Play ‘Til It Hurts

This week’s guest columnist is Dr. James Hyatt, a family practice resident at the University Hospital and Clinics here in Lafayette.

“Winning isn’t everything, it’s the only thing.”  This quote, made famous by Vince Lombardi, is a mantra for generations of athletes.  This attitude permeates all sports, even at the youngest level.  If you watch Esquire Network’s “Friday Night Tykes,” you’ll understand how intensified kid sports and sport-related injuries have become commonplace.  You’ll see football coaches yell at children like they’re college phenoms, and then watch the kids get seriously hurt.

Every year, more than 3.5 million children under age 15 require treatment for sports injuries.  This evolution from mere games to full-on quests to turn kids into tomorrow’s superstars has caused a rise in injuries.  What are the perils of youth sports today, and how can we avoid sports-related Emergency Department visits?  One peril is concussions, particularly when kids are charging at each other with extra zeal.

Bailey was a 14 year-old soccer player.  In one tight game she came head-to-head with not another player, but her greatest opponent, the ball itself.  She took her eye off of it for a split second and it struck her in the forehead.  As she lay on the ground, all she remembered was the brightness of the lights and the hush of the crowd.  She tried to stand up but felt too dazed, and began having a headache and nausea.  The coaches were worried she had a concussion, so her parents took her to the ER.  Hours later, after a CT scan of her head, she was discharged with instructions to not play or even work out for at least a week.  Intense play resulted in a long time on the DL.

The American Academy of Pediatrics recommends kids who sustain a concussion be evaluated by a doctor before returning to play.  They need “brain rest,” to resolve the symptoms and let their brains heal.  This means physical rest and “cognitive” rest, relieving the thinking part of the brain.  Cognitive exertion, like homework, video games, or school work may worsen headaches, nausea and fatigue, and make them last longer.  Some kids need weeks or months for these to go away.

12 year-old Bradley was at bat.  Bases loaded, bottom of the ninth, he envisioned his  hit sailing over the outfield wall.  Instead he took the pitch to his ring finger.  He missed the post-game festivities, finding himself in the Emergency Department getting x-rays.  The finger was broken.  

Besides broken bones, or concussions like Bailey’s story above, kid sports injuries often happen less dramatically.  While Bailey and Bradley’s mishaps could happen in sports at any level, the intensification at youth level often leads to overuse injuries we used to see only in college or professional athletes.

Take Little League Elbow.  This didn’t exist when I was young, but now happens to kids who throw too much.  It mostly affects pitchers, but anyone who throws baseballs or softballs a lot can get it, stressing the ligament on the inside of the elbow.  The ligament becomes inflamed, swollen, and hurts.  In extreme cases the underlying bone can come apart, or kids can develop arthritis.

To prevent Little League Elbow, everyone’s now aware of the pitch count.  There’s tables to tell how many pitches children are allowed by their age, but coaches need to be careful.  The school coach may hold his pitchers under their counts, but does he factor how many pitches the kids are throwing at private lessons, or with a select team?  The sum of all those should be under the safety number.

Better prevention of overuse injuries, and more fun, is to vary children’s sports.  If a kid loves sports, she should do a variety- soccer one season, running another, baseball another, etc.  Also, parents and coaches need to dial back the intensity.  The science is clear- too much training is more likely to lead to an injury, rather than to a college scholarship. Kids should learn injury prevention skills like hydration, warm-up exercises, warm-down stretches.  They shouldn’t be pressured to play hurt, but instead encouraged to speak up when in pain.  Then they need adequate rest and rehab.

Preserving young athletes’ health is everyone’s responsibility: coaches, teammates, parents, and physicians.  It’s a balance between keeping kids out the ER, and heeding the call to ”Put Me In Coach!”

Extreme Adventures With Kids

This week’s guest columnist is Dr. Corey Gardner, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Coming over a coral ridge, I saw everyone staring down at a rock.  That’s odd, I thought, what’s so fascinating?  Then I noticed a flicker of movement and a beady little eye peering at me.  The rock began to move and transformed into a giant sea turtle, complete with barnacles on his back.  He paddled past me and with one more glance back, disappeared into the blue.

This took place about 50 feet below the Caribbean Sea, one of many adventures I had since earning SCUBA certification.  The Professional Association of Diving Instructors (PADI) has courses for kids too, as young as eight years, in a class called Bubblemaker.  This is a safe and fun way for kids to learn diving, and paves the way to certification.  Ask about courses at your local dive shop.

But isn’t diving expensive and dangerous?  Well, there are front-end costs for courses, gear rental, and family vacations to diving spots.  However, certification is for life. Imagine the opportunities for your children to appreciate a natural world few get to see. And kids learn important lessons about conservation and responsibility.  You may also consider the less expensive alternative- snorkeling.

As for danger, SCUBA and snorkeling are far less risky than many things Louisiana kids do, like riding ATVs, motorcycles, or jet-skis.  Far more kids are injured on these vehicles than SCUBA.  SCUBA has the advantage of stringent classes that thoroughly drill safety and responsibility.  And while anyone can zip around on ATVs or boats without proper training or safety gear, it’s hard to find a dive crew that’ll take you out without PADI certification and proper equipment.

So if you’re looking for another way to get your kids away from their phones and video games and into the great outdoors, consider SCUBA.  You can have shared adventures and create some science enthusiasts in your kids.  They’ll see exotic animals and plants in another world, and you’ll have life-time family memories.  I’ve had the privilege of watching an octopus steal a Go-Pro, nurse sharks sleeping in their coves, and an eight-foot Moray eel eat a lionfish.  What will your child find under the waves?

Another time, I was jogging on my usual nature trail when POOF!  There was a tiny deer, a Bambi-incarnate, standing by the path munching grass.  He was maybe three feet tall, and not startled as I pulled up short. Soon he was joined by a second Bambi impersonator.  The three of us had a moment as I got my phone out and snapped a picture.  Then I took off to finish my run. The deer, less rushed than I, continued their lunch.

I share this story to maybe peak your children’s interest in the great outdoors. There’s many ways to get your kids outside, away from phones and video games, besides the SCUBA and snorkeling we discussed above.  One of the great joys of these sports is seeing exotic sea creatures like turtles, tropical fish, octopi, and rays.  But there’s also lots of animals on dry land , and kids love seeing animals in the wild.

Louisiana is a wonderful place to start your kid’s hiking career.There’s dozens of trails, long and short, throughout the state.  And with the heat soon to break, it’s a great time to get out there.  You can catch a family of raccoons scurrying up a tree, or spot a lone gator floating at Lake Martin.

Kids enjoying the outdoors not only makes them nature and conservation enthusiasts, but also helps fight the epidemic of childhood inactivity, obesity, diabetes, and hypertension.  The Japanese call hiking “forest bathing,” and the science is clear that hiking in the woods improves blood pressure, decreases stress hormone production, and improves overall well-being.

Hiking is also a family activity, so parents reap these benefits as well. You can start close by in a local park.  If you want more elevation and beautiful views, venture out to Tunica Hills or the Kisatchie National Forest.  For the really big animals and spectacular vistas, there’s always parks like Yellowstone and the Grand Tetons, to name just a few.  So get out there and have an adventure with your kids!  They could use one, and so could you.

Throw Like a Girl

Today’s guest columnist is Dr. Corey Gardner, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

“You can’t beat me!” yelled Jacob, the ringleader of the third-grade boys who controlled the playground at recess.  He was yelling at me, the scrawny little thing in the ankle-length blue dress with flowers on it.

“Oh yes she can, and she will, even in that dress,” countered my friend Reggie.  I stood silently, waiting for the race to start.  Reggie and I had played lots of tag and touch football, he knew my speed, and that no dress would hamper it.  With the distance marked and the rules set, we lined up.  ”Go!”  I took off, blue skirt streaming behind me like a sail. Jacob had no chance.  He couldn’t catch me that day, and from then on the boys let me play as an equal.

This story raises the issue of young girls in athletics.  Multiple studies demonstrate that fewer girls participate in sports.  That number drops off even more once girls hit puberty. There are myriad reasons cited, including disinterest, teasing, body changes, lack of female athlete role models, and believing boys will like them less.  The sports drop-out rate for girls around adolescence is six times greater than for boys.  Only a quarter of high school girls are in sports, compared to over half of high school boys.

When we lose these girls to culture and peer pressure, they in turn lose valuable opportunities: to gain self-confidence, leadership experience, and of course better health. The science is clear that sports and fitness activities stave off obesity and heart disease, substance abuse and depression, and even lower rates of teen pregnancy. Participating girls tend to go on to have better lives, including chances at college scholarships, and better professional development.

Gender equality in physical activity starts in grade school.  Girls need to know that they have a right to enjoy sports, to feel strong and have fun playing.  This includes the right to that recess playground and the chance to run like the wind, even if she’s wearing a blue dress with flowers on it.

The Olympics in Rio last summer showcased many elite female athletes. Simone Biles won five gold medals in gymnastics, including the best and most fun floor exercise in a long time. Then on NBC’s Today show, she even eclipsed her celebrity crush, actor Zac Efron. He was invited on to surprise the gymnast and her team, but he was clearly awed himself. “They won gold medals, they were crushing it the entire Olympics,” explained Efron, “and I was like hiding in a closet waiting to come in.”

Like we discussed above, more girls need to be in athletics, having fun, staying fit, and living their own great moments.  It’s even better when girls play multiple sports, instead of being single-sport “specialty” athletes. However, kid sports have evolved to nurture hopes of creating stars. Sport-specific camps and select leagues provide opportunities for kids to slog away at one sport year-round.  Parents believe they’re doing their kids a service with the extra practice time and experience, grooming them for futures in the major leagues. In fact, the data shows the exact opposite.

Children who are channeled into single sports often burn out by high school. Not only do they get bored playing one sport, but injuries increase significantly.  We see these kids in the Emergency Department, when after going through the same motions year after year, they get worn-out, swollen and painful joints.  That’s no path to success. In fact, coaches like Nick Saban, Urban Meyer, and Brian Kelly prefer and actively scout multi-sport athletes. Most NFL quarterbacks played more than one sport in high school and college.

Changing sports broadens a kid’s peer group- more friends, more fun. Multi-sport kids get more overall fitness, training different muscles necessary for each sport.  And switching joint use spreads out the strain. Finally, kids get less bored not having to throw a zillion pitches day after day, if they get to tumble in the gym instead.

Next time, instead of enrolling your child in another select league, maybe encourage her to try a different sport that season. Who knows, maybe a miniature Alex Morgan will come out on the soccer field, having been hidden behind mediocre T-ball skills.

Modern Adventures for Kids

In 2008, New York City mom Lenore Skenazy was shopping with her 9 year-old son.  They rode the subway, and that day he begged her to let him ride home alone.  Ms. Skenazy decided it was time for some independence and let him.  He returned home safely and was ecstatic with his feat.  But when Ms. Skenazy wrote about it in a newspaper column, she set off a storm of controversy.

Some called her the “world’s worst mom,” and child protection agencies took note.  Others praised her for not being afraid to give her child freedoms not allowed by  “helicopter parents,” so-called because they hover over their kids’ every move.  Ms. Skenazy recently completed a reality TV series where she coached such parents on letting their kids ride bikes or slice vegetables, to give the kids some independence.  The show’s title: World’s Worst Mom.

In the Pediatric Emergency Department, we often roll our eyes at what some kids are allowed to do- ride 4-wheelers or use the microwave.  But we only see the kids who get hurt; scads of kids use microwaves without spilling boiling water on themselves, and jump on trampolines without breaking something.  The key is teaching children to do these things safely.

Before Ms. Skenazy let her 9 year-old ride the subway alone, she had coached him on reading subway maps and identifying uptown versus downtown trains.  It’s the same with kids doing any risky thing, like riding bikes or 4-wheelers.  There’s rules and training before setting your kid loose.

Of course, learning to ride a bike requires teaching; kids can’t just get on and ride.  But the safety stuff requires more parenting- teaching the rules of the road and enforcing helmet use.  When my son wanted to ride to his friend’s house miles away, we went riding together to show how to stay on the right side of the road and cross busy streets safely, and to be sure he knew the way.  And we had him call when he arrived so we could relax.

When I was eight years-old, they built a hospital near my house.  Construction sites are as good as Disneyworld to a child: piles of dirt to play on, and those big yellow machines!  Fortunately the workers took the keys out of the bulldozer; otherwise we would have fired it up and gone for a spin.

One day I ran across the site and into a mud patch.  It was deep enough that I sank to my knees, stuck.  Remembering the quick-sand scenario in movies, I was scared that I might sink more.  I yelled to my buddy, but he stood helplessly at the edge of the patch, no rope or stick handy to save me.  Since no other rescue was likely, I decided I had to save myself and began to slog my way to a big rock nearby.  Three or four heaves in that direction and I was able to hug the rock and haul myself out.

Parents worry about letting their kids out into the world.  If my folks had known about that deep mud, would they have let me go to the site?  Perhaps not, but back then things seemed safer.  There wasn’t 24-hour cable news, needing to fill a whole day with attention-grabbing stories to scare parents.  Every child abduction in the country now gets breathless attention.  Before cable and internet there were only brief TV news programs and newspapers; no space to report every child tragedy in the nation.

In reality, back then children were actually less safe.  Crime was rising in the 1970s and 1980s, peaking in 1993.  Now there is 50% less crime than when I was a kid.  In addition to a more dangerous environment, kids went out without cell phones or bike helmets.  So the world turns out to be pretty safe for kids; the odds that your kid will be kidnapped or seriously hurt are very tiny.

And children yearn for freedom.  They want to explore, push boundaries, and be proud of their accomplishments.  Lenore Skenazy’s boy was beside himself with joy at going home alone on the New York subway.  While many think that’s extreme, even the FAA lets 14 year-olds fly gliders solo.  Makes a bike ride across town seem pretty tame.

Play Time Is Serious Business!

I often pick a column topic based on what I am seeing a lot at the Pediatric Emergency Department here at Lafayette General.  Lately we have been seeing lots of unhappy kids- suicidal teenagers, violent grade schoolers, children with anxiety and panic attacks.  Even minor things like cars backing into each other in parking lots become blown up: parents and their kids feeling victimized in these accidents and exaggerating their neck and back pain.

Pick up any newspaper or listen to a news report and you will hear the same.  It is a national trend that people are unhappier, using more antidepressant medication, attempting suicide more, and of course there are more and more mass shootings.  What happened to easy-going kids and adults?  It seems that kids once handled adversity better, took losses with good grace, negotiated well with others, and generally were happier with their lot in life.  Many researchers are beginning to believe that a lot of these problems in kid and adult functioning are partly because of an erosion in the amount of time kids are allowed to play.

Really?  Loss of play time leads to unhappy kids and adults? Play has been called “the work of childhood.”  Play is more important to a child’s development than homework.  Lion cubs play at hunting so they can learn to hunt and eat and survive as adult lions.  Kids need play to practice what humans do as adults- interact well and handle life in complex society.  For lion cubs and kids to play, of course, it has to be fun.  No kid wants to “play” corporate board meeting or how to settle a lawn mowing dispute with their neighbor.  But if you think about it, isn’t this what they are learning when they play Monopoly?

What is the best kind of play?  Researchers are finding that the best play is kid-driven, kid directed: simple games that are fun, with the rules regulated by the kids themselves: games like tag and pick-up baseball, doll houses and board games, imaginary play as explorers and heroes.  These are games where kids play face to face and talk through the rules and parameters themselves.  When kids run the game and make it fun, they end up practicing adult life skills.

Organized sports and computer games do not fit the bill when it comes to making mature, capable kids.  The problem with organized sports is that they are adult-regulated, which automatically takes a lot of the fun out.  Adults make the rules and settle the disputes while the kids mope around the dugout waiting for a brief turn at bat.  Adults tell the kids how they should act or behave instead of the kids trying out how to act and behave between themselves.

In computer and video games, the game program sets the rules and runs the play.  Sure they are fun, but the fun is transient and superficial, continual brief episodes of a “fun high.”  Playing video games is the psychological equal of eating candy- something that is nice once in awhile, but not something kids should do all day.  No lessons are learned in video games except how to run the controller better and better.

The life lessons learned in real play time are life-long.  How to take a skinned knee without being a victim.  How to lose gracefully.  How to live with disappointment and carry on with a smile. Of course, kids don’t learn this right away.  There are tantrums and kicking over the checker board and storming away.  But if kids want to continue to have fun and play with others, they have to control those childish actions.  And when they practice controlling their childish urges as kids, that control is “hard-wired” in them by the time they are adults.

So adults, let’s protect our kids’ play.  Limit the computer games.  Allow every opportunity for your kids to play with others.  Encourage your schools to keep recess.  Cut back on organized sports- your kid is not going to end up playing for the Yankees or the Saints anyway.  But she will probably have to negotiate a bank loan, and how can she do that if she hasn’t played Monopoly?

Special thanks to Daniel Yeager, a child therapist here in Lafayette, for ideas and input.