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River Valley Pediatrics |
531 Central Park Avenue, Suite 102
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Sports Section Concussion
A concussion is defined as any injury that causes disruption of the neurons in the brain. Most concussions in sports occur with a head injury. Concussions can and often do occur without a loss of consciousness. Football, lacrosse and ice hockey are sports with high risk of concussion. Athletes with a concussion can feel confused, woozy, nauseous, dizzy, irritable, or have headaches. Call immediately if your child is experiencing these symptoms. Symptoms from a concussion can last for minutes to months. Physical or mental exertion can worsen symptoms of a concussion (yes, even homework). Having one concussion makes an athlete more likely to have another concussion in the future with an even smaller injury. Athletes should NEVER ever ever participate in sports while they still have symptoms of a concussion. An athlete who still has headaches or other symptoms is at risk for catastrophic brain injury if they receive another concussion. The problem is, many athletes minimize or disregard these symptoms in an attempt to get back on the field. Sideline testing by an experienced doctor or trainer is essential before allowing an athlete back on the field. Close follow-up with a doctor in the days after a concussion is also critical. Athletes in sports like football, lacrosse, biking, and skateboarding should always wear approved and well-fitting helmets.
Performance Enhancing Drugs Recently, there has been a great deal of media attention paid to performance enhancing substances in sports. Unfortunately, the practice is more common in children, mostly adolescents, than we had previously thought. For instance, studies have consistently shown that approximately 6% of adolescent boys admit to having taken anabolic steroids. It is important to note that many kids take these substances not for athletic competition but to improve their appearance. Performance enhancing substances range from vitamins and protein bars to injectable steroids and designer hormones. The most basic thing to remind our kids is that there is no quick and easy method to become bigger, stronger, or to lose weight. There is no substitute for hard work and exercise. Many substances purchased in health food stores claim to make the user stronger or give more energy. These products are unregulated and can contain harmful substances. Huge amounts of protein in shakes or bars are usually not even absorbed and are excreted in the urine (which makes for very expensive pee). Steroids can cause a whole host of problems, including acne, male pattern baldness, testicular shrinkage (most disconcerting to teenage boys), bone problems, decreased adult height, liver problems, and psychological problems. Lab tests often fail to identify kids using these substances. Discussing these issues with your kids will help to bring these problems to light.
Sudden Cardiac Death Sudden Cardiac Death is a rare but catastrophic occurrence in pediatrics. Approximately 10 to 15 adolescent athletes per year in the U.S. die of unexpected, sudden, nonviolent cardiac causes. These events usually occur during or immediately after athletic competitions and cause shock and grief in communities due to the death of a seemingly healthy athlete. Sudden cardiac death is usually caused by a previously unknown heart condition. The most common causes found are hypertrophic cardiomyopathy (a sometimes inherited condition where the muscle of the heart is enlarged and therefore ineffective), coronary artery abnormalities, and electrical abnormalities.
There is a great deal of controversy as to how to best screen athletes for these conditions, which are not always picked up on standard testing. The current consensus is that a detailed written screen, such as on the pre-participation exam, and a focused history and physical exam are the best tools. A good deal of the questions on the pre-participation physicals required by school athletic programs attempt to screen for the conditions that predispose kids to sudden cardiac death. Please fill out the school form for athletics with your child. It will ask for family history and any possible symptoms that an athlete might experience. Any history of dizziness, chest pain, or shortness of breath (out of proportion to fitness level) with exercise needs to be brought to the doctor's attention. A past or present heart murmur is almost always harmless, but should also be discussed with the doctor. Any family history of sudden, unexplained death or heart disease in a young person (under the age of 40) is also very important to know. Even with all of this screening information, it is very difficult to diagnose these conditions, due to their rarity and subtlety. For now, we would only recommend further testing such as an EKG or echocardiogram if we have concerns. Awareness of worrisome family history and physical symptoms are our most important tools to prevent these tragedies.
Female Athlete Triad Female Athlete Triad is the combination of eating disorders, menstruation problems, and osteoporosis or decreased bone mineral density. The disordered eating can be either intentional, such as with anorexia or bulimia, or unintentional. Many athletes do not realize how many calories they burn in their sports. Athletes can actually have disordered eating and an energy deficit if they are not eating enough calories to make up for losses. Some female athletes have irregular or absent periods, especially in their sports season. This is NOT normal. This is a sign of an imbalance in the body, caused by a deficit of calories and decreased hormone production. These imbalances and nutritional deficiencies cause bone mineralization to become inadequate. In the short term, this can lead to increased chances of injury and stress fractures. In the long run, this can lead to premature osteoporosis and decreased bone mass. Most of an adult woman's bone mass is acquired before the age of 19. Unfortunately, it is mostly downhill after that, and we just try to maintain that level. Prevention is the key to avoiding female athlete triad. Eating a healthy, well-balanced diet to make up for burned calories is critical. It is up to athletes, parents, and coaches to be aware of the signs of eating disorders and to confront the athlete for their own health. Delayed or irregular menstruation should be evaluated by a professional. Losing a previously normal period is a warning sign. Female athletes should get at least 1300mg per day of calcium, either through diet or by vitamin supplementation. Drinking milk is important, as the Vitamin D in milk enhances absorption of calcium.
Heat Illness Summer is a wonderful time to be outside engaged in physical activity. However, it is important to be aware of the risks of heat illness (including heat cramps, heat exhaustion, and heat stroke). Our bodies are designed to sweat and use other methods to regulate heat during exercise. If these methods become overwhelmed, the body temperature can rise to harmful levels. Every year, we hear of several tragedies of high school athletes that die from heat stroke. These deaths are preventable through adequate planning, supervision by coaches and trainers, hydration, and awareness of worrisome signs and symptoms. Athletic activities should not take place outside in the summer during peak heat and sunlight hours. Frequent (every 20 minutes) water breaks in the shade are imperative. Athletes should drink at least 20 ounces every hour of athletic activity. Drinking before the activity also helps build up a reserve. Water is adequate for athletic activities lasting less than 2 hours. After 2 hours, the body also needs some salt replacement, so products like Gatorade or Powerade can be used. Practices should take place with few to no pads and light, loose-fitting clothing. Athletes should wear sunscreen of at least SPF 15. Weighing athletes before and after practice can demonstrate how much water weight has been lost. A weight loss of more than 3% is considered worrisome. Severe muscle cramping, dizziness, disorientation, nausea and vomiting, and weakness are important signs of heat illness. Any athlete experiencing any of these symptoms, or just feeling "off", should sit in the shade and drink as much as possible. If an athlete becomes disoriented or confused, they should lie down in the shade, ice should be applied to their armpit and groin areas, and 911 should be called. Teaching kids to DRINK DRINK DRINK can prevent many of these illnesses.
Sprains and Strains Unfortunately, muscle strains and ligament strains are common injuries in sports. Most of these injuries occur from overuse, poor conditioning, or from imbalances in muscle strength. Sprains and strains generally take a few days to a few weeks to heal. The mainstays of treatment are rest, ice (20 minutes at a time, 3-4 times a day), compression with a wrap or bandage, elevation, and anti-inflammatories such as Ibuprofen. After the initial injury, it is critical to rehab the muscle or joint adequately, or the injury will recur. Please speak to our sports medicine doctor about home exercises or whether your child needs formal physical therapy. Young children who experience these types of injuries are more likely to have more serious injuries. Younger children have more open growth plates in their bones, which are points of weakness and can fracture. The same minor-appearing injury can result in a sprain in a 16-year old athlete, and a fracture in a 6-year old athlete. We are therefore much more conservative with younger athletes, and depending on their examination, would be much more likely to recommend X-rays. Conditioning is critical to avoid sprains and strains. Slow and gradual increase in activities acclimates the body to the athlete's demands. Adequate footwear is important. Wraps and braces do NOT prevent injury. Listening to your body and not pushing through true pain (as opposed to discomfort) will prevent further injury.
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