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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

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

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

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?

 

Daily Dose

Sledding Accidents

Over 20,000 children were seen in the emergency room for sledding accidents. how to keep your kids safe while still having fun.With another major snowstorm hitting most of the East Coast and blanketing the south in ice, it seems like there will be several more “snow days” with children (and their parents) home from school.

I have such fond memories of growing up in Washington, D.C. and the idyllic “snow days” spent outside with our Radio Flyer sleds.  My brother and I would head out the door for the big hill right outside of our house which would become a mecca for the sledders. The street was fairly steep and for that reason was often closed (guess they didn’t make 4 wheel drive vehicles then?), and the hill was perfect for a fast ride that was probably ¼ mile long. The ride down was glorious, the trek back up seemed VERY long.  Those were the days!  We could spend hours out there, only coming in long enough to change out of wet gloves, grab a hot chocolate, and back out we went. I must say, most of the time there was very little adult supervision, and thankfully there were no “major” injuries that I recall. With those memories in mind I decided to do a little research on sledding safety and accidents. An article in the September 2010 issue of Pediatrics reviewed sled related injuries.   Did you realize that there were over 230,000 sledding injuries reported over a 10 year retrospective period, in other words more than 20,000/year and those were only those that were seen in emergency rooms. There were probably many more that went unreported as the child was seen in an urgent care, or private practice rather than ER. Children 10 – 14 years of age were in involved in 42.5% of sledding related injuries and boys represented about 60% of all cases.  WOW! Sleds can reach speeds of up to 20-25 mph and head trauma is one of the biggest concerns.  It is reported that the head was the most commonly injured body part (I feel lucky that I survived those sled races) and that injuries to the head were twice as likely to following a collision. Children 4 years of age and younger were 4 times more likely to sustain a head injury. Other injuries reported from sled related accidents included fractures, contusions and abrasions.  In this study about 4% of cases required hospitalization and of this number nearly half were due to fractures while about ¼ were due to traumatic brain injuries. The injuries were more common when toboggans, snow tubes or discs were used than with traditional sleds that have a steering mechanism. Another interesting finding was that many of the injuries occurred due to the fact that the sled was being pulled by a motorized vehicle which resulted in more collisions. As you well know, the advent of helmets has really helped to prevent injuries from biking, and helmets are now recommended for sledding, skiing and snowboarding.    A report from the consumer product safety commission showed a 58% reduction in head injuries among children less than 15 years of age after helmets were used for skiing and snowboarding. As more and more people wear helmets for these activities one would hope to see a decrease in injuries reported from sledding. To ensure safety while sledding make sure that there is parental/adult supervision at all times. Sledding on streets should be discouraged and never sled where a hill meets a pond which may not yet be frozen. Sledding slopes should be free of tress and other obstacles that might cause collisions.  Children should sit up and face forward and never sled head first. Sleds should never be pulled by a motorized vehicle, which includes a snow mobile.  Sleds with the potential to rotate like discs (I guess that is the flying saucer of old) and snow tubes may carry significant risks, and should be discouraged. With 49 of 50 states currently reporting have snow “somewhere” on the ground make the winter sledding safety a priority and go buy a helmet and have fun. That’s your daily dose for today.  We’ll chat again tomorrow. Send your question or comments to me. I would love to hear from you.

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