kidSPORTS MAGAZINE Fall 2013
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Feature Story
Balancing Sports & Family Caffeinated Sports Drinks Foot and Ankle Injuries Playing Sports with Asthma
Welcome With the school year underway, the excitement of fall and winter sports is here. This is by far one of the busiest times of year for many young athletes. From football and basketball, to volleyball and hockey, the competition is heating up. Now, as our children are used to this new rhythm of life that includes earlier wake up calls, after school practices and keeping up with homework, it is important for parents to help them balance priorities. In this issue, Dr. Molly Wimbiscus provides some advice for balancing sports, family life and scholastics in an article on page 4. This fall issue of KidSports explores a variety of useful topics from eye and foot health, to coping with asthma and the impact of caffeinated beverages on our kids. We hope you find it interesting and useful. I wish you and your young athletes a healthy and safe sports season. Sincerely,
Paul M. Saluan, MD Director, Pediatric & Adolescent Sports Medicine Cleveland Clinic
4 Balancing Sports and Family
10 Avoiding Eye Injuries
6 Foot and Ankle Injuries
12 Athletes and Asthma
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8 Hockey Injuries
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3 The Effect of Caffeine on Kids
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The Scoop on Caffeinated Beverages for Young People
f your child is active in sports, there likely has been or will be a time when he or she asks for an energy drink or sports drink. They may have seen their friends drinking one or they believe the ads that say the drink will improve energy, decrease fatigue and improve performance. As a parent you may be wary of how your child is hydrating. So, let’s take a closer look at the difference between sports drinks, energy drinks and caffeinated drinks in general. A sports drink is a
flavored drink that contains sugar to maintain energy levels during exercise, plus electrolytes, salt and potassium, which are lost through sweat and necessary to maintaining hydration. Sports drinks are appropriate for children who are participating in an hour or more of higher intensity exercise daily. For the average child who may be physically active less than an hour per day, drinking water is the best choice. Drinking a sports drink increases intake of calories from sugar, which can lead to being overweight and tooth decay. Energy drinks are also flavored drinks that con-
tain sugar, but they also contain stimulants, such as caffeine, guarana, taurine, ginseng and creatine. The stimulants in energy drinks are touted to increase energy levels and hence improve athletic performance. The problem is that the effect of caffeine on
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young athletes’ performance has not been studied and many energy drinks do not list the caffeine content on their packaging. Though the United States has not determined guidelines for caffeine intake for kids, the Institute of Medicine states that, “stimulant-containing energy drinks have no place in the diets of children or adolescents.” The risks seem to outweigh the benefits given that there are side effects associated with caffeine, which include: • Increased heart rate and blood pressure • Jitteriness and nervousness • Upset stomach • Decreased attentiveness • Sleep disturbances Depending on the amount of caffeine in an energy drink and the volume consumed, caffeine toxicity and addiction are possible. The primary source of caffeine for children comes from soda (or pop). Though the caffeine content of soda is less than in energy drinks, it provides no nutritional value. Drinking soda and energy drinks means kids are missing out on essential vitamins and minerals that they could get by drinking more nutrient dense drinks, such as 100 percent fruit juice and milk. So, the recommendation is that sports drinks are suitable for active child athletes, while energy drinks and soda are discouraged and should be replaced with water, 100-percent fruit juice and milk. By Katherine Patton, MEd, RD, CSSD, LD, a Certified Specialist in Sports Dietetics for Cleveland Clinic Sports Health. To schedule an appointment, call 877.440.TEAM.
Q&A Balancing Youth Sports and Family Life
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oday’s kids are more involved in school and organized sports than ever before. During the school year especially, this means fewer dinners as a family and less downtime as the whirlwind of practices, school homework and early wake up calls get underway. Cleveland Clinic child and adolescent psychiatrist Molly Wimbiscus, MD, says, “Families love sports, but parents just need to be aware of the stress it can cause and do what they can to help their kids balance priorities.”
Here, Dr. Wimbiscus provides some advice on how families can achieve that balance between sports, family and academic life.
KS: So, what are the pros of being involved in sports? Dr. W.: There are many good
things about being involved in sports, including socialization with peers, a sense of beKS: In your practice, do you longing, satisfaction in skill see sports activities being an mastery, learning good sportsissue for families? manship and working hard toDr. W.: Yes—especially for wards a goal personally and as families involved in traveling a group. And of course, staysports teams, multiple compe- ing active. With childhood titions and more than weekly obesity an issue, and one in practices. The time committhree children not getting ment and interruption in enough exercise, it is a good evening and weekend activithing when kids get involved ties can be a real issue. in sports. 4
KS: What are the major cons you see when talking with children? Dr. W.: It can be exhausting if a child is over in-
volved in sports activities. It can interfere with academic success and cause stress. Sometimes the focus on the athletic competition can outweigh the value of the sports activity. It can also interfere in family life, evening activities, diversity of activities and mastery in other areas. And it can easily begin to interfere in sleep schedules if children have evening practices and they have to finish homework. This is why it is so important to be disciplined about staying on a schedule with practices, homework and bedtimes.
take a day off of the game or a practice if it is a special holiday or family event. Let the coach know beforehand. Sometimes family and personal priorities need to come first. Many times, less IS more! When parents feel the strain of having too many sporting events and don’t get the personal and family time to check in and engage with their children, it may be time to decide what sports and activities are most important and which ones can be set aside for now. Your pediatrician can help. If you have tried working out the issues as a family, but still have questions and are not sure how to find that healthy balance, talk to your child’s pediatrician for advice.
Molly Wimbiscus, MD
KS:What can a parent do to help their children? Dr. W: The time children spend
KS: How can parents help Child and Adolescent Psychiatrist as a family doing fun activities their kids stay healthy? can be just as valuable for self-esteem and skill Dr. W.: Always monitor their functioning in
academic, social and emotional spheres. If behaviors, sleep patterns, grades, social engagement and emotional responses begin to change, discuss these changes with your child. Be open in talking with him or her and discuss a plan to make things better. KS: Will kids talk about their feelings of being overwhelmed? Dr. W.: Each child is different. Some children
may love sports and not recognize the strain it is causing them. Others may be capable of explaining the stress of their lives. It’s up to parents to recognize issues and talk with them about it. KS: What recommendations do you have for finding balance? Dr. W: Don’t forget your priorities. It is OK to
mastery. Parents can model good sportsmanship for children in many settings. Engage in family and neighborhood sports activities together such as community runs, bike rides, swims, and/or hiking around your neighborhood or the Metroparks. And finally, remember: Kids learn by example. Try to be a good role model for your kids by staying active and living in a healthy and balanced way. You can be sure that they will catch on! Talk with a psychologist is beneficial for anxiety, trauma and behavioral issues. If therapy is not effective, you may want to consider medication with a psychiatrist. For an appointment: with a pediatric psychologist, call 216.636.5860; with a pediatric psychiatrist, call 216.444.5437.
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What to Expect Foot and Ankle Injuries F oot and ankle injuries can be common among children and adolescents, particularly those who participate in contact sports like basketball, football and soccer. The most-often seen sports-related foot and ankle injuries are sprains and fractures, according to R. Tracy Ballock, MD, of the Cleveland Clinic Center for Pediatric Orthopaedic Surgery. Overuse injuries are another area of concern.
Sprains
Most ankle sprains happen when the young athlete rolls over on the outside of the foot and the ligaments that connect one or both of the shinbones to the anklebone are stretched or torn. With an ankle sprain, your child will have immediate pain and swelling. If he or she can’t bear weight or has no motion, this may indicate a more serious injury.
The good news is that most sprains will heal on their own. A more serious sprain may require your child to wear an air boot until the tenderness has completely resolved. Your young athlete can usually return to sports with a protective ankle brace for up to one more month. “A common mistake that I see is a child who returns to sports too quickly after an ankle sprain, which can lead to several months of chronic ankle pain and instability,” says Dr. Ballock. High ankle sprains are more serious than typical sprains. This type of sprain occurs when the syndesmosis—a tough sheet of connective tissue that binds the shin bones together between the knee and ankle—is stretched or torn. High ankle sprains take longer to heal and, in severe cases, may require surgery to insert a screw to stabilize the syndesmosis. Fractures
Ankle fractures (or breaks) in children frequently involve the growth plates, which are the discs of cartilage located near the ends of long bones that allow the bones to increase in length. The growth plate is more commonly injured because the growing cartilage is weaker than the surrounding bone and ligaments. While most growth plate fractures heal without complications, these injuries need to be treated immediately and often require special attention to avoid future problems with growth. A stress fracture is the earliest phase of a bone fracture before the injury is visible on an X-ray. Stress fractures are due to the production of microscopic cracks within the bone. 6
“If your child does not get sufficient rest, these small cracks can coalesce to become bigger cracks,” explains Dr. Ballock. If your child has a stress fracture, it will be treated by a period of rest and immobilization in a walking boot until the pain and tenderness have completely resolved. Overuse
the same season.“ So, what is tendonitis? This is excessive soft tissue stress followed by insufficient rest, which would allow recovery. Achilles tendonitis, often associated with running or dancing sports, is the most common in children. For tendonitis, Dr. Ballock says several weeks of rest and using a rubber heel lift inside the shoe can help relieve stress on the Achilles. It usually resolves with three to four weeks of rest in a walking boot. What can parents do to help their children avoid foot and ankle injuries? Experts recommend that your child practice good sports technique and have a good period of rest to avoid too much repetition. But keep in mind, these injuries can still happen and your child will heal.
A stress fracture is considered an overuse injury. Overuse injuries occur over time when your child participates in repetitive activity without enough rest. Tendonitis is a common overuse injury involving the foot and ankle. Your child’s symptoms in overuse injuries happen more gradually, with vague or subtle pain that is made worse with activity. “Overuse injuries in children are unfortunately becoming all too common in our society,” says Dr. Ballock. “This phenomenon is directly related to the To schedule an appointment with Dr. Ballock or anincreasing number of children involved in one sport other pediatric orthopaedic surgeon, call year-round, or competing on multiple teams during 877.440.TEAM.
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What to Expect Hockey Injuries T he fast-pace, hard-hitting and high-action intensity of hockey have made the sport more popular among American youngsters than ever before. The very idea of a game being played on an ice surface practically guarantees a lot of action. And like any contact sport, injuries are a part of hockey at any level. “It’s a high risk sport – you go very fast and there’s contact, so there is a risk for injury,” says orthopaedic surgeon Anthony Miniaci, MD, with Cleveland Clinic’s Center for Sports Health. According to Dr. Miniaci, the most common hockey injuries occur to the shoulder, knee and ankle.
SHOULDERS
Shoulder injuries are fairly common, especially separations and dislocations. Injuries to the AC joint, which is located between the clavicle (collarbone) and the acromion (roof of the shoulder bone), can occur when a player is hit against the boards, disrupting the joint and causing what is commonly called a shoulder separation. A dislocation, when the shoulder joint itself comes out of the socket, is often caused the same way. Icing and immobilization are typical treatments for either injury, with dislocations normally taking a slightly longer recovery time than separations (4-6 weeks for a separation, up to 12 for a dislocation). KNEES
Injuries to the medial collateral ligament (MCL) and anterior cruciate ligament (ACL) are the most common knee injuries in hockey. The MCL is the ligament on the inner part of the knee that prevents the knee from bending out, while the ACL is in the middle of the knee and prevents the shin bone from sliding out in front of the thigh bone. ACL injuries are typically more serious than MCL injuries. Fortunately for hockey players, there are less ACL injuries in hockey than soccer, football or basketball, says Dr. Miniaci. “A skate is on the ice is often relatively frictionless and can easily slide,” he explains. “That alone makes it very different from basketball, soccer or football, where you end up planting the foot into the turf and there’s a lot of momentum pushing it the other way.” ACL injuries occur in hockey, but the lack of repetitive jumping and landing leave the ligament less exposed to that type of injury. According to Dr. Miniaci, many MCL injuries in hockey occur when a player rolls up on the outside of another player’s knee.
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See also Foot and Ankle Injuries article on page 6.
Recovery time varies. MCL sprains can heal with rest, while serious ACL tears require surgery and at least nine months of recovery.
To schedule an appointment with Dr. Miniaci or another pediatric orthopaedic surgeon, call 877.440.TEAM.
ANKLES
The most common ankle injuries in hockey are sprains – especially high-ankle sprains. A regular ankle sprain involves the ligaments on the outside of the ankle, while high-ankle sprains involve the connecting ligaments that hold the tibia and fibula together. High-ankle sprains are very common in hockey, says Dr. Miniaci, when the skate becomes jammed on the ice – if a player slides foot-first into the boards. Regular ankle sprains can take 4-6 weeks to recover, sometimes less, while high-ankle sprains typically take a little more time.
An Effort to Minimize Head Injuries Equipment changes and a push for less contact for younger players is helping to alleviate some injuries in hockey. In addition to orthopaedic injuries, concussions can happen in hockey for a variety of reasons. Hits to the head, even inadvertent, inevitably happen in a hockey games and can cause concussions. Players often make contact with the boards or fall to the ice as well. According to Anthony Miniaci, MD, changes in coaching, improvements in equipment and a fundamental awareness have caused a measurable decrease in many serious head and neck injuries associated with hockey. Dr. Miniaci is with Cleveland Clinic’s Center for Sports Health “Serious injuries have kind of subsided because of changes in equipment and more
awareness in youth hockey,” he says. “They’ve really stressed an elimination of hits from behind now, and that’s caused a reduction in serious neck and spinal injuries as well.” One major equipment change that has aided in the reduction of head injuries is the requirement of youth players to wear a full protective cage on their helmets. Education and awareness are the best way to prevent serious injuries, says Dr. Miniaci. “There is a push to get a lot of the contact out of the sport at the younger ages,” he explains, “and hits from behind are being eliminated. People are more aware of it and the more aware you become of these things, the more you prevent them.” For more on concussions, read this video transcript with pediatric physicians Paul Saluan, MD, and Richard Figler, MD. 9
Safetyfirst
Avoid sports injuries with proper eye wear
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ach year in the United States, hospital emergency departments treat more than 40,000 sports-related eye injuries. Almost every sport poses the potential for an eye injury for your child. Any sport in which balls or flying objects are present can pose potential dangers to the eyes – and fingers and elbows can be frequent culprits as well. Types of eye injuries
Elias Traboulsi, MD, a pediatric ophthalmologist at Cleveland Clinic, breaks most eye injuries into two categories – injuries to the orbit, and injuries to the eyeball itself. The most common of injuries are scratches on the surface of the eye or bruises on the lid or around the eye. While they are typically not that serious, they can lead to major issues for your child if not treated quickly and properly. More serious eye injuries in sports are ones that occur to the eyeball, even though it is not necessary to penetrate or perforate the eyeball to cause serious injury. “Sometimes something will hit your child’s eye itself without rupturing it or cutting it, and that will result in bleeding or hyphema, which means blood in the chamber of the eye,” explains Dr. Traboulsi. “That’s probably the highest on the list of problems resulting from an eye injury.” Hyphema usually resolves itself within a couple of days, but children with bleeding in the eye
should be taken to an emergency room immediately. Most of the time hyphema heals with no significant consequences, according to Dr. Traboulsi. Fortunately, injuries that actually penetrate or rupture the eyeball are unusual in most sports. Preventing injury
The best news is that almost all eye injuries are preventable. “If your child has well-designed protective eye gear, nothing is going to hit his or her eye directly and nothing is going to hit the orbit,” says Dr. Traboulsi. Cleveland Clinic optometrist Diane Tucker, OD, says protective eyewear can be found in all shapes and sizes for your young athlete, at your local sporting goods store or in many eye doctor’s offices. “If your child is playing contact sports, sports goggles can be made with a prescription,” says Dr.
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Tucker. “Even swim goggles can be made with a prescription, and of course they make sports bands that hold the regular glasses on your child’s head.” Dr. Tucker recommends eyewear with lenses made of polycarbonate, an impact-resistant material that can protect your child’s eyes from fast-moving objects. Polycarbonate also has built-in ultraviolet protection, a must for outdoor sports. Sports goggles should be properly fitted for your child, Dr. Tucker notes. “If frames are too large, their protection is limited,” she warns. “Frames that are too small or that the athlete has outgrown are not safe either.” Eyewear that is too small is uncomfortable, which
may cause your child to decide not to wear it. Tightfitting goggles also obstruct peripheral vision. Dr. Traboulsi has seen many injuries occur during practices and warm-ups, when athletes decide they don’t need to wear their eye gear. “I would make a plea to your child to wear eye gear whether they are practicing or in a game where they are obligated to do so,” he says. “They will be glad they did.” To schedule an appointment with Dr. Traboulsi, call 216.444.2030; to make an appointment with Dr. Tucker, call 216.831.0120.
What to do in case of an eye injury “Instead of putting a bag of ice on it, you should actually put a cup over your child’s eye and prevent anything from pushing on it,” says pediatric ophthalmologist Elias Traboulsi, MD. A foam cup with the top cut off, and the bottom placed over the eye will do the trick. Sunglasses can also be used to shield the eye from bright lights. Seek medical help immediately if any of the following symptoms occur: If your child does suffer an eye injury during sports, there are a few things you can do until medical help arrives. The first and most important step is to determine where the injury is. “If the injury is around the eye and not in the eye, you can use ice to try to keep the swelling down,” says optometrist Diane Tucker, OD. However, if there is any suspicion that the eyeball itself has been injured, it is important NOT to put any pressure on your child’s eye. Do not apply ice in these cases.
• Extreme pain • Blurred vision or any change in vision • Redness or discoloring in the eye • Lack of proper eye movement in all directions • Bruising around the eye “The threshold of taking children to the ER should not be very high,” warns Dr. Traboulsi. “If there’s any suspicion at all of serious injury, they should go to the ER.”
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Athletics & Asthma
Keeping Exercise-Induced Asthma at Bay
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ypically, we think about asthma being There are preventive actions one can take for triggered by smoke, pollen and other exercise-induced asthma. With proper medicaenvironmental factors, but exercise can be a tion and conditioning, kids with asthma will be major trigger for many children. In fact, about able to participate fully in sports. 80 percent of children with asthma experience Relaxing the airways asthma symptoms when they exercise. Asthma medications can prevent these airway With fall sports underway, it’s particularly important for parents, coaches and teachers to spasms. A short-acting beta-2 agonist (such as albuterol), inhaled 15 to 20 minutes before exerunderstand and recognize exercise-induced cise, can prevent spasms for several hours. asthma (EIA). This is because playing winter Long-acting bronchodilators work for 12 hours. sports compounds the problem, and upper Long-term inhaled anti-inflammatory medicarespiratory infections can worsen asthma. tions may also be required to "quiet" the airways. In general, sports that require short, intermittent bursts of Control through energy, such as football, During exercise teamwork wrestling, gymnastics Children may not be in control of their Gaining and mainand track are easier on environment during a game, but they can taining optimal conthe airways than sports adapt the way they practice by: trol over EIA often that require endurance, • Wearing a scarf and breathing through it to requires teamwork. such as hockey, longpre-warm the air Letting the coach distance running and • Avoiding exercising outdoors in frigid know that your child basketball. temperatures has asthma is so im• Doing 10-minute warm-ups and cool-downs How asthma works portant—and having to help their airway adjust to the colder When children (or an inhaler close at temperature anyone for that matter) hand is key. All parties breathe normally, air is should know the warmed and moistened by nasal passages, proper dosage and how to use it before and durpreparing it for absorption through the lungs. ing an asthma episode. This will help keep your When playing sports, however, children tend to child’s asthma well-controlled, so that exercise is inhale short, shallow breaths through their less likely to trigger symptoms. mouths. This type of quick breathing takes in cold, dry air and causes the airway muscles to Cleveland Clinic sports and exercise medicine contract and spasm. When the airway becomes physicians are available to help you manage your narrow, this brings on asthmatic symptoms of child’s asthma. For an appointment, call wheezing, coughing, chest tightness and short- 877.440.TEAM (8326). ness of breath. 12
About Us Cleveland Clinic’s Pediatric Sports Health Program brings together top orthopaedic surgeons, sports and exercise medicine physicians, physician assistants, nurses, physical therapists, certified athletic trainers and exercise physiologists. We are part of Cleveland Clinic’s Orthopaedic & Rheumatologic Institute and associated with Cleveland Clinic Children's. We see child and adolescent patients at more than 20 locations throughout Northeast Ohio. Through our program, we offer a comprehensive array of services to meet the needs of each young athlete.
Our Services Sports and exercise medicine physicians specialize in the nonoperative treatment of medical conditions your child may face, including acute injuries (such as sprains and fractures), overuseinjuries, care for athletes with chronic or acute illnesses (such as asthma or diabetes), and concussion evaluation and management. When surgery is needed, our expert orthopaedic surgeons can repair torn ligaments and tendons, broken bones or damaged cartilage. We use minimally invasive techniques (such as arthoroscopic surgery) whenever possible to minimize pain, scarring and recovery time. Advanced rehabilitation services are available for our young patients, including the latest in diagnostic and rehabilitation techniques and treatment protocols. Our sports dietitians can help you and your child by designing a tailored meal plan for optimal performance and/or establishing and supporting goals to achieve successful weight loss or weight gain.
Making an Appointment To schedule an appointment, call 877.440.TEAM (8326). Same-day appointments are available.