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Concussions

Concussions & Young Athletes

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!

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Prevent a Concussion!

Prevent a Concussion!

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Sports

Sports Injuries

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

Daily Dose

Sports Drinks or Water?

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 just 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!

Your Child

Kids: Mouthguards For All Contact Sports

1:45

Youth sports participation has grown steadily over the years and so have injuries. The National Youth Sports Foundation for Safety reports dental injuries as the most common type of face and mouth injury kids experience in sports related accidents.

A new report issued by dental experts at the University of Alabama at Birmingham, says that mouthguards should be included in safety gear for all contact sports.  

Sports-related dental injuries send more than 600,000 people to the emergency room every year, the U.S. Centers for Disease Control and Prevention reports.

Most of these injuries involve the front teeth, but the tongue and cheeks can also be hurt while playing sports, the UAB team said.

The best way to protect the mouth and teeth during sports is to wear a mouthguard, says Dr. Ken Tilashalski, associate dean for academic affairs at the UAB School of Dentistry. Mouthguards have been shown to reduce the risk of sports-related dental injury by 60 times, he said.

"Wearing a mouthguard reduces the chances of tooth fractures, tooth dislocations and soft tissue cuts," Tilashalski said in a university news release. "The guards also protect against jaw fractures and concussions by absorbing the energy of a traumatic blow to the chin."

The American Dental Association (ADA) recommends wearing custom mouthguards for the following sports: acrobats, basketball, boxing, field hockey, football, gymnastics, handball, ice hockey, lacrosse, martial arts, racquetball, roller hockey, rugby, shot putting, skateboarding, skiing, skydiving, soccer, squash, surfing, volleyball, water polo, weightlifting, and wrestling. Other experts include baseball and softball infielders on that list. They further recommend the mouthguard to be worn during all practices and competition.

There are basically three types of mouthguards to choose from:

·      Stock: These are preformed and ready to wear, but they may not fit well inside the mouth.

·      Boil and bite: These may be customized and molded to the mouth by softening in boiling water before biting down.

·      Custom-made: A dentist tailor-makes these mouthguards to fit an individual's mouth. These mouthguards provide the best fit and the highest level of protection.

"For my kids, I have chosen to use custom mouthguards as they fit and feel better, do not interfere with speech, and are essentially invisible," Tilashalski said. "Mouthguards need to be replaced as they wear down, and athletes in the tooth-forming years will have to have these replaced more often as the mouth grows and the teeth change."

These mouthguards vary in price and comfort, yet all provide some protection. According to the ADA, the most effective mouthguard should be comfortable, resistant to tearing, and resilient. A mouthguard should fit properly, be durable, easily cleaned, and not restrict speech or breathing.

After each use, rinse your mouthguard and store it in a hard container to prevent the buildup of germs, Tilashalski said. Players should also avoid chewing on their mouthguard to extend its life.

It is important to remember damaged teeth do not grow back. Protect your child’s teeth by making sure he or she wears a mouthguard during practice, competition or just out having fun in a sport where falls are common such as biking, skating and skateboarding.

Story sources: Mary Elizabeth Dallas, https://consumer.healthday.com/dental-and-oral-information-9/misc-dental-problem-news-174/mouthguards-key-defense-against-sports-related-injuries-716284.html

http://www.nationwidechildrens.org

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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