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Your Child

Young Baseball Pitchers Playing With Pain


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,

Your Teen

Cheerleading Still Most Dangerous Sport

Cheerleading continues to cause more serious and deadly injuries by far than other sports.Cheerleading continues to cause more serious and deadly injuries by far than other sports, despite the fact that safety efforts have led to modest reductions in the number of serious injuries in recent years. However, until recently, records about such injuries were poorly kept. An updated to the record-keeping system last year found that between 1982 and 2007 there were 103 fatal, disabling or serious injuries recorded among female high school athletes, with the vast majority, 67, occurring in cheerleading. The next most dangerous sports were gymnastics, with nine such injuries and track, with seven injuries.

Recently the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill released its annual report on the topic. The report defines catastrophic injuries as severe or fatal injury incurred during the participation in the sport. The new numbers for 1982 to 2008 showed that there were 1,116 catastrophic injuries in high school and college sports. Cheerleading accounted for 65.2 percent of high school and 70.5 percent of college catastrophic injuries among all female sports. The report, however, shows that cheerleading injuries fell slightly in the 2007-2008 academic year. “Progress has been slow, but there has been an increased emphasis on cheerleading safety,” said the study’s author Frederick O. Mueller. “Continued data collection on all types of cheerleading injuries will hopefully show that these safety measures are working to reduce injuries.

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!

Your Child

Kid’s Severe Injuries linked to BB Guns, Paintball


A new study says that Paintball, airsoft and BB guns are responsible for causing severe and sometimes life-threatening injuries in children.

"The popular conception is that they are toys," said Dr. Nina Mizuki Fitzgerald, the lead researcher and a pediatric emergency medicine fellow at the University of Texas Southwestern Medical Center/Children's Health in Dallas. Not so, she said,   "Injuries can be extremely severe and [children] can have long-term deficits."

Fitzgerald and her team evaluated medical records of children seen at Children's Medical Center Dallas of non-powder gun accidents between 2010 and 2015. In all, 288 children, average age 11, were treated for the gun injuries, more than three-quarters of which involved a BB gun.

About one in four children had to undergo surgery for the injury. Nearly 45 percent had a foreign body injury (such as the BB). About 15 percent were hospitalized. In addition, one in 10 had a functional deficit that interfered with daily tasks, and the overwhelming majority of those were eye-related. Seven children had an eye injury so severe surgeons had to remove the eye, the researchers reported.

"The biggest take-away for parents is that kids should always be supervised when using non-powder guns," Fitzgerald said. And children should always wear eye protection, she stressed.

BB gun pellets often leave a small puncture mark, giving the impression that there is only a minor injury. But Fitzgerald warns parents that these injuries may need medical attention. "There may be a tiny puncture mark, and it doesn't look bad at all. But they can have severe internal injuries," she explained.

The study results are not surprising because they build on previous research that found the same, said Dr. Roberto Warman, director of pediatric ophthalmology at Nicklaus Children's Hospital in Miami. He has seen many such eye injuries in his years of practice, and recalls having to remove eyes that could not be saved. One child was only 3 years old, he added.

With paintball, kids may think the game is over, take off their eye protection, only to be shot by another child who hasn’t finished the game or shoots one last round. Collecting the paintball guns and then the goggles could help reduce that possibility, he suggested.

While some doctors think these activities should be banned for young children, others think education is the key to fewer accidents.

While it’s easy to think of these objects as toys, they are not. Experts agree that parents need to be informed that their children must wear goggles during the gun play and need to be supervised at all times.

Fitzgerald will present her findings at the American Academy of Pediatrics meeting in Washington, D.C. Studies presented at medical meetings are viewed as preliminary until published in a peer-reviewed journal.

Source: Kathleen Doheny,

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kids sports injuries

Young Athletes & Injuries

Your Child

Sports Variety Recommended to Avoid Overuse Injuries


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:


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Sports Injuries

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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


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