Don’t tell this to my kids – but my favorite place to sled as a kid was a hill in the woods behind a friend’s house. And, my second favorite hill was at the high school, Senior Hill, which ended at the driveway entering the campus. Talk about violating just about every sledding rule there is! If I only knew then what I know now.

The statistics on injuries from sledding may surprise you. The Consumer Product Safety Commission estimated that 14,000 kids ages 5-15 were treated for sledding injuries in 1997. In 2003, the CPSC reported over 90,000 total ER visits for all sledding injuries with half occurring in people under 20 years of age. Luckily, most injuries are minor – cuts, sprains and strains, but fractures, dislocations, facial injuries and serious trauma to the head and spine do occur. And, the younger a child, the more they are at risk for the more serious types of injuries.
Even knowing these statistics, all too many people tempt fate and convince themselves that it’s possible to defy physics. What they fail to realize is that the physics of sledding actually explains why sledding is so dangerous and supports the adage ‘the bigger you are, the harder you fall’. Very young kids are the only exception. Young children are more vulnerable to injury because of how large their heads are compared to their bodies which raises their center of gravity compared to ours.

If you think back to your school days, you’ll likely recall Newton’s First Law of Physics: Force equals mass times acceleration or F=MA. The greater the weight on a sled and the steeper the grade, the greater the force generated that pushes you down the hill. If it weren’t for the safeguards nature builds in with competing forces we’d end up going infinitely fast. When sledding, the friction of the snow and the wind pushing against us do slow us down but we can still clock speeds of 20-25miles per hour.

Add to speed and slick snow sleds that don’t steer and obstacles often covered in snow and the result is out of control sleds and falling people. The other major downhill winter sports, skiing and snowboarding, have professional programs we can fall back on to master some skills and reduce injury. Sledding is also different in that experience doesn’t make us more competent. F=MA will win all the time.

So, what can we do? Sled smartly. The American Academy of Orthopedic Surgeons (AAOS) offers the following tips to make your next run as safe as possible:

* Parents or adults must supervise children, while sledding, at all times.
* Sled only in designated areas free of fixed objects such as trees, posts and fences.
* Do not sled on slopes that end in a street, drop off, parking lot, river or pond.
* All participants must sit in a forward-facing position, steering with their feet or a rope tied to the steering handles of the sled. No one should sled headfirst down a slope.
* To protect from injury, it is important to wear helmets, gloves and layers of clothing.
* Do not sit/slide on plastic sheets or other materials that can be pierced by objects on the ground.
* Use a sled with runners and a steering mechanism, which is safer than toboggans or snow disks.
* Sled in well-lighted areas when choosing evening activities.
* Individuals with pre-existing neurological problems may be at higher risk for injury.

Let me highlight a few additional tips especially relevant to kids:

* Never sled alone
* Make sure that the child is strong enough to control the sled
* Make sure the kids are old enough to understand the need to hold on
* Develop a safety plan that your kids can follow in case someone gets hurt
* If you enforce no other rule, enforce this: no helmet, no ride – and that should be true for adults and kids.

So, have fun the next time you test physics in motion…but when you sled, don’t forget to protect your head!

It never fails.

In fact, not only can I count on this, so can you:

2 kids + 1 back yard trampoline = injury

The injury may be mild or major and may involve one or both kids but it WILL happen. What about safety nets? They help prevent crashes to the ground…just not injury.

You may think that most sound parents, including ourselves, would be swayed by the reams of data that support the dangers of trampolines and keep their kids off. But, more times than not I hear parents say “What can I do? She (or he) just loves it so much!”

This is usually mentioned to me during an evaluation for an injury, by the way – injuries such as sprains, contusions, lacerations, head traumas, spinal traumas, dislocations, bumps, bruises and concussions.

Now do you see why I’m worried?

Bouncing is fun but it is impossible to bounce in totally control.  Three rules come into play that I can always count on. These rules, while based in science, are my own creation and come from years of treating kids with similar injuries from bouncing substrates:

• Whoever goes up, must come down.
• The bigger you are, the harder you fall.
• If there is something that can cause hidden harm, it will.

Part of the issue with back yard trampolines is the actual rules are hardly ever followed.  Here’s a link to typical rules for backyard trampolines (www.trampolineworld.com/safety.htm) How often have you seen “spotters” by the sides? How often is there just one bouncer on at a time? What about height? Most instructions say to keep the bounce “low” – does that occur with your kids? What about supervision? Let’s be honest, the rules if followed make sense but no one follows these rules at least.

The American Academy of Pediatrics feels so strongly that trampolines are dangerous that in 1999 the following policy was reaffirmed: www.aap.org/advocacy/archives/maytra.htm.

In the press release, the AAP states:

“Despite all currently available measures to prevent injury, the potential for serious injury while using a trampoline remains. The need for supervision and trained personnel at all times makes home use extremely unwise,” states the revised policy.

Based on data collected by the Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS), the AAP found that trampoline related injuries are on the rise.

• Trampoline-related injuries increased 140 percent from 1990 to 1996.
• An estimated 83,400 trampoline-related injuries requiring an emergency department visit occurred in 1996 in the United States.
• 30 percent of trampoline-related injuries treated in an emergency department were fractures, often resulting in hospitalization and surgery.
• Catastrophic cervical spine injuries are rare, however head and neck injuries constitute a notable number of the more serious injuries requiring hospitalization.
• Since 1990, the CPSC has received reports of six deaths involving trampolines. Victims ranged in age from 3 years through 21 years. Most deaths occurred when victims fell from the trampolines, and most involved the spinal cord.

The AAP concluded that the largest proportion of trampoline-related injuries occurred on home trampolines and that most trampoline-related injuries occurred either while children played on trampolines or as they fell off. They also found that most injuries happen when there are simultaneous multiple users. If a trampoline is to be used, the AAP does offer specific guidelines on design and behavioral use for kids to lesson the chance of injury.

Trampolines are not the only backyard summer danger, however. Recreational toys with water are close behind. I’m not talking about pools, that’s a topic that deserves it’s own column. I’m talking more about the small backyard slides and novelties such as Wham O!’s Slip N’ Slide and the Six Flag’s Backyard bonsai inflatable water slide.

In fact, you can apply the same three rules I use with trampolines with a few small modifications:

1. An object in motion will stay in motion…unless something stops it (usually something big like a house or person).

2. The bigger you are, the faster you’ll slide – and harder you’ll hit the object in #1.

3. If there is something that can cause hidden harm, it will – and you’ll likely slide over it – and not see it because you’ll be moving too fast. See #2.

In addition to the dangers of movement and collision that are very similar to trampolines, the element of water poses extra risks.  Even small amounts of water are drowning hazards for small kids. Water makes things slick which can easy cause kids to trip and fall, making whatever is on the ground now in harm’s way. And, nearby electricity is an electrocution risk, especially if the actual water slide requires electricity to operate.  To add insult to injury, most of these small backyard water slides have height and weight guidelines that are designed to avoid injury in older, and bigger people which are all too often ignored. All in all, a set up for someone getting hurt. It’s not a matter of ‘if’ but ‘when’.

By the way, if your neighbor won’t respect your safety rule for your child when you talk about your concern’s with their back yard stuff, whether a trampoline, slide, or anything for that matter, the question to ask yourself, is whether the fun is worth the risk?? I’m thinking “no” but that’s just my 2cents.

(Originally posted July 2007; Updated June 2011)

Are sports drinks, energy drinks harmful to kids?: MyFoxBOSTON.com

The AAP Committee on Nutrition and Council on Sports Medicine and Fitness released a Clinical Report this week that is important for any parent who had kids in sports or kids who drink sports drinks or energy drinks. The report, Sports Drinks and Energy Drinks for Adolescents: Are They Appropriate?, puts into perspective not only who should be drinking these drinks but the risks and benefits for each.

This is no small problem to tackle. Young athletes are bombarded with the message that these drinks are an important part of their sports diets. Advertisements for all the popular sports and energy drinks show popular sport stars, celebrities and bands drinking these, and liberally. The ads cite health benefits such as rehydration, electrolyte replacement and carbohydrate replacement. Check out this link,  this , this, and this to see the heavy handed endorsements for yourself.

What these advertisements don’t discuss, though, is the downsides of use in our teens and when, exactly, our teens should be drinking these drinks.

I went onto Fox News to discuss these very topics this morning:

What is it? The inability for Seniors (typically) to focus due to a feeling that “they are done”. However, this can occur in all kids at various stages.

Symptoms:

Not applying as much effort in school work

Loosing interest in activities

Grades slipping

Lackadaisical attitude

What you should do as a parent:

• Talk to your child
• Talk to the school

The goal is to uncover from your child what is driving your child’s thinking and motivation. Your job is to be helpful and to be a good listener. The school is your best ally in helping you talk to your child and explaining the big picture.

The Cure

GRADUATION! And, staying busy and involved well before then.

However, your Senior needs to understand that some colleges and universities are not as forgiving if grades slip too much. Scholarships and awards have been revoked so it is important to keep GPAs respectable. Many schools have helped by keeping kids busy with projects and fun class activities.

See Resources for more information and tips.

Resources For Parents

What to do about Senioritis (College Board Association)

PedsNow article March 2006

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/2010/04/helping-overweight-kids-become-healthy-and-fit/?utm_source=rss&utm_medium=rss&utm_campaign=helping-overweight-kids-become-healthy-and-fit http://www.pediatricsnow.com/2010/04/helping-overweight-kids-become-healthy-and-fit/#comments Wed, 14 Apr 2010 10:00:47 +0000 DrGwenn http://pediatricsnow.com/wptest/?p=334

Fostering healthy eating and fitness is often a wrestling match of Olympic proportions. In one corner, our kids highly motivated but under trained in the rules of health. In the other, the tag team of activity and food which can change as fast as a chameleon from working for the health of your child to a pure health enemy.

You never know what you’ll get in the ring – exercise or video games. Cookies or carrot sticks. You, the parent, are the referee, and get to play dirty. This is one match where referee interference is not only expected but crucial for our kids to have the winning move.

Bob vs. Carb: losing by default

Kelli is mom to a typical 8 year old son, who I’ll call Bobby. Kelli’s son is in a match against junk food and lack of exercise and appears to be losing. Standing 51” tall and weighing 85 pound, Bobby prefers carbohydrates and meat to fruits and veggies and is described as “hungry all the time.” According to a standard growth chart, he is at the 75%ile for height and above the 95%ile for weight.  This is overweight by today’s standards.

When Bobby was young, he was a very picky eater and really never developed a taste for many fruits and veggies. So, his parents gave him what he would eat to avoid struggles. As he got older, those patterns never changed.  For Bobby to turn this around, he needs to move more and eat differently and perhaps even less.

Bobby would benefit from the Ref Kelli calling him on shady plays and unwise moves. Perhaps the ref could take on more of a coaching role to help Bobby view this a bit more positively. So, “you can’t eat that right now” can become “if you want a snack, you can have some carrot sticks with ranch dressing or peanut butter, or a yogurt”. Ref Kelli will have to be tough because Bobby may pull out his secret whining weapon. While that can make the match proceed more smoothly, it is a set up for sure loss. For Bobby to win, he has to start playing by new rules. And, Ref Kelli has to recognize that the players of this match have to change. Junk food needs to be thrown out of the ring, and healthy food allowed to enter. Similarly, exercise needs to have a bigger role.

Kids love games. If Bobby views this as a game, he may just get on board quicker with stomping out his carb consumed opponent. Perhaps he’ll be convinced to walk around the block with Mom and Dad. Perhaps he’ll discover that dried veggies can taste very similar to chips. Perhaps he’ll see that a 100 calorie pack of Oreos tastes like Oreos. The key to winning is reframing the problem. Bobby may understand better if Ref Kelli compares his body to a car. Cars need care and fuel to run, as do bodies. Mud in the gas tank will get a car just as far as all carbs will for a body. If this becomes a family game, he’ll be more interested. Blame has no role here. This is not necessarily anyone’s fault. But, now that it is an identified problem, the variables need to be examined and tweeked.

Ref Kelli has a few tricks up her sleeve she can pull out. Tie eating well during the week with a special treat on the weekends. Have Bobby help plan meals and even prepare them. Take him shopping and show him what portions are and calories. Kids are very visual. He may not understand he’s eating too much but he will get that 2 bowls of ice cream is putting mud in a car but 1 bowl with a piece of fruit is ok.

Kelli also has an option to throw up her white flag and call for backup. Her pediatrician is a phone call away and can help support this match to a more favorable outcome. One thing is clear, right now, the opponent is winning and Bobby is partially pinned.

The Grey Zone: All Bets Are Off

Bobby’s situation is obvious but many other kids fall into a vast grey zone where they may be normal or just a tad under or over weight.  For these kids, the key is not wrestling the match but training well so the match barely begins. Unlike Bobby whose match is clearly in progress, most other kids have a match lurking on the horizon that may never begin, especially if we train them correctly.

DG found herself in this situation very recently with her three kids, two girls and a boy, ages 4, 6 and 8, who appeared “normal” to her but whose karate instructor felt were underweight compared to other kids in the class. DG has always tried to focus on good health with her family.  “I try to serve healthy meals and my children enjoy a lot of healthy things that their peers won’t eat”, DG told me via email. “We consume low fat dairy and slim milk, eat and snack on a variety of cheese.  They all enjoy yogurt and even ice cream sometimes too. I serve fish twice a week, beans and beef weekly and we eat a lot of veggies, and chicken.”

Diet and exercise are clearly the prime determinants for overall health but bodies are all wired differently and have different needs. Think about that car engine again. While on paper they all may have the same RPM and horsepower, there will be slight differences from car to car. Bodies are the same way.

So, what works for one child may not work for another. A child’s growth parameter’s are what will clue us in to potential chinks in their health and fitness armor. A child who is proportional weight for height and with a normal BMI is the ideal. But that rarely happens. Often a child’s weight is a touch more or less than their height. This may not be an issue if the pattern over time is stable.  Changes in the pattern do need attention.

Kids who are having trouble gaining weight may need more calories while kids who are gaining too much weight need less calories and more activity. The latter is what happened with Bobby and is becoming all too common today.

Back to our story.

Reviewing the heights and weights DG sent me on standards growth charts was very interesting.  One of her daughters was actually a tad underweight for height while the other two kids had the opposite problem and were slightly overweight. This may all point to matches on the horizon more than an active issue depending on where these points fell compared to past growth. As the referee here, DG should be vigilant for sure but may not have to change much given the kids ages and activity levels.

I would suggest DG follow many of the same tips I suggested for Ref Kelli. If nothing else, empowering the kids to be more active and eat healthier can only benefit them in the long run. DGs goal is to change the game plan now so that these potential issues don’t become true battles.

What about the karate instructor’s observations? I’m not too surprised. Our litmus for “normal” is heavily altered today by the rise in childhood obesity. Relying on observation alone will be falsely reassuring for the many kids in the grey zone whose match bell is about to ring.

And The Winner Is…..

While beauty is in the eye of the beholder, we have to be honest about our kids’ weight status for their sakes. A child becoming overweight or underweight is simply telling you their body’s needs are different from what they are getting. So, change the game plan.

You’ll have some hurdles for sure. Studies today are clear that our kids are getting the wrong messages about foods from the media – this will thwart any attempts we make at teaching them to be healthy unless we become open and honest with our kids about the issues. Similarly, studies also confirm that all it takes is 15 minutes a day of vigorous activity for our kids to combat obesity. Even the busiest of families can fit that in!

Our kids’ bodies are already telling us what they need to be healthy.  All we have to do is listen carefully and referee their individual matches in whatever way makes them the winner.

(Originally posted May 2007; Updated December 2009)

We have been incredibly spoiled in New England the last few years between the Patriot’s Super Bowl run and the Red Sox finally winning the World Series. It’s no wonder kids try to emulate the sports heros they see on TV, and parents smile at the notion of that dream coming true for their child. Then we blink and realize it’s just a child’s dream. After all, we know the reality of our kids fulfilling that dream are as likely as finding a pot of gold at the end of a rainbow. Or do we?

Do you realize that only 0.03% of high school athletes will make it to the pros? In fact, 99.9% of athletes will never play at the professional level regardless of how good they are. “Youth sports are about building better kids, not building better athletes”, says Dr. Bruce Svare, author of Reforming Sports Before the Clock Runs Out and Director of the National Institute for Sports Reform (www.NISR.ORG). The performance pressure is so extreme on young athletes while in elementary school that 70% are burning out and dropping out of sports by middle school. Moreover, Dr. Svare points out that “athletic brilliance prior to puberty has no relationship to athletic success after puberty”. In fact, some of our greatest sports heros did not even begin their sport until well into the teenage years.

Dave Wohl, Assistant Coach to the Boston Celtics agrees. “Michael Jordan was actually got cut from his high school team”, says Wohl, “and I didn’t start playing basketball until after I was 10”. Coach Wohl notes that there is a huge mismatch in body types before puberty that may give some kids an athletic edge while young that inevitably disappears once their peers catch up to them in growth.

Both Dr. Svare and Coach Wohl feel kids can learn some important life lessons in sports, if the sports are structured correctly. In addition to the many health and fitness benefits, sports teaches kids how to work in a team. Sports teach kids how to push themselves to their best level. And, sports teach kids that failure happens at times but that life goes on.

It’s natural for parents and coaches to want children to try their best. But kids are instead being told that their best is not good enough. Parents rationalize that it is acceptable for their child to be benched so that their team can win. And, we turn a blind eye on the bad behavior and poor sportsmanship of other coaches and parents, all in the name of winning.

Coach Wohl is amazed how many parents ask him what is wrong with their young athlete because their child is not focused enough. He fondly remembers his dad’s comments after his games as a child: “Did you play as hard as you can? Then hold your head up”.

It’s no wonder the injury rate and burn-out rates for youth sports are so high – kids are being pushed mentally and physically in directions they are just not wired to go while still so young. Their bodies and souls are being asked to perform at a level really meant for much older kids – high school and beyond. Before that point, the emphasis should be on fun, skill building and teamwork. It’s like trying to race the Indy 500 in a VW Beetle or a Toyota Camry. Sure, it will run and may even win but then the engine will be permanently shot in the process.

We seem to accept when our children express a dislike for certain foods, TV shows, books, or even friends; but we often fail to accept our child may not like a certain sport. Childhood is really a journey of exploration and it’s actually the child who has the map; we are merely guides. There’s a world of sports and activities to choose from – but we need to remember that it’s our child who is participating in that activity, not us. Even more so, we need to remember that just because a child is good at an activity, does not mean that he will want to continue that activity or just do that activity.

Reforming youth sports will not happen over night but we can make a huge amount of positive strides but just changing our own expectations and behavior. I truly believe that when parents learn to just encourage their children without pushing, the clock will start to slow. When parents learn to enjoy watching their child learn new skills and new found confidence, the clock will slow even more. But the clock won’t truly stop and reset until our children start having fun again. It could happen today and you’re the one to take the first step.

© 2005-2006 Pediatrics Now.
All rights reserved. PEDIATRICS NOW is a trademark of Pediatrics Now.

Curt Schilling has one. So does Manny, Mia Hamm, Tom Brady, and college athletes. What about your young athlete? What is the mystery thing? An off season.

#1 Avoid Injuries: The Importance of an Off-season

And it is a mystery. It’s a mystery why pros have one and youth athletes don’t.  It’s a mystery why coaches and parents refuse to acknowledge the reams of data proving youth sports are out of control. And, it’s an ever bigger mystery why community based coaches, and parents, fail to heed the cries of these athletes whose bodies and minds are screaming out that enough is enough by record numbers of injury rates and emotional burnout.

The concept of an off season is simple. Work hard while in season but work differently off season. That’s why you see so many pros playing golf off season! Brian Grasso, Executive Director of the International Youth Conditioning Association (www.iyca.org) notes “The off-season is important, so much so that true athletic development and the ascension to becoming a better athlete isn’t possible without one.”

“The key”, notes Grasso, “is to make sure that people understand the notion of off-season not as completely devoid of exercise or even competition, but more accurately a re-characterization of the activity stimulus that young athletes encounter. Simply put, play a different sport. Participate in no organized sports, but remain informally active.”

Eric Cressey, strength and conditioning specialist at Excel Sport and Fitness in Waltham, who has trained all levels of athlete from youth level to elite, shares Grasso’s perspective: “The in-season period is the ideal time to develop the player, but the rest of the year should focus on developing the athlete.  This should take place at the Olympic and professional levels making it even more important at the youth levels. The off-season is a time to escape from competition and focus on preparing the body in a general sense for what’s ahead.”

The proof for the need in an off season lies in the injury rates seen in youth sports. Dr. Pierre D’Hemecourt, Pediatric Orthopedist at Children’s Hospital Boston, has seen “an exponential rise” in overuse and repetitive use injuries over the last decade. Like Grasso and Cressey, he feels lack of free play and cross training are the culprits. To add insult to injury, kids are also not being allowed to heal properly after an injury. The pros have a disabled list. Why not youth sports teams?

#2 Play According to Age: Kids Need Time to Develop

It may help you to conceptualize a child’s developing body like baking a chocolate chip cookie. For the perfect cookie, you need specific ingredients in the right proportion for the cookie to bake correctly.  A child’s growing and developing body is similar and needs a variety of ingredients to grow correctly – a balance of foods, physical activity, education, rest time, enrichment, and fun.  Miss an ingredient, add too much of an ingredient, and the child won’t “bake” right.

For our kids, today’s level of youth sports participation is like having too many chocolate chips in a cookie – too much of a good thing, particularly in prepubertal kids. Labelling a child as a star athlete before puberty is complete is like awarding a baker the best recipe for a cookie before the taste tests are complete.

During puberty, growth rates accelerate, hormones change strength and physical changes occur and as a result a child’s coordination becomes temporarily awkward. Many kids, in fact, become worse at sports during puberty before settling into their new bodies. All kids have to get used to new height and strength and girls have to get used to a completely new body shape all together.

Bob Bigelow, former NBA player and youth sports activist, is very concerned that too many kids are marginalized as being poor athletes before they’ve been given an opportunity to finish growing and develop. Many of our best known sports stars had their own sports struggles. Did you know that Michael Jordan was cut from his sophomore varsity basketball team? He was only 5’9” at that time. But, over the next two years he grew 8 inches and developed enough coordination while on JV to be on the varsity team as a senior in high school. And, that’s when his true skill started to shine.

Many sports are starting to take a more developmental approach which is why soccer now has shortened fields, and t-balls are used for young baseball and softball. Bigelow would like to see modifications in other sports as well. For example, have a 3 on 3 for youth basketball instead of the 5 by 5 we may be more familiar with from TV. Bigelow is quick to remind parents that what we see on TV is the tip of the iceberg, the most elite. Kids are still developing so they need very different sports structures and experiences. As Bigelow notes, “adapt the game to the kids, not kids to the game”.

The idea is to encourage kids to “play against their last best effort”, as Bigelow puts it, and not focus on specialization until growth is complete, which may not be until the junior year in high school for most teens, or even college.  This is no different than majoring in any subject in school. You’d never pick a major without first tasting a smorgasbord of courses. And, even then, you always have a minor or two to keep yourself balanced.

One way to create variety is to expose kids to individual sports that can be enjoyed into adult life without the burden of a team. Golf, tennis and swimming fall into that category and so do baseball and basketball where there are often adult leagues. However, Bigelow cautions, it has to be on the child’s terms. “Kids love wacking balls”, notes Bob. “Let them create their own rules. Give them balls and a racquet and let them decide how to wack them over the net”.

#3 Stay Active: Mix Organized Sports with Downtime

Kids need a certain level of kid-friendly activity for their bodies to develop appropriately as athletes. Otherwise they will end up either underdeveloped, and overweight, or pushed too much, with physical and emotional burnout and injury.

Appropriate levels of activity also impacts youth sports injury rates.  Dr. D’Hemecourt explains that many sports have been studied and the injury rate does increase if participation is beyond 15 hours a week for most sports. For example, if little league baseball players play for longer than 9months a year, shoulder injuries rise.

Equally important to the need for physical activity in childhood is the right amount of activity. In fact, appropriate levels of sports participation are actually much less than what kids are currently doing. Youth sports experts like Bigelow and Grasso feel kids in 3rd to 5th grade should be doing 1 organized sport per season for no more than 3 times a week at 90 minute durations. And, all kids should do something active every day informally with friends and family.

#4 Have a Good Leader: An Experienced Coach is Important

Baking a cookie and developing a young athlete do have one important difference: we can bake an outstanding cookie by simply following the recipe. But, coaching involves a great deal more than following a recipe.  In fact, it is what is not in the play book that our kids need. Bigelow compares coaching to teaching. “A parent coaching doesn’t make any more sense than one of us teaching English or math because we took it in school.” Just like we have trained and educated teachers, youth sports needs trained and educated coaches.  As we all know, today’s community coaches are often well meaning parents whose only expertise is watching ESPN and having played sports as a child.

When in doubt, just have fun.

Sports are in good company in today’s childhood. The same overuse phenomenon is happening in music, dance, art, acting, horseback riding, and just about every activity our kids are interested in. Sports should be coupled with nonsports and everything coupled with downtime. Otherwise, today’s kids will end up incomplete – just like serving chocolate chip cookies sans the chips.

Don’t let your kid become chipless. Give them a chance to absorb all the right ingredients, in the right way, before it’s too late.

(Originally posted April 2007; Updated December 2009)

Kids today play hard. From pickup games to organized sports, children are playing more aggressively and at younger ages than previous generations. With increased participation and younger ages comes a higher risk of injury particularly to the developing brain. The scenarios for injury are endless but the concerns are always the same: is my child’s brain ok? When is it safe to return to sports? Should I call the doctor?

Most children love to play sports and there are many reasons to encourage our children to participate from overall fitness to the many benefits of learning to be part of a team. However sports can be dangerous to children due to their developing bodies and immature coordination. Children also grow at different rates and can be injured by other kids their age who are taller or heavier. This is one of the factors driving the debate over the appropriate age for children to start contact sports which many sports experts and pediatricians feel is currently too young.

Head injury is one of the more serious of sports-related injuries and sports is actually classified by their potential for brain injury. The highest risk sports are the contact sports such as basketball, field hockey, tackle football, ice hockey, lacrosse, martial arts, rugby, ski jumping, soccer, and wrestling. Moderate risk sports have limited collision risk and include baseball, bicycling, cheerleading, white water canoeing, fencing, floor hockey, flag football, gymnastics, horseback riding, skating, skiing, skateboarding, snowboarding. Low risk sports have minimal contact such as archery, weight lifting, bowling, rowing, dancing, golf, walking, sailing, swimming, tennis and curling.

Head injury can cause external injuries to the scalp or skull as well as internal injuries to the brain such as bruises, bleeding, and concussions. Any internal brain injury can be serious but concussions are the most common and can be the least obvious. A concussion occurs when the brain is shaken causing a temporary disruption in how the different nerves talk to each other, similar to a power surge at home. Symptoms vary and often include seeing stars, being dazed, blurred vision, nausea and occasionally amnesia. With more serious concussions, headache, vomiting, balance problems and changing levels of consciousness may occur. Contrary to popular belief, it is possible to have a concussion without loosing consciousness and even minor head injury can cause concussions.

It is crucial that all children with head injury get observed closely for the development of symptoms, and even more crucial that athletes not return to play until their clinical status is clear. Asking a child to “shake it off” in the setting of a head injury is a set up for disaster if that child gets hit in the head again. Multiple concussions during a given game, season or life-time put a person at risk for long-term problems with thinking and memory. One concussion followed closely by another increases a person’s chance for a more catastrophic injury, including coma and death.

Return to play guidelines are utilize concussion severity grading systems and are designed to allow for maximum safety. The American Academy of Neurology’s concussion grading scale is one of the most widely used and classifies concussions into 3 grades. Grade 1 is a concussion with no loss of consciousness and symptoms occurring for less than 15 minutes. Grade 2 is a concussion with no loss of consciousness and symptoms lasting more than 15 minutes. Grade 3 is any concussion with any loss of consciousness. Young athletes with head injury and symptoms of a concussion need to be evaluated on the field as well as by a physician after the game. Kids with a grade 1 concussion require only close observation at home while athletes with symptoms of a grade 2 or 3 concussion should be taken to the nearest emergency room as those kids usually require prolonged observation or special imaging studies such as a head cat scan. A child should be evaluated again by their doctor or a pediatric neurologist before resuming team activities. You can find more information at www.aan.com (American Academy of Neurology), www.safekids.org (National Safe Kids Campaign) and www.aap.org (American Academy of Pediatrics).

After a head injury, an athlete should be removed from play immediately and kept out of sports for at least one week. Sometimes an athlete’s season will need to be terminated either due to the severity of a concussion or due to how many prior concussions the athlete has suffered.

It is easy to get caught up in our children’s excitement for the sports they love and allow them to return to play too soon after a head injury, especially if they seem “fine”. Ultimately, it is better to be out of play for a week, a month, or even a season then to be benched for a lifetime.

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