THEME: YOUTH SPORTS HEALTHAND SAFETY

Concussion inYouth Sportsby Marla S. Kaufman, M.D.

A concussion is a mild traumatic braininjury that results from an impact directly tothe head or indirectly via an impact to thebody that transmits forces to the brain.Although some symptoms of a concussionmay be evident immediately, this braininjury may evolve over hours to days.Typically, concussions result in short-livedimpairment, with about 85% of athletesrecovering within 7-10 days. Unfortunately,the time frame for recovery may beprolonged in children and adolescents ascompared to their adult counterparts.

The mainstay of management for youthathletes while recovering from a concussionis rest: physical and relative mental rest.Several risk factors exist for athletes

returning to play prior to full resolution ofsymptoms from the initial concussion.Premature return to athletics may increaseboth the severity and duration of symptoms.Hence, early recognition of concussions isessential in order to limit increased exertionduring the acute symptomatic periodfollowing the injury.

Proper management of concussions isespecially important in young athletes.Recovery from concussion can be longer inyouth, and they are at increased risk forcatastrophic injuries such as secondimpact syndrome (SIS). SIS is a condition inwhich a person sustains a second headinjury prior to recovering from the first. Thissecond impact causes rapid brain swellingand progressive deterioration.Unfortunately, this condition is often fatal,and young athletes are more susceptiblethan their older counterparts. Once itoccurs, there is very little that can be doneto improve the condition of the athlete.

One youth athlete who has suffered acatastrophic brain injury is Zachery Lystedt.On October 12, 2006, at age 13, Zachery’slife was forever changed. He was anotherwise healthy middle school athleteplaying on his school’s football team. Threeplays prior to halftime, he made a tackleand likely sustained a concussion; he wascaptured on home video lying on theground, holding his helmet. An officialtime-out was called, and Zackery wasremoved from play. No medical personnelwere present, and he was returned to thegame during the second half. He collapsedafterward and required surgery for bleedinginside his brain. Zackery was in a coma forseven days, and now requires 24-hour perday care from his parents. In an effort toprevent other parents from enduring thesame tragedy, Mr. and Mrs. Lystedtpartnered with athletic associations,politicians, physicians, and attorneys toboth legislate and educate.

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A m e r i c A n c o l l e g e o f S p o r t S m e d i c i n e

AcSm Fit Society® pAge

Letter from the Editorby Dixie L. Thompson, Ph.D., FACSM

Welcome to the April 2013 edition of theACSM Fit Society®Page, supported byLiberty Mutual. Youth sportsparticipation brings many wonderfulpotential benefits for physical, social andemotional development. At the sametime, we must honestly confront thepotential issues that can arise whenyoung people engage in competitivesports. Physical injuries (concussion,heat illness, etc.) and emotional distresssometimes result particularly whenchildren are thrust into highly competitiveenvironments. In this issue, our expertwriters provide information and adviceabout keeping kids healthy while beingactive. While we can never completelyeliminate risk in sports, we can minimizerisk and provide the best opportunity forchildren reap the full benefits of sportsparticipation.

Dixie L. Thompson, Ph.D., FACSMEditor, ACSM Fit Society® PageEmail: dixielee@utk.edu

To subscribe to the ACSM Fit Society® Page,please send an email to publicinfo@acsm.org.

Volume 15 | Number 1 | April 2013

INSIDE THIS ISSUE:1 | Letter from the Editor1 | Concussion in Youth Sports2 | Q&A with ACSM3 | Overuse Injuries in Young Athletes

3 | Youth Sports: Keeping Kids Safe in the Heat4 | Developing a Positive Youth Sports Culture5 | The Athlete’s Kitchen

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Washington State led the way as the firststate to enact legislation to protect youthathletes from this devastating event. Gov.Christine Gregoire signed the ZacheryLystedt Law (Washington State House Bill1824) into law on May 14, 2009. In additionto school programs, this law also stipulatesthat any private, nonprofit youth sportsassociations using publicly owned playingfields or facilities must also comply with thelaw. This groundbreaking law containsthree core principles:

Core principle #1: Education. EachWashington State school district isresponsible to develop guidelines in orderinform and educate coaches, athletes, andtheir families regarding concussions,including risks of continuing to play. Aninformation form must be signed byathletes and their parents/guardians on ayearly basis.

Core principle #2: Removal. Perhaps themost important tenet of the law is that ayouth athlete SUSPECTED of a concussion

must be removed from play. Although aconcussion cannot be prevented,further/potentially catastrophic events canbe avoided.

Core principle #3: Proper clearance. Youthathletes cannot return until evaluated byand received written clearance from alicensed health care provider (MD, DO,PA-C, ARNP, AT-C) who is trained in theevaluation and management ofconcussions.

Since 2009, many states have followed. Asof March 5, 2013, 43 states and the Districtof Columbia have laws passed protectingstudent-athletes from returning to play toosoon after sustaining a concussion.Arkansas, Tennessee, South Carolina, andWest Virginia have legislation pending.Montana, Mississippi, and Georgia remainthe only three states without pending orpassed legislation.

To my knowledge, since the enactment ofthe Zachery Lystedt Law in 2009, there has

not been bleeding inside the brainrequiring surgery or a fatality from asports-related concussion in a youth athletein Washington State.

Recently, there has been much mediaattention surrounding the potential risks oflong-term exposure to repetitive headtrauma. Although there may be anassociation between chronic cognitiveand/or psychological/psychiatric problemsand sports participation, these complexissues are difficult to characterize.Post-concussion syndrome (PCS) may bedefined as symptoms related to aconcussion that last beyond the expectedperiod of time. In comparison, in chronictraumatic encephalopathy (CTE), chroniccognitive and/or behavioral dysfunctionoccurs, and unique cell pathology isidentified on autopsy. Risk factors for CTEare unknown at this time, and it is unclearwhat, if any, relationship exists betweenCTE and a history of multipleconcussion/repetitive head trauma.

Q&Aby Anthony Luke, M.D., FACSM

Q: My 12-year-old son wants to train withme for a half-marathon. Should pre-teenathletes run endurance events?

A: Recent debate has flared over what ageis appropriate for children to startparticipating in marathons andhalf-marathons. In the past, runners had tobe at least 18 years old, but now mostraces allow younger athletes to participate.So far these younger runners seem to haveparticipated without abnormal health risks,but some argue that it is better to be safethan sorry. Should such young runnersparticipate at long distances?

Some experts express concerns aboutgrowth-related issues, hormonal issues,and psychological issues likeburnout—especially considering the heavytraining that is often necessary for racingsuch long distances. These critics citestatistics suggesting that as the number ofyoung runners increases, so does thenumber of injuries in this age group.

The possible health risks of running longdistances at a young age have not beenclearly identified by research. A study ofthe Twin Cities Marathon found that onlyfour of the 310 participants of ages sevento 17 needed medical attention after therace. Another study of 50 runners age

13-17 showed no adverse changes inelectrolyte and blood levels after running amarathon. Additionally, experts note that insome African countries it is common forchildren to run many miles to school everyday.

Current scientific understanding indicatesthat it is probably not detrimental foryounger runners to participate inendurance events, although more researchis necessary to be certain. As with everyathlete, it is important for the runners (andtheir families) to be clear about themotivation for their training, especiallyconsidering the required level ofcommitment and possibility for injury. Closemonitoring for signs and symptoms ofoveruse injuries, regular medical checkups,and clear and honest conversations aboutthe emotional aspects of training arerecommended for all young athletesengaging in intensive training.

Q: Sports injuries seems to beincreasing in the United States. What isbeing done about this?

A: There are many efforts to help keep ouryoung athletes safe, ranging from nationalinitiatives to local educational efforts forcoaches. However, there is clearly still aneed for improved understanding of safetraining amounts and activities in organizedyouth sports. The American College ofSports Medicine partnered with SanfordHealth in 2011 to create the National Youth

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ACSM Fit Society® Page Editorial Board:

Dixie L. Thompson, Ph.D., FACSM, EditorUniversity of Tennessee

Thomas S. Altena, Ed.D.Southwest Missouri State University

Katherine A. Beals, Ph.D., R.D., FACSMUniversity of Utah

Greg Chertok, M.Ed.The Physical Medicine and Rehabilitation Center

Dawn Coe, Ph.D.University of Tennessee

Kate A. Heelan, Ph.D., FACSMUniversity of Nebraska-Kearney

Cherilyn Hultquist, Ph.D.Kennesaw State University

Gerald J. Jerome, Ph.D.Towson University

Anthony C. Luke, M.D., M.P.H., FACSMUniversity of California, San Francisco

Lynn Millar, Ph.D., FACSMWinston-Salem State University

ACSM is the world’s largest associationdevoted to sports medicine and exercisescience. ACSM advances and integratesscientific research to provide educational andpractical applications of exercise science andsports medicine. Visit www.acsm.org.

Permission to reprint material from thispublication is granted by ACSM contingentupon manuscripts being reprinted in totalwithout alteration and on proper credit givento ACSM by citing ACSM Fit Society®Page,issue and page number; e.g., “Reprinted withpermission of the American College ofSports Medicine, ACSM Fit Society®Page,April 2013, p. 3.”

Concussion in Youth Sports (continued from page 1)

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THEME: YOUTH SPORTS HEALTHAND SAFETY

Overuse Injuriesin Young Athletesby Andrew Gregory, M.D., FACSM

Participation in youth athletics hasdramatically increased over the last twodecades. Approximately 45 million childrenages 6-18 participate in some form oforganized athletics.1 The total number ofhigh school students participating in sportshas increased by 75% since 1970, due inlarge part to the passage of Title IX andsubsequent access that girls had toparticipation. With the growing number ofyoung athletes, increased attention is beinggiven to overuse injuries in this population.Approximately half of all injuries evaluatedin pediatric sports medicine clinics areassociated with overuse.2

Overuse injuries are chronic injuries thatoccur with repetitive stress on themusculoskeletal system over the course oftime without allowing time for adequaterecovery. Pediatric athletes are prone tooveruse injuries due to stresses placed onthe growing bones. External factors thatcontribute include inappropriate increasesin training, hard training surfaces orimproper equipment. Internal factorsinclude decreased muscle flexibility andstrength or extremity malalignment, such asexcessively flat feet.

Overuse injuries manifest in the youngathlete in a multitude of ways. The mostcommon overuse injuries in the youngathlete include an irritation of the growthplate (apophysitis), problems with tendons,stress fractures, and patellofemoral (knee)

pain. Pain, decreased performance,limping and swelling are signs of overuseinjuries that should be evaluated.

You may have heard the adage thatchildren are not just small adults. Theinjuries that young athletes sustain are verydifferent than those of adults. The mainreason for this difference is the growingskeleton and its open growth plates. Thegrowth plate (physis) is made up ofcartilage that is becoming bone and assuch does not yet have the strengthproperties of adult bone. For this reason thegrowth plate tends to be injured before thesurrounding bone or ligaments. Thedifficulty in recognizing injury to the growthplate is that they are not always palpable,they can be difficult to detect on X-ray andthere is wide variability in the location andclosing (fusing) of growth plates.

Growth plates occur where ossification(bone-making) centers are located on theskeleton, at the end of long bones(epiphysis) and at the attachment sites fortendons. These ossification centers appear(ossify) and disappear (fuse) in a relativelyordered fashion depending on age, gender,genetics and location on the skeleton.Ossification centers at the knee appear inthe first year of life where as some in theelbow don’t appear until the tenth year oflife. Most centers disappear after theadolescent growth spurt but some, like inthe pelvis or clavicle, can stay open as lateas 20+ years of age.

Another trend seen in youth sports is theearly specialization of sport. With moreathletes and earlier specialization, we areseeing more overuse injuries. Because ofearly sport specialization and increasedavailability of indoor training facilities,young athletes are increasingly playing onesport year-round. With year-round trainingin a single sport, children don’t give theirbodies adequate time off for rest andrecovery. The best athletes tend to getmore injuries because they log moreminutes on a club or travel team in additionto their school team. No one knows exactlyhow much is too much, but one month offfrom a year-round sport every six months isa good rule. This does not mean completerest, but rest from the primary sport.Cross-training with other sports isencouraged. One day off per week, onesport per season, one team per sport andincrease training intensity gradually over aperiod of weeks are all good rules ofthumb. Resources for overuse injuryprevention are available at the websites ofthe American Academy of PediatricsCouncil on Sports Medicine and Fitnessand STOP Sports Injuries.

Overuse injuries are common in youngathletes. We must be aware that there aredifferent types of overuse injuries and thediagnosis affects the treatment. Any athletewho exhibits pain, decreased performance,limping or swelling deserves evaluation bya sports medicine provider familiar withinjuries in young athletes. The commonthread among these overuse injuries isovertraining, so education of athletes,parents and coaches is essential forprevention. We must let them know thatadequate rest and recovery is an integralpart of training.

THEME: YOUTH SPORTS HEALTHAND SAFETY

Youth Sports:Keeping Kids Safein the Heatby Michael F. Bergeron, Ph.D., FACSM

It is commonly accepted that regular,age-appropriate exercise and physicalactivity can provide improvement in overallhealth and fitness, as well as numerousother immediate and potentially lifetimeadvantages, for school-age youth. Sportscan play a key contributing role inachieving these gains in a fun andcompetitive way. The benefits of regularphysical activity and sports participation asa student-athlete can even extend toenhanced academic achievement. Playingsports effectively and safely in the heat,however, can be particularly challenging,especially during two-a-day workouts ororganized tournament competition whenyoung athletes have to train or compete indemanding environmental conditionsmultiple times on the same day.

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Even with all the attention on the dangerouseffects of the heat, most hot-weatherrecommendations and guidelines foreffectively managing hydration, reducingthermal strain, optimizing performance,and minimizing exertional heat illness riskare not amply evidence-based orsport-specific. Notably, there has been alongstanding perspective that children andyoung adolescents are less effective thanadults in regulating body temperatureduring exercise and other physical activityin the heat, and consequently are lesstolerant of and capable of performing wellin a hot environment. Current researchsuggests that youth are no more at riskthan adults for heat-related problems whenhydration is sufficiently maintained.Therefore, safety and performanceguidelines for youth athletes training andcompeting in the heat should focus onreadily modifiable risk factors such asintensity and duration of activity, hydrationmanagement and scheduling of play.

With an emphasis on modifying the mostcommon factors that actually put kids atrisk in the heat, health care providers,parents, coaches and youth sportsgoverning bodies can more effectivelyimprove the health and safety of youthathletes during practice, training andcompetition in the heat, so that they cancontinue to participate, have fun and enjoythe health-enhancing benefits of sports.

The following guidelines are summarizedfrom the most recent Policy Statement onClimatic Heat Stress and ExercisingChildren and Adolescents from theAmerican Academy of Pediatrics1.

• Education and guidelines on the dangersof training and playing in the heat andeffective prevention or risk-reductionstrategies should be regularly providedand emphasized to youth athletes,parents, coaches and staff and othersoverseeing or assisting with youthathletes participating in sports.

• Protocols should be in place andpracticed, and trained personnel withreadily available facilities should beon-site for effectively treating all forms ofexertional heat illness for youth athleticactivities that involve moderate tovigorous physical activity in the heat.

• Youth athletes should be well-preparedprior to participating in any strenuousathletic activity in the heat. This includesbeing well-hydrated and well-nourished,as well as sufficiently fit and rested.

• Young athletes should be encouraged tobe honest and promptly report anysymptoms or signs of developingexertional heat illness for themselves ortheir teammates.

• Graduated appropriate exposure to a hotand/or humid environment, the uniformand protective equipment, and theintensity and duration of practice/trainingand competition is essential to minimizethe risk of exertional heat illness risk inthe preseason or when traveling to amore stressful (greater heat and/orhumidity) environment.

• Water and other appropriate fluids shouldbe readily accessible and youth athletesshould be given regular opportunities toconsume these fluids throughout athleticactivities to offset sweat losses andmaintain adequate hydration.

• Outdoor athletic activities should beappropriately modified for safety inrelation to the environmental conditionsand individual athlete health status andfitness. Effective modifications includelowering intensity and/or duration ofactivities, increasing frequency andduration of breaks to rehydrate and cooldown, minimizing uniform and protectivegear or canceling an activity altogether orrescheduling it to a cooler time of day.

• All youth athletes should be closelymonitored in the heat. Participationshould be immediately stopped andappropriate medical attention/treatmentshould be promptly sought andimplemented at the earliest signs ofdeveloping exertional heat illness.

• A written emergency action plan formanaging severe exertional heat illnessand other medical emergencies shouldbe in place and practiced ahead of timefor all youth athletic activities in the heat.

• Coaches and tournament/eventadministrators should provide sufficientrest and recovery time between multiplesame-day training sessions and contestsin the heat.

With sufficient preparation, appropriatemodification of known contributing riskfactors and close monitoring, exertionalheat illness is usually preventable.Accordingly, most healthy children andadolescents can safely participate inoutdoor sports—even when it is hot.

Editor’s note: Dr. Bergeron was co-chair ofthe roundtable that produced theConsensus Statement “Youth Football: HeatStress and Injury Risk.”

He serves as executive director of theNational Youth Sports Health & SafetyInstitute.

1. Council on Sports Medicine and Fitness, Council onSchool Health, Bergeron MF, Devore C, Rice SG, etal. Policy Statement-Climatic Heat Stress andExercising Children and Adolescents. Pediatrics.2011;128(3):e741-7

THEME: YOUTH SPORTS HEALTHAND SAFETY

Developing aPositive YouthSports Cultureby Greg Chertok, M.Ed., CC-AASP

This past season, I attended a LittleLeague Baseball game to watch anine-year old player I had coached. Inaddition to watching the game, I wasinterested in watching the parentalinteraction. I sat beyond the communityfield’s designated fan area. Along with whatwas happening on the field, I was attentiveto what was happening off the field, whichincluded:

• Conversation among fathers comparingtheir sons’ statistics;

• Parents exclaiming “Don’t strike out!” and“Don’t hit it to shortstop!” from the standstowards their child before an at-bat;

• The immediate negative reaction(head-shaking, dirt-kicking) and harshverbal response of one team’s coach afterhis left fielder committed an error;

• The expensive apparel and sportingequipment paid for by moms and dadsas well as the exorbitant fees associatedwith participating on one of the teams.

All of this further confirmed for me that,although well-intentioned, parents andcoaches contribute to the increasinglywinning-obsessed, stat-focused,talent-glorifying youth sports culture oftoday. While it may seem harmless, such aculture can lead to young athletesexperiencing less enjoyment, heightenedperformance anxiety, and increased risk ofburnout.

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Keeping Kids Safe in the Heat (continued from page 3)

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In considering the toxicity of today’s youthsporting environment, parents may quicklyturn to the sensational headlines revealingoff-the-field father brawls andcoach-vs-umpire physical altercations.However, these violent physicalconfrontations, thankfully, are rare. Thesubtler, nonviolent everyday interactionsbetween parent and child or coach andathlete are far more common and perhapsjust as harmful. This article will addresshow to assist youth in developing differentperspectives on sports and provide tips toparents and coaches to facilitate thisalternative approach.

To create the ideal environment for youngathletes, let’s consider why kids themselvesenjoy sports. Youth sports organizationshave surveyed thousands of children onwhy they play their sport, and two themescontinually prevail: fun andself-improvement. Kids form a connectionto a sport or activity when it is enjoyableand they feel that their skills are improving.While children have a natural curiosity tolearn and will respond positively to beingsuccessful, young athletes rarely identifywinning as a motivator for playing theirfavorite sport. “Being the best” and“obtaining a college scholarship” areseldom mentioned. Those desires are oftenadult-constructed and media-driven.

As children are the central participants inyouth sports and have candidly reportedon why they play their sport, it is importantto align the goals of the team, coach andparents with those of the children. Mostimportant at the youth level are thefollowing goals:

• Fun• Safety• Personal growth and development (thisincludes learning such skills as workingwell with teammates, sportsmanship,leadership, building friendships,accepting defeat, and physical skilldevelopment)

The primary focus, then, should not be on ayoung athlete enjoying an undefeatedseason, nor must it be on the playerexcelling at such refined skills as perfectlyexecuted double plays and drag bunts.Those are undoubtedly important, perhapsprimarily so at higher levels. However, atthe youth level these are not as significantas helping the athlete develop a sense ofpassion for the sport. Many elementaryschool-aged children lose their passion forsports during these years because theyfeel unable to live up to the pressure-filledexpectations that accompany a

winning-oriented competitive environment.This typically results in a high dropout rate,occurring most frequently at the middleschool level. These negative outcomes canbe minimized by shifting the focus tohappiness, not performance.

Young athletes’ goals can change in apositive way over the course of a seasonwhen their coaches create a focus onpersonal excellence rather than a focus onwinning. This means that when parents andcoaches stress positive communication,teamwork and doing one’s best—actingexcellently—a child will believe that he orshe can accomplish more challenginggoals. The opposite happens in azero-sum, results-oriented climate, typifiedby many professional sports coaches,which focuses on winning at all costs. It isunderstandable why children whose senseof self-esteem and worth are placed solelyon winning would have troubledemonstrating good sportsmanship after aloss.

So, stressing a climate of personalexcellence and reinforcing positiveepisodes for your children—for instance,good performance, good hustle, goodexamples of sportsmanship orleadership—will help build confidence andincrease their passion for participating.Asking young athletes questions like, “Whatdid you do well today?” or “What was themost exciting or fun part of the game?”rather than “Did you win?” sends apowerful message. After all, in a child’seyes, when a parent’s or coach’s love andapproval depend on the adequacy andcompetency of performance—in otherwords, “the better I play, the more love I’llget”—sports are bound to be highlyevaluative and highly stressful.

Shifting toward a culture of enjoyment,self-referenced growth and personal effortand away from a culture narrowly focusedon winning and statistics may effectivelycultivate passion within our youth athletes.This passion can lead to success on thefield. But more important, passion results insustained performance, rich socialexperiences and positive self-esteem.

THE ATHLETE’S KITCHEN

Your OverweightChild: What’s aSports Parent toDo?by Nancy Clark M.S., R.D.

“My son is chubby. What can I do to helphim lose weight?

“My ten-year-old niece sure could skip afew meals…”

“One of my kids is skinny but the otherchild is chunky. How can I feed one butrestrict the other?”

Most readers of my sports nutrition articlesare lean and fit. But with more than 60% ofAmericans being overfat or obese, youlikely have relatives who are fat, unfit andunhealthy—perhaps even your fifth-gradedaughter who is pudgy or your chunky sonwho loves TV.

As a sports parent, you can be a good rolemodel for athleticism and healthful foodchoices. But when it comes to controllingyour children’s eating and exercisepractices, you likely feel more and more outof control with each passing year. Onceyour child is old enough to march off to thecorner store to spend his or her allowanceon candy, chips and soft drinks, what canyou do to regain control without becomingthe food police—especially if your child isoverweight?

The answer is complex, under-researched,and a topic of debate among parents andpediatricians alike. We know that restricting

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Positive Youth Sports Culture (continued from page 4)

a child’s food intake does not work. Rather,restricting kids’ food tends to result insneak-eating, binge-eating, guilt andshame—the same stuff that adultsencounter when they “blow their diets.” Butthis time, the parents become the foodpolice—an undesirable family dynamic.The following tips are based on informationfrom books by family feeding expert EllynSatter: Your Child’s Weight: Helping WithoutHarming and Secrets of Feeding a HealthyFamily.

Food restrictions cause problemsDespite your best intentions to preventcreeping obesity, do not put your overfatchild on a diet, deprive him of French fries,nor ban candy. Dietary restrictions don’twork—not for adults, and not for kids. Thinkabout this: If diets did work, then themajority of people who have dieted wouldbe lean. That’s far from the case.

Diets for children cause more problemsthan they solve. They disrupt a child’snatural ability to eat when hungry and stopwhen content. Instead, the childovercompensates and doesn’t stop whenhe’s content (binges) or stuffs himself with“last-chance eating.” A danger is that thementality becomes, “Last chance to havebirthday cake so I’d better eat a lot nowbecause when I get home, I’m restricted tocelery sticks and rice cakes.”

If you are a parent of a chubby child, notethat children commonly grow out beforethey grow up. That is, they often gain bodyfat before embarking on a growth spurt.Instead of putting your daughter on a diet(which damages self-esteem and imprints

the message she isn’t good enough theway she is), get her involved in sports andother activities. You can delicately ask ifshe is comfortable with her body. If she isdiscontent with her physique andexpresses a desire to learn how to eatbetter, arrange for a consultation with aregistered dietitian who specializes inpediatric weight control. (Use the Academyof Nutrition and Dietetics’ referral network atwww.eatright.org.)

Is your child really overfat?If you are feeling anxious about your child’sweight, get some professional advice fromthe pediatrician to determine if the problemis real. You must remember the body your10-year-old daughter has duringpre-puberty will change as she grows anddevelops. You can also monitor your child’sweight on charts available athttp://www.cdc.gov/growthcharts/.

Some parents are rightly concerned abouttheir child’s weight. We are seeing moreand more medical problems with childhooddiabetes, high cholesterol and high bloodpressure. But for other parents, theconcerns about their child’s weight reflecttheir own anxiety about having an“imperfect” kid. Yes, you say you want tospare your child the grief of being fat—butbe sure to also examine your own issues. Ifyou yourself are very weight-conscious andput a high value on how you look, you maybe feeling blemished if your child is overfat.Often, the child’s weight problem is reallythe parent’s issue. You may want a “perfectchild.” Working through this issue willrequire some sincere self-reflection.

Be sure to love your overfat child from theinside out—and not judge him from theoutside in. Just little comments (“That dressis pretty, honey, but it would look evenbetter if you’d just lose a few pounds…”)get interpreted as “I’m not good enough.”Self-esteem takes a nosedive andcontributes to anorexic thinking, such as“thinner is better.”

Weight management tipsSo what can you do to help fat kids slimdown? Instead of maligning them andtrying to get them thin by restricting food,we can get them healthier by helping themsee the benefits of being more active. Thiscould mean watching less TV, planning

enjoyable, physically active family time,and perhaps even creating a walkingschool bus with the neighborhood kids. Asa family, you might want to sign up for acharitable walking or running event. As partof a society, make your voice heard aboutthe need for safe sidewalks, health clubsthat welcome overfat kids, and swimmingpools that allow children (and adults, forthat matter) to wear T-shirts and shortsinstead of embarrassing bathing suits.

Food-wise, provide your kids withwholesome, nourishing foods as well assemi-regular “junk foods” (otherwise, theywill go out and get them). Encourage themto eat breakfast. Plan structured meals andsnacks; take dinnertime seriously. Your jobis to determine the what, where and whenof eating; the child’s job is to determinehow much and whether to eat. (That is,don’t force them to finish their peas, norstop them from having second helpings.) Ifyou interfere with children’s natural ability toregulate food, you can cause a lifetime ofstruggles. Trust them to eat when hungry,stop when content—and have plenty ofenergy to enjoy an active lifestyle.

The Athlete’s Kitchen (continued from page 5)

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Sports Health & Safety Institute. TheInstitute’s mission is to advocate foradvancing and disseminating the latestresearch and evidence-based education,recommendations and policy to enhancethe experience, development, health andsafety of our youth in sports(www.NYSHSI.org). Also, ACSM andgroups such as the American Academy ofPediatrics and the American MedicalSociety for Sports Medicine publishposition statements on various pediatricsports medicine topics, which can beaccessed online by health professionals,coaches and parents.

To describe the state of youth sports, thereis an interesting interview by DennisManoloff of the Cleveland Plain Dealer withDr. James Andrews, the famous orthopedicsurgeon recognized as a top go-to expertby athletes in Major League Baseball andthe NFL. Dr. Andrews discusses hisconcerns of specialization in one sportwhere young people are playing the samesport all year, which increases their riskfactors for overuse injuries.

Dr. Andrews also expresses concern aboutprofessionalism, where children train asseriously and intensely as pro athletes,which can lead to excessive pressure. Herecently wrote a book with Don Yaegercalled “Any Given Monday: Sports Injuriesand How to Prevent Them, for Athletes,Parents and Coaches—Based on My Life inSports Medicine.” He also works with theAmerican Orthopedic Society for SportsMedicine’s youth program Sports Traumaand Overuse Prevention to help educateand promote safe practices in youth sports.

We must get the word out to the playingfields and into family conversations so thattraining at safe activity levels is the norm.Individuals and organizations in youthsports must all play a part in spreading theword. I remember the advice of a fantasticphysician, researcher and advocate, thelate Dr. Oded Bar-Or. The most importantthing for children’s sports, he said, is tohave fun.

Q&A (continued from page 2)

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Unfortunately, to date there is no helmet,mouth guard, or padding that can preventa concussion. Through a combination ofeducation and proper medical treatment,we can train coaches, athletic trainers andother medical professionals, athletes andparents to recognize the signs andsymptoms of a concussion in order to bestmanage this population of youth athletesand to allow them to safely return to theirsports. My best advice: WHEN IN DOUBT,SIT THEM OUT.

Concussion in Youth Sports (continued from page 2)