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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.

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

Spring Sports Injuries

1.30 to read

With the advent of spring the sport season heralds in baseball, softball, track and field.  This also means that kids need to be prepared to play.   

Professional ball players spend 4-6 weeks in spring training, preparing for the season, but for many kids the spring ball season starts without any real spring training.  Some kids have been less active during the winter, others may have been playing indoor sports, but with spring kids of all ages head outside to “play ball”.  Their bodies may not be quite ready for “full steam ahead” play.  

I am already starting to see both boys and girls coming in complaining of early muscle strains and sprains.  Kids need to get into shape with throwing, hitting, pitching and fielding increasing over time. But no one seems to understand “gradual” these days.  

Kids want to play ball and they may want to impress their coaches as well.  They are being watched to determine who plays which position, batting line up etc. which may make some athletes try to throw too much or too hard as they first start back. 

Parents (and coaches) need to encourage daily pre-activity warm up and stretching followed by light throwing to prepare the body to increase the activity and intensity over several weeks rather than days.  

Kids need to learn proper throwing mechanics which will not only improve efficiency but will control stress on the body.  The shoulder joint is held together almost entirely by muscles. Developing strength and endurance in the key muscle groups that keep the shoulder stable will help to prevent fatigue. 

The same goes for pitching.  Strict adherence to pitch counts, and well as following the recommended rest period between pitching will help to prevent overuse injuries as well. I have already seen a high school baseball player with elbow pain who admitted to me that he was pitching curve balls and fast balls, far over the number that he is supposed to. He does not realize the stress that he is placing on his body, and it is still very early in the season.  He was not thrilled that I told him he need a week off to rest before he started back and then much less aggressively. He has a few more years of high school ball before he even thinks about college baseball and needs to stay healthy. 

Remember to use ice as an anti-inflammatory as well as ibuprofen. And if shoulder or elbows already hurting, try a slower spring re-entry into throwing and pitching. 

There is an American Academy of Pediatrics policy statement on Baseball and Softball with some practical information for parents and coaches and officials.  Check it out at: http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2011-3593

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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.

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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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.

Your Child

Concussions May Last Longer in Girls

2.00 to read

New research suggests that girls who suffer a concussion may have more severe symptoms that last longer compared to boys.

No one seems to know why there is a difference, but other studies have come to the same conclusion.

"There have been several studies suggesting there are differences between boys and girls as far as [concussion] symptom reporting and the duration of symptoms," said Dr. Shayne Fehr, a pediatric sports medicine specialist at Children's Hospital of Wisconsin.

In his new study, Fehr also found those differences. He tracked 549 patients, including 235 girls, who sought treatment at a pediatric concussion clinic.

Compared to the boys, the girls reported more severe symptoms and took nearly 22 more days to recover, said Fehr, also an assistant professor of pediatric orthopedics at the Medical College of Wisconsin.

In the new study, Fehr tracked patients from 10 to 18 years old. All were treated between early 2010 and mid-2012. Each patient reported on their symptoms, how severe they were and how long it took from the time of the injury until they were symptom-free.

Girls reported more severe symptoms and took an average of 56 days to be symptom-free. In comparison, the boys took 34 days. Overall, the time to recovery was 44 days when boys and girls were pooled.

The length of time it took for patients to fully recover from concussion is quite a bit longer than people usually think.

"Commonly you hear that seven to 10 days [for recovery] is average," Fehr said.

The patient’s who were part of this study went to concussion clinics, so their injuries may have been more acute.

Fehr did not find age to be linked with severity of symptoms. Most of the injuries -- 76 percent -- were sports-related, with football accounting for 22 percent of the concussions.

The top five reported symptoms were headache, trouble concentrating, sensitivity to light, sensitivity to sound and dizziness. Boys and girls, in general, reported the same types of symptoms, Fehr said, but the girls reported more severity and for a longer time period.

Fehr will present the findings at the American Medical Society for Sports Medicine this week. Studies presented at medical meetings are typically viewed as preliminary until published in a peer-reviewed journal.

Whether it’s a boy or a girl that suffers a concussion, it's important to be seen by a doctor and not return to play prematurely, which can be dangerous or even fatal, according to the American Academy of Pediatrics.

Anyone with a history of concussion is also at higher risk for another injury.

Source: Kathleen Doheny, http://www.webmd.com/brain/news/20140410/girls-suffer-worse-concussions-study-suggests

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