, we will be able to prevent tragic accidents. Lastly, with more children participating in skiing there have been reports of head injuries and many resorts are requiring helmets in children under 13. I think it is a good idea to start off the new skier with helmets and again make it routine. The best skiers on the mountain seem to be in helmets, so they know something. There have been several recent deaths in teenagers who were skiing or snow boarding and skied into trees and suffered devastating head injuries. Accidents are just that, unplanned occurrences. Insist that your children wear their helmets. That's your daily dose, we'll chat again tomorrow.

Your Teen

Early Puberty and Bone Health

1.50 to read

The normal rate of bone mass decline in adulthood is about 1 to 2 percent each year. This means that a 10 to 20 percent increase in bone density resulting from a naturally early puberty could provide an additional 10 to 20 years of protection against normal age-related decline in bone strength, according to the researchers.A new study suggest the earlier your child starts puberty, the lower the risk he or she will have osteoporosis later in life.

The research was based on 78 girls and 84 boys, who were studied from the time they began puberty until they reached sexual maturity. The investigators found that adult bone mineral density was influenced by age at puberty onset, with greater bone mass linked to early puberty and less bone mass associated with later puberty. However, bone strength did not seem to be affected by how long puberty lasted. "Puberty has a significant role in bone development," study leader Dr. Vicente Gilsanz, director of clinical imaging at the Saban Research Institute of Children's Hospital Los Angeles, said in a hospital news release. "During this time, bones lengthen and increase in density. At the end of puberty the epiphyseal plates close, terminating the ability of the bones to lengthen. When this occurs, the teenager has reached their maximum adult height and peak bone mass," Gilsanz explained. Reduced bone mineral density leads to osteoporosis, which affects 55 percent of Americans aged 50 and older. The normal rate of bone mass decline in adulthood is about 1 to 2 percent each year. This means that a 10 to 20 percent increase in bone density resulting from a naturally early puberty could provide an additional 10 to 20 years of protection against normal age-related decline in bone strength, according to the researchers. The study was published in the January issue of the Journal of Pediatrics. Pediatricians have long understood the role of pediatric bone development in osteoporosis prevention. The tween and teen years are critical for bone development because most bone mass accumulates during this time. In the years of peak skeletal growth, teenagers accumulate more than 25 percent of adult bone. By the time teens finish their growth spurts around age 17, 90 percent of their adult bone mass is established. Following the teen years, bones continue to increase in density until a person is about age 30. The need for calcium in the diet. Calcium is critical to building bone mass to support physical activity throughout life and to reduce the risk of bone fractures, especially those due to osteoporosis. The onset of osteoporosis later in life is influenced by two important factors: •   Peak bone mass attained in the first two to three decades of life •   The rate at which bone is lost in the later years Although the effects of low calcium consumption may not be visible in childhood, lack of adequate calcium intake puts young people at increased risk for osteoporosis later in life. Other foods, including dark green, leafy vegetables such as kale, are also healthy dietary sources of calcium. But, it takes 11 to 14 servings of kale to get the same amount of calcium in 3 or 4 8-ounce glasses of milk. In addition to calcium, milk provides other essential nutrients that are important for optimal bone health and development, including: •       Vitamins D, A, and B12 •       Potassium •       Magnesium •       Phosphorous •       Riboflavin •       Protein The role of physical activity in bone development. Weight-bearing physical activity helps to determine the strength, shape, and mass of bone. Activities such as running, dancing, and climbing stairs, as well as those that increase strength, such as weight lifting, can help bone development. For children and teenagers, some of the best weight-bearing activities include team sports, such as basketball, volleyball, soccer, and softball. Studies show that absence of physical activity results in a loss of bone mass, especially during long periods of immobilization or inactivity.

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