My high school daughter left for school the other day in her sneakers. If it weren’t for the fact that our driveway is a bit of a hill and we’re surrounded by mounds of snow, and the day before were slammed with 6 more inches of snow and an ice storm significant enough to close school for the afternoon and evening I’d think nothing of it. I’m not entirely sure, to be honest, how she made it up our hill, down the next hill to the bus stop or traversed around her open campus school that day…but she did!

I asked her about her footware decision when she arrived home later that day. She was honest about her choice. “It boiled down to function vs. fashion”, she told me with a smile. “My boots would have been better for the ice but simply didn’t match my outfit. The sneakers were truly the only choice. You know how that goes.”

Thinking as an adult, boots seemed like the best option. However, having been a teenage girl, I saw her point. However, as an adult, the boots truly were the better option…and the safer one for the cold, the ice and the snow. It occurred to me that if I didn’t handle the situation in a way that resonated with her teen sense of style, the sneakers would win out next time, too.

So, this is how I responded:

“I see your point. Boots wouldn’t have worked with that outfit. Perhaps next time we have an ice storm you could consider a more boot-appropriate outfit so you don’t slide into a building or down the hill into oncoming traffic?”

Then I added: “Remember, your sister ended up with a whopping case of frostnip a few years back when we went skiing wearing ski boots and the proper socks. And, those toes still bother her today when it’s really cold outside.”

Without us locking horns or having a big fight, she’s been wearing her boots again. With teens, it’s all in the approach and once in a while us parents luck out in how we accomplish that. This time, I got through and won the boot battle sans battle.

It’s tough to get kids to wear winter-appropriate garb, The best approach is to help them understand from a young age why the weather can be dangerous and that we’re not just being parental nags when we force upon them all these clothing rules. Use books, the internet and other adjuncts to teach them why you are doing what you are doing so they have a frame of reference. It helps kids to know there’s actual fact behind our edicts. And, it helps if we practice what we preach. We can’t very well expect our kids to don their finest winter grab if we don’t do the same.

Fashion is seasonal. Sometimes we have to be the ones to remind our kids of that – and be strong enough to enforce it. They might not “feel cold” but we have to remind them that there’s a reason that cold weather shelters open during cold advisories and recess gets cancelled. Even ski slopes issue advisories and shut down when necessary.

Function or fashion? Sometimes you can have both but when it comes to weather safety, function has to win out, all the time.

(Image: http://www.shoes.com/ProductImages/shoes_iaec1230091.jpg)

Today’s school backpacks are an amazing amalgam of fashion and function – with sometimes a dash of technology as many seem to come either prewired for ear phones or with a special place for them.

As our kids move through elementary school and beyond, the look of this bag becomes as important as what is inside – and perhaps even more so. Today’s backpacks remind me of Hermione Granger’s purse – they all seem to hold an endless array of stuff. The thing is that pile of necessary stuff packs on the pounds setting the state for a lifetime of back woes…unless we change the equation starting today!

Backpack’s are one of the leading causes of injury to children with more than 7000 children injured last year due to overloaded backpacks according to the U.S. Consumer Product Safety Commission. Back experts recommend that backpacks weigh no more than 10-15% of a child’s weight but many kids carry at least 20% of their weight. The type of injuries caused by backpacks are more varied than you may realize. The most typical injuries are shoulder and back strain from improper backpack use and overloading. Shoulders and backs are not the only part of the body at risk from backpacks, however. Many children each year actually injure their feet, toes and legs from tripping over heavy backpacks put on the ground to give their owner’s backs a break. Head trauma and lacerations have also been reported from children using their backpacks as impromptu balls. Backpacks indeed put the entire body at risk.

Helping our children not only choose a proper backpack but wear it correctly will dramatically reduce a child’s chance of injury. Leading orthopedic experts agree that most back and shoulder pain in children is avoidable by simply wearing the backpacks correctly and resisting the temptation to sling the back from one shoulder. Additionally, the straps should hold the bag close to the body fairly snugly. Spreading the contents throughout all the compartments will help distribute the weight more evenly in the bag but in the end it’s the overall weight that matters.

Just like with clothes, backpacks are actually sized. Just like we would never have our children wear adult sized shoes, we need to be careful they are not hauling adult size backpacks. In addition to the weight of the actual pack, a fully loaded backpack may end up weighing more than your child!

True outdoor stores such as LL Bean and Eastern Mountain Sports, as well as popular retain stores, have backpack lines designed just for children and teens but similar lines. So, before you pull out your wallet and head for the cash register, check the tag of the backpack to make sure it’s designed for your child’s age.

What features of a backpack should you look for beyond the age specifications on the tag?

• wide shoulder straps with one for each shoulder so the bag’s weight can distribute evenly over the child’s back and not place too much strain on any one shoulder joint.
• Padded backs and waist straps to help distribute the load in the bag more evenly.
• Wheels: while many kids refuse wheeled backpacks these are the best way to avoid strain on the back. However, these are only a good option if your child’s school is on one floor.

Keep in mind that part of the issue is the amount of material our kids need to trek to and from home each day as well as to each class. The school day doesn’t seen to allow kids to return to their lockers easily so many end up lugging a heavily load all day long…and on one shoulder!

Keep in mind that while most backpack injuries are weight and use related, some are due to tripping over packs put on the ground. A few kids a year do break toes and sprain ankles and wrists from tripping over heavy backpacks put on the ground to give their wearer a much needed break. The solution for this is for kids to not only pay more attention to where they are walking but for kids to pay more attention to where they leave their backpacks…at least until we collectively fix the weight problem.

So, as you embark on back-to-school shopping, add backpack fitting to the list and have kids try a few on for size and comfort. In the end, your child will find a backpack that provides the fashion statement they desire with the safety and fit features you know they need.

(Originally published 2008; updated 8/22/2011)

Looking for some homework helpers for the new school year? Here’s a list in progress of sites that have helped my kids over the years.

Ask For Kids

Great search engine for kids of all ages.

Ben’s Guide To US Government For Kids

Huge assortment of topics and web sites for fun and learning.

Fact Monster from Information Please

True fun with learning for teens and tweens.

FirstGov for Kids

Government Sponsored Web sites on oodles of topics. You name it, you’ll find it here.

High School Ace

Homework helper for High School students.

Homework Spot

Great site for older elementary school and middle school students.

KidSpace

Online Library for Elementary School and Middle School students from The Internet Public Library.

Teenspace

Online Library for Teens from Internet Public Library.

Kid Info

Has sections for younger elementary school kids and older kids on every topic their school covers.

National Geographic for Kids

Everything adults love about National Geographic done kid-style! Covers many nature and social studies topics.

Reading Rainbow

Targets ages 4-8. Has games, family activities and ideas to help your young child learn to love reading.

Refdesk.com

Online reference desk for kids of all ages.

Time For Kids

Great for older elementary school and  middle school students. Covers world news appropriate for kids in a way they can understand.

Yahooligans – web guide for kids

As a new school year is about to begin, I’m reminded of a conversation I had with my oldest teen once she began high school:

“Hey mom”, my 15 year old said as she walked in the living room with that ‘I’ve been thinking about my life’ look that teens get once they enter high school. “How much homework did you have when you were my age?”

“This could potentially be a trap”, I thought. “Answer carefully”, I told myself.

“Well…,” I began cautiously, trying to read the look on her face – trying to see if she was just curious or about to have a HUGE stress out moment because of having too much homework that night.

“It does seem like you have more homework than Daddy and I had when we were in High School. But…our afterschool lives were also not quite as full.”

She gave me a blank look before responding.

“I think we have too much homework and we need more time to be kids. You and Daddy tell me that you and your friends used to do things and have time to hang out on weekends and stuff. My friends and I don’t have that. We even have tons of homework on weekends. THIS – IS – JUST –WRONG!!”

Then she added: “THEY…”, she pointed to her book bag, “ are stealing are childhood!”

I didn’t say anything in response just yet.

“So”, she continued. “Do you think we have too much homework? Do you think our childhoods have been stolen?”

I didn’t want to freak her out, but the truth is I did think she was right and knew the data supported her observation. So, I simply replied. “Times are different today but I have to agree the homework seems excessive. Perhaps there’s a way you and your friends can look into this and see if so much homework is needed.”

“That’s a great idea! Our Principal seems like a really cool guy. We’ll do some research.”

With that, she left, seeming more at ease.

In truth, our kids have much more homework than we had, as well as more overloaded afterschool lives. How much more homework? About 50% more!

Kids need a balance of education, extracurricular activities and free time. Since we were kids, so much attention has focused on programming their lives that no room has been left for our kids to water their own childhoods and to grow them in the direction of their choosing.

We live in a time of excess and the concept of moderation has flown out the window. Our kids can’t keep having every aspect of their lives pushed to the max: homework, afterschool activities, school sports.

TIME Magazine ran a very interesting article on The Myth About Homework that not only echoes my daughter’s concerns but tosses out some intriguing solutions, such as homework limits. The article points out what I’m seeing in my daughter, her friends and teens nationwide: the push on homework is actually backfiring – our kids are getting burned out and turned off to learning.

So, it’s time we support the movement my daughter and so many other teens nationwide are demanding in their lives. This is their childhood and they deserve time to explore more than just books and word problems.

BTW, the data is on the side of the teens with this one. More free time is exactly what their lives need for better learning…and better health!

Do your tweens and teens feel their childhoods are under attack either from too much homework or too many activities…or any other reason? If so, you are very much not alone. There is a solution – speak up in your communities so we can stop the clock on this madness.

My family has a tradition of getting all our back-to-school shopping completed just before our big end of the summer vacation. Lunch boxes used to be big ticket back to school items but since my girls are tweens now, as Hilary Duff once sang, “that’s so yesterday”. Plus on most school days we’re lucky if their lunches make it from the frig to their backpacks!

If only the choice of what to have for lunch these days were as easy as whether to brown bag it or have a fancy lunch box. With the confusing food pyramid and ever changing food guidelines coupled with school days that barely allow for time to eat lunch, it is truly a challenge to get kids a proper lunch.

Let me give you a preview of what’s about to come: don’t view nutrition as one meal but view it as a group of meals that balance out together and function like a bank; lunch may very well be the new breakfast, meaning our kids most important energy meal.

Some Thoughts To Ponder

As my kids have gotten older, I’ve realized that helping my kids eat healthy is a balance between offering healthy foods, giving them control of some of their meals, and helping them learn to incorporate the less healthy foods with the healthy foods. Concerning lunch specifically:

1. Given how much of their day is decided by others, especially at school, I give my kids total control over what they have for lunch among the foods we have at home.
2. I’ve started to realize that lunch is not just a meal in a day but a meal that has to get my kids through the entire day including learning and after school activities. It is perhaps their most important energy meal when viewed this way.
3. Fruits and veggies are crucial to their overall growth but don’t always get that energy jolt needed to learn.  So, I tend reserve fruits and veggies for dinner and after-school snacks and add more carbohydrates like pretzels and granola bars for lunch and in-school snacks.  The energy they provide lasts longer for my girls.
4. It occurred to me that getting through a school day is like a mini marathon for my kids but involving both body and mind.  Just like with a marathon, hydration becomes as crucial as energy. So, I’ve put more emphasis on what they drink during the day and how much.
5. When my kids have a sugary snack occurring at school, we don’t pack a snack that day or pack veggie sticks but leave lunch untouched. Lunch needs to happen as planned to learn well.

Kids and Food: The Big Picture

These concepts that have helped me, can work for your kids, too. In addition, you have to remember that kids have simple tastes hence why kids menus have the same 5 foods on them regardless of the restaurant! And, unlike us parents, kids can truly eat the same meal every day without getting bored. I swear my youngest daughter will one day become a ham or waffle!

As I mentioned earlier, considering lunch in the big picture of your child’s overall nutrition is really helpful.  The government’s new food pyramid (www.mypyramid.gov) gives a great visual description of what kids should eat during the day but it can be overwhelming. I know my kids don’t come anywhere close to what the pyramid suggests for a given day but their nutrition is fine if I take into account what they eat over the course of a few days.  So, if one day has more carbohydrates or fewer fruits, I help them make-up for it the next day. If one day has an extra treat built in, we skip dessert.

Your Kids Food Bank

Give and take, and balance. Those are the ultimate ingredients to success. Each meal has its own role in a child’s day. Breakfast jump starts our bodies after a long sleep. Dinner helps us refuel after the afternoon of physical and mental work and gives us fuel to keep our bodies going while we sleep. Lunch, on the other hand, has to catch us up from the morning and get us through the afternoon until dinner. A lot is being asked of our kids through the day, and lunch has to meet all those needs, including physical growth.  In many ways, breakfast and lunch need to be a bit more carbohydrate slanted and snacks and dinner more balanced with fruits and vegetables.

Lunch is tricky because of not only how brief it is in most schools but because of how important it is. Kids have to make up from energy lost from the morning and store energy for the afternoon, and eat it in about 10 minutes. Pre-cut fruits and vegetables and even prepackaged items such as the new 100 calorie packs are very useful for both purposes. The 100 calorie packs also visually teach portion control which is very useful for prepubertal and early pubertal kids who are primed to gain weight entering puberty. Using these items may not seem healthy to you but it’s what the kids like to eat and what they see their friends eating.

Sandwiches tend to be the best way to get grains and proteins done all at once and are easy to eat quickly. Kids tend to not like the taste of the real grainy breads so try the grain or wheat breads that look like white.   My kids can’t tell the difference.

Finally, for hydration with lunch, my choice is water. Kids don’t get enough during the school day and while I understand that school nutritionists view lunch as a way of getting calcium into our kids we can do that at home. What our kids need is water and more of it during school.

My kids hate buying lunch at school but I know many kids who love school lunches. The problem is school lunches are not always as balanced as they should be. On days your child buys lunch, plan dinners higher in proteins, fruits and vegetables and less in fats and carbohydrates to balance out the day better. Be sure you ask your kids specifically what they had for lunch if they buy to help you plan meals better.

Finally, no school year would be complete without the birthday treats and special events but that extra sugar load need not derail our child’s nutrition train. You can plan a healthier lunch the day of the treat or the next day to balance out the extra treat. Or, just skip dessert with dinner that night. I’m a believer that our kids can have a daily treat once a day but if it happens at school, then it doesn’t happen after school. This is how our kids learn to incorporate the sweets into a normal diet without adding pounds.

Making Deposits and Withdrawals

Clearly lunch will provide the most benefit if the remainder of your child’s meals are healthy.  Kids need breakfast  and skipping it is akin to trying to start a car without gas.  At the end of a day, kids need a healthy dinner, preferably with the entire family as studies demonstrate huge value to kids for the family meal and time together around the table. It fuels their souls! This may not be logistically possible if parents work late or kids need to eat earlier, but have a consistent time all of you are around the table. Perhaps breakfast works better for your family or dessert.

In addition to healthy eating, regular exercise has to be a priority. After sitting in school all day, kids need to burn off steam and have some unstructured time.  You don’t need a gym or organized sport. Just playing outside and regular walks together as a family can go a long way to staying fit. When I was a kid, my dad and I would go for a walk after dinner. Exercise and family time all wrapped into one – and calorie free!

What about weekends? Most weight experts and programs advocate a 5:2 plan for staying on track and this can work for families, too. You stay on track Monday through Friday with healthy eating and exercise but loosen the reins on weekends.  This is when most families eat out or order pizza. There is nothing wrong with indulging once in a while if the remainder of your week is healthy with food and exercise. If our kids learn this now, they’ll have it well ingrained by the time they are on their own.  But, even on weekends, lunch is still the pivot meal. You can’t skip it just because you are having a bit dinner that night. Eat lighter but still eat lunch.  It is that important.

Lunch: the new breakfast

So, breakfast, watch out, there’s a new meal in town, that may very well be more important than you are.

Here’s to a wonderful school year with new horizons and healthy choices…and perhaps even time for our kids to eat their lunch.

(Originally posted August 2007; Updated September 2011)

It seems the fashion industry doesn’t realize we still have a good half the summer to go! Everywhere I go there are reminders that another school year is around the corner. Although we’d all rather block this from our brains, it’s actually not such a bad idea to at least get into a quasi-back to school state of mind. Doing so will help you and your kids considerably once that first day of school does arrive.

Since the last school year ended, we’ve been on a diametrically opposite schedule from what we live when school is in the mix in just about every way:

• Sleep: Sleep tends to be more free in the summer with later bed times, wake up times and no set schedule.
• Nutrition: Fruits and veggies may be more abundant but people also indulge on more ice cream and treats at barbeques they don’t often eat at other times of year.
• Exercise: Many kids are either not in camp, in “indoor” camps or in sports camps that focus on just one sport and not overall fitness, so kids are actually less active in the summer than in the past.
• Activities and Hobbies: Most kids put on hold the activities they pursue rigorously over the school year – music, art, even some sports.
• Reading: Many schools have reading expectations for the summer so most kids do read each summer.
• Technology: For most kids, especially tweens and teens, they’ve had much more use of technology over the summer than in the school year and likely without the oversight that you’d normally have over the school year.

Making small tweaks now in all these areas will help ground our kids and give them the energy they need to stay on top of school and the increased demands they’ll feel.  To nudge your kids back to tip, top school shape, try these ideas out:

• Sleep: You can change your kids’ biological clocks from summer to school  by moving them to an earlier bedtime and having them wake up with an alarm for at least 3-5 days before the first day of school. The more time their bodies have to adjust to the new time, the better they will feel when they have to do it every day – and the easier it will be.
• Nutrition: In addition to needing three meals a day, kids eat healthier when they help make meals. Try that out this month and then continue it in the school year.
• Exercise: Growing kids need daily exercise, even if they play team sports. And, kids who play sports need a break once in a while or they risk overuse injuries. The goal is 30 minutes of moving a day. If you can get that in for your kids, they’ll feel great and their bodies will benefit.
• Activities and Hobbies: The best rule of thumb is to slide into the school year and see what the work load is like before adding too many new activities, especially if activities are already in place from last year. And, to remind your child it isn’t the end of the world to try something new and drop it if they don’t like the activity or it’s too much for their schedule.
• Technology: Whatever your usual technology plan is for the school year, now is the time to regroup on that and revisit expectations that make sense once homework kicks in. I’ll have more on this soon so stay tuned!

If you enjoy today while being realistic about tomorrow, tomorrow can be enjoyed much more, even if it is the first day of school!

A high school friend posted on Facebook recently that her 11 year old son noticed a Cialis add during a football game and asked about it. Remind us all to thank the sports world for introducing these fun concepts into the minds of our very hormonal tweens and teens!

Not sure how to respond, she did what most parents do these days…turned to her Facebook friends. We offered up our usual sage advice after which I was reminded of a post I wrote a few years ago after we took our kids to see the movie, The Pink Panther, when my oldest daughter was 12. That was 4 years ago now. A similar “male enhancement pill” question emerged in our family and here’s how it unfolded:

We took our kids to see Pink Panther a few weeks ago. What an enjoyable family day! My husband and I laughted hysterically with the “middle age magic man pill” scene, and breathed a huge sigh of relief with neither of our daughters, ages 12 and 10, asked what it was. Kids don’t miss a beat, though, so we wondered if the other shoe would drop.

It did…4 weeks later. Our 12 year old started joking with my husband about “the middle age magic man pill”, just plopping it in conversation assuming we’d laugh as we did in the movie. He asked her what it was and she gave him a blank stare and walked away. The next  day she asked him what it was and he pulled a typical dad –puberty move: sent her to me. He gave me a heads up and I figure I have about a week before she’ll come to me wondering what this “middle age magic man pill” is about. By then, she will have learned “reproduction” in 5^th grade science and my goal is to have a simple conversation that builds from there. In other words, I’m going to talk about biology and that sometimes biology needs a little help because it’s complicated.

Puberty has to be the most difficult topic to address with kids but it is important to be straightforward. I do not believe talking about sex promotes sexual exploration – in fact, just the opposite, it promotes safety and smart thinking. I also believe that talking about these issues helps kids understand that they are biological and do sometimes need medical intervention. That will help our kids when they get older should they have any sorts of issues with their reproductive systems.

Even  good kids get themselves into pickles where hormones are concerned. What good do we do them if we go nuts as they figure out what those hormones mean? It’s our job to help them sort this out. It’s our job to be clear minded and remember that at young ages they are just curious about the biology. Let’s not make it more complicated than it already is!

So, if your kids ask you about any of these “male enhancement” pills…don’t freak. Just calmly explain what they are for and move on. Remember, kids just have inquiring minds and are just inquiring. Your job is just to respond back with your best poker face and hope for the best!

Besides, who would you rather answer this intriguing question for your kids – you or your spouse, your your child’s equally clueless friend or the internet?

I was away this week when Glee’s “Never Been Kissed” episode first aired. Being a huge Bon Jovi fan, my 13 year old daughter couldn’t wait for me to get home so she could watch the episode again with me. “You’re going to love it!”, she told me. “But, there are some surprises in the episode…so I should warn you.”

So, we plopped on the couch and got into our watching positions.

I had heard mixed reactions on Twitter about the “Stop Me Up/Livin’ On A Prayer” mash up but I really liked it. After all, this is Glee and they tend to put their own twist on our favorite tunes – which is what we want them to do. To just resing an artist’s song would make the show into a fancy version of video karyoke. One of the pluses of Glee is watching the reinvention of songs many of us either grew up with or have had a long standing relationship with from artists we’ve been following for a long while.

My daughter seemed pleased that I liked the mash up. Being the true Glee expert in our house, that could have made watching the remainder of the episode sticky at best!

It was clear, though, that the episode was truly about Kurt. After the second or third shove into the lockers, my daughter said to me “get ready  – something shocking is going to happen. I wasn’t ready for it the first time I saw the episode. Didn’t see it coming at all!”

When Kurt was kissed by that lug of a football player, my daughter simply turned to me and said: “I told you – shocking.”

I agreed with her – the kiss was a twist to the plot and something not often seen on prime time teen TV but it was not “shocking”. In fact, I explained to her it made complete sense.

“It’s so hard for kids to be different today or feeling different from other kids in their peer group. Discovering you’re gay or lesbian is one of the biggest feelings of “different” there – at any age. I know so many people who truly, truly struggle with this.

The thing is…we often think of bullies as bullying because they are scared of people who are different from themselves but just as often they bully because they are scared of those people being the same. That’s what’s happening here. This football player is supposed to be this macho guy and instead has discovered he’s gay – that’s not easy. So, he’s pisssed off and instead of embracing it and seeking people to turn to, he’s rebelling and actually punishing those he’s attracted to. Not healthy at all but that’s what some bullies…some people in pain…do.”

My husband, who was in the room by now, nodding in agreement. This is tough stuff for young kids. But, we both felt the episode truly drove a very challenging point home about teen life and bullies home in a very well done way – a way that teens, even young teens, can understand.

Teens learn best about tough topics when they have a frame of reference. Shows like Glee provide that for us – they give us a much needed foot in the door with our own teens on some very challenging topics.

If you’re looking for additional talking points from this past week’s Glee episode, here are a few that can help you with your own teens:

1. Bullies don’t always bully for the obvious reasons – it’s important to uncover the true reasons. In this week’s episode, the football player wasn’t just being a bully, he was actually gay and struggling with that himself. He needs help as much as the person he’s victimizing because he’s in a lot of pain, too.
2. Teachers must intervene more than just talking to the victim and asking if they are ok. Mr. Schu gave Kurt too much credit by just having a chat and leaving it at that. True intervention has to involve stopping the bully and holding the bully accountable for his or her actions. That wasn’t done for Kurt at his own school and we heard from Blaine a similar experience at his old school. That’s simply wrong. Sadly, that’s also what’s occurring much, much too often.
3. Bystanders, students and teachers and others, must do something if they see the bullying occurring. To not step in is to be a type of bully – it’s bullying by association. By not protecting the victim and ignoring the problem, the bystander is as guilty of bullying the victim as the bully because it perpetuates the cycle. So, all those friends of Kurt who saw him getting slammed into those lockers were part of his bullying, too, and fed into his pain. For them to truly help, they needed to either stand up to the bully for him or get a grown up to help.

Glee is planning to cover bullying throughout this season so I’ll be intrigued to watch and see how the continue to cover this complicated and important issue with other school groups and with teachers. So far, they are off to a fantastic start – people’s eyes are opening and conversations are starting. I’ll continue to watch, too, and offer my 2cents, insight and talking points to help you talk to your kids.

If you saw this week’s episode, what did you think? What did your kids think? Let me know. The more we all talk and share, the better off all our kids will be.

Image sources:

http://cdn04.okcdn.okmagazine.com/wp-content/uploads/2010/11/Chris_Colfer_Glee_Nov10.jpg

http://www.projectqatlanta.com/news_articles/view/gay_for_glee_lesbian_sues_feds_illinois_unions?gid=6741

As sure as the sun rises and sets every day, resistance from sports parents and young athletes with return to play recommendations, especially when it comes to concussions, is something I’ve come to expect in my work as an urgent care pediatrician. This is one of the biggest uphill battles we face as pediatricians but one we can’t afford to lose without resulting in dire consequences for an athlete and a family.

For concussions, Boston Bruin’s Patrice Bergeron’s story and his cautious, step-wise slow return to play when he returned to the ice in early 2009 the exact play book we need to follow when handling concussions in athletes of ages, and is consistent with current recommendations from the American Academy of Pediatrics as explained in the January 2009 Pediatrics with a hot off the presses Clinical Report released in the September 2010 Pediatrics.

Bergeron sustained his second concussion on December 20, 2008, the having occurred on October 27, 2007 after playing only ten games during that season. On January 4, 2009, two weeks post-injury, Boston Bruins General Manager Peter Chiarelli reported that Bergeron was starting light exercises because his symptoms were progressing well. Bergeron continued his slow, step-wise return to play until his return to the ice January 11, 2009 but was not cleared to play a game until January 27, 2009. His health was the driving factor; not playing in a game.

The currently accepted, step-wise return to play protocol involves starting with rest and progressing slowly as follows:

Step 1: No activity with rest.

Step 2: Light aerobic activity

Step 3: Sport-specific exercise

Step 4: Noncontact drills; progressive resistance training

Step 5: Full contact training after medical clearance

Step 6: Game play

Like with Bergeron, we have to be very cautious with concussions in young athletes and follow a similar plan. Returning to play too quickly and skipping steps can result in either catastrophic neurologic events resulting in permanent issues or death. In addition, we must recognize that one concussion increases the chance that more concussions will occur. We must recognize that the symptoms of a concussion are variable and can be as obvious as headache and loss of consciousness to as subtle as feeling “out of it” or being moody. We must be realistic that most athletes fail to report their own symptoms in order to keep playing, putting them in harm’s way. And, we must be willing to recognize when a player has had too many concussions to make some sports safe to play at all. This is where a medical team and neuropsychological testing can be very helpful.

Parents and coaches need to be educated on this step-approach to concussions, but so, too, do the athletes if we are to keep our teams truly safe. Everyone needs to be on board with how the system works and why youth sports teams need DL’s just like the pros. For the players, it is imperative that they understand that a concussion is a guaranteed, nonnegotiable spot on the DL. They each only have one lifetime brain; this is the only way to keep that brain safe and healthy during high risk sports.

Put another way, playing one more game in the setting of a concussion is like playing Russian roulette. So ask your self, is the risk really worth it?

(Originally posted March 2009; Updated September 2010)

]]> http://www.pediatricsnow.com/2010/09/concussions-in-kids-lessons-from-the-pros/feed/ 0 http://www.pediatricsnow.com/2010/08/back-to-school-tips/?utm_source=rss&utm_medium=rss&utm_campaign=back-to-school-tips http://www.pediatricsnow.com/2010/08/back-to-school-tips/#comments Wed, 11 Aug 2010 18:25:44 +0000 DrGwenn http://pediatricsnow.com/wptest/?p=96

Preparing for a new school year is always challenging, and always catches even the most organized of parents off guard. In the blink of an eye, summer is over and we’re in school mode again – just like that!

Before you panic, keep in mind that you don’t need to organize the entire school year right now.  To help you get organized, just think

“BACK TO SCHOOL”!

Breakfast of Champions!
Activities
Cell Phone Rules
Kid Time
Texting & Sexting, and the Internet
Oh my aching back!
Sleep
Come To Dinner
Health Check
Outdoor Time
Organization & School Work
Lunch Plan

Breakfast of Champions!
Breakfast is the most important meal of the day. Not having it is like attempting to drive your car on fumes for miles and miles. Breakfast doesn’t have to be huge or complicated…it just has to occur!

Activities
Don’t overload the plate! Try to balance sports and nonsports.  If  your child wants to drop a sport or musical instrument for another, don’t get caught up on age or how many years have been invested. All isn’t lost…this is childhood and variety is the name of the game, not specialization.

Cell Phone Rules
With cell phones common and ubiquitous, we need to be involved with how our kids use them. Check in with your kids to be sure they are using features appropriately and not using features such as the web that has zero filter and ability to control from a cell phone right now.

Kid Time
Kids who work hard need to play hard! Make sure your kids have time each week of nothing scheduled for 100% down time.

Texting & Sexting, and the Internet
Do you talk with your kids about social networking, sexting and computer use? Dr. Gwenn’s new book CyberSafe has all the information you need to get you on the same page with your kids and perhaps even a step ahead.  More information coming soon!

Oh my aching back!
Backpacks are true health hazards for our kids. Be sure they are the proper size and that your kids are wearing them properly. For more information, click here:

Sleep
Kids in school need at least 10 hours of sleep. Start tweaking that schedule now to get into the sleep/wake cycle your child will have for the new school year, and try to keep to it on weekends.

Come To Dinner!
Studies show that family dinners not only help boost our kids self-esteems but may be the best antidrug around.

Health Check
Even if your school doesn’t require an annual physical, this is the best way to be sure that all the needs or your child are addressed entering a school year including medications, immunizations, issues lingering from the prior year, including emotional issues.

Outdoor Time
Studies show that spending time outside not only is a stress buster but an excellent way to increase daily exercise for kids.

Organization & School Work
Help your kids have a homework routine. If homework seems excessively long or stressful, call the school and ask for guidance.

Lunch and School Day Snack Plan
Helping kids plan for their school day meals and snacks helps them understand how to make healthy decisions. The more involved you are, the more informed they will be.

All kids have butterflies out of the gate even if they don’t show it. The more organized and in control you are, the more at ease they will be as the year slides into full swing.

(Originally posted August 2009; Updated August 2011)