When I saw this story today on the BBC News Health page, two simultaneous thoughts popped to mind: parents would be nervous and US pediatricians would once again have to defend our stance that EKGs are not needed as a routine part of youth sports health screening (a/k/a the pre-participation evaluation or PPE).

This issue, to screen or not to screen for heart disease with EKGs, is not new. This is one of the more deeply discussed and hotly debated topics in child health today. The topic gets discussed routinely but also when headlines rattle us, such as when 13 year old Justin McAfee, an Idaho baseball player, collapsed of a supposed heart attack this past spring while running the bases in a Little League baseball game.

When that story broke, I turned to one of the top pediatric cardiologists in the country, Dr. Reggie Washington from Sky Ridge Medical Center in Colorado, for answers. Dr. Washington told me:

1. “True heart attacks (myocardial infarctions) are extremely rare in children."
2. “The most common causes (of heart attack-like events) are not myocardial infarctions but some muscle issue with the heart”.
3. “The American Heart Association and American Academy of Pediatrics are opposed to routine global screening for heart disease in athletes”. Instead, Dr. Washington explained that screening is done if a patient has symptoms or if there is a family history of heart disease.

Different countries do practice medicine differently. We often learn a great deal from our International colleagues but that doesn't mean that we are always going to agree. We have to make sure the means justifies the ends whenever we recommend a test for a child, or an adult. So far, EKGs are not a good screening test when the physical examination and family history are both squeaky clean.

So, call your pediatrician if you are concerned about your child's heart health. A good review of your family history with a complete examination of your child will help your pediatrician decided if your child fits the criteria for a more thorough heart screening. And, just in case, have all adults and teens in your home learn CPR. We all have to be realistic that heart health sometimes changes despite our best preventive efforts. As we learned with Justin last last spring, it really is a life saver.

For more information on heart health in kids and why you should learn CPR, click here.

Where sports are concerned, our inner need to protect our kids can sometimes be at odds with our desire to allow our kids to spread their wings.  While most sports are safe with proper equipment and coaching, there are always risks involved, especially with contact sports. The question is, how safe is some of the specialized equipment our kids are asked to use, such as chest protectors? 

Doctors and researchers have been particularly concerned about sports safety and have spent countless hours and research dollars try to develop new safety equipment for our young athletes. One are of particularly high interest has been in developing  reliable chest protector to protect against one of the most dangerous and sometimes fatal heart injuries seen on the field today, commotio cordis. Commotio cordis occurs as a result to a blow to the chest, most notably the sternum, during which time a sudden disruption in the way the heart beats results in sudden cardiac arrest in an otherwise normal young athlete.  Wearing chest protectors as well as automatic external defibrillators (AEDs) on the sidelines are all efforts intended to battle back against the rare moments commotio cordis occurs. 

You've likely seen one of the currently available chest protectors if your child plays a contact sport such as hockey, baseball, or lacrosse.  These chest protectors do provide some protection aginst blows to the chest, and most kids do survive their blow to the chest. However, a recent commentary in Pediatrics revealed that these protectors still only adequately protect 2/3 of athletes struck in the chest  and that 40% of blows to the chest are still resulting in fatalities.  So, while we can be reassured that more kids are surviving a blow to the chest, it's disappointing that the years of research time and millions of research dollars hasn't yielded a more favorable outcome. 

In fact, if you tease through the results given in that commentary closely, there hasn't been anything new to the market in a few years. Seems to me we need a new research and R&D approach in the chest protector development industry on all levels. The answer could be a new design or a new material. We won't know until someone looks at the situation with eyes wide open and a willingness to consider new ideas and options. So far, the same old, same old doesn't seem to be helping our kids the way we hope. 

Until that day arrives and someone develops a more reliable chest protector, we need to protect our athletes on the field in other ways. First, we need to be sure that the rules are followed appropriately. Illegal checks and roughhousing only increase a child’s chance of suffering a blow to the chest. Second, we need to make sure proper pads are worn at all times for all activities that put the chest at risk. The current chest protectors are better than nothing at the moment! Third, AEDs and CPR training is a must on the sideline. Many leagues now have EMTs and certified trainers on the sidelines. If your team doesn't, be sure someone has 911 programmed into a cell phone. When seconds count, you don't want to take any more time than the press of 1 button. Also, be sure that cell phone is charged!!

Keep in mind that your child's pre-participation evaluation or sports screening examination just captures a moment in time and doesn't truly take into account the stress your child's body is under while competing. Any new symptoms that develop after that evaluation need to be investigated by your pediatrician, especially ones that occur during exertion, such as getting winded or dizzy or feeling faint or queasy or having chest pain or developing a head ache. Better to have a symptom checked out and have it be nothing than to find that a major medical problem was brewing. 

Finally, our sports screening exam itself needs to get a check up each year. I'd like to see an annual evaluation of our sports screening practices against those in other countries just to be sure we are still doing what is in the best interests of the health and safety of our kids.  With new sports screening data constantly coming in from around the world, we have to always be willing to say there is another way or a better way to keep our kids safe while they compete in the sports they love and push their bodies to amazing extremes.  Other countries rely on US data all the time to guide their medical practices. It would be arrogant of us to not do the same. 

Keep in mind that medicine is an evolving science. What works for us today in keeping kids healthy on the sports field may not work tomorrow. But, we won’t ever know if we aren’t brave enough to ask some tough  questions and take another look  at sports health screening and chest protectors from as many angles and perspectives as we can. Our kids deserve at least that much from the research dollars being used in the name of their health and safety, don’t you think?

A couple week's ago, I caught an episode of Ellen with my daughter that had an unusually inspiring story involving college softball players.  One of the players, Sara Tucholsky, tore her ACL after hitting a home run and fell to the ground in incredible pain. By league rules, her teammates could not touch her until the inning was over or she would be out. The opposing team’s firstbase player asked the umpire if she and another of her teammates could carry her around the bases instead so the run could count – he was puzzled but allowed it!  So, Mallory Holtman and Liz Wallace carried Sara around all the bases. The run was allowed and Sara's team won the game.  By the way, this was Sara's first home run ever!!

Here’s the segment complete with a clip of the famous carry around the bases. I love the cheering and clapping as the girls ‘round third base – by both sides!! And, the UTube clips of the same story (also worth viewing).

The comments on The Ellen Show website speak volumes of so much of what is good and not good in sports today: 

• “Things can get very competitive and people can get down right nasty. I am a firm believer that sports should and can be fun as well as competitive, if you don't have fun the competition will turn you sour.”
• “It's an incredible thing to see that in today’s world of "it's all about me" philosophies that even rivals in competitive sports can take the time to show such amazing compassion.”
• “As the old saying goes..."It's not who wins or looses, it's how you play the game." Too bad more people don't understand that.”
• “This just goes to show that not all universities focus on sports and winning. Sportsmanship is more important than any win.”
• “Professional athletes take note. This is what sportsmanship is!!!!!!!!!!!”

A picture really does speak louder than words. Show this video to your kids. Make sure your kids’ coaches see this video. Any coach who thinks this video doesn’t represent the core of what youth sports must be has no business coaching our kids. This example may be on the collegiate level but represents the values we need to instill in all sports on all levels. These players’ parents and coaches are to be congratulated for getting it right. Those girls wouldn’t have had the value system to have come up with that idea on the spot if they had not been raised in some sort of child-centered, positive, team focused sports environment.

What’s beyond amazing is the fact that winning and losing were not part of anyone’s thinking. The game was about playing the game and doing what was right when it mattered. The outcome was not what was important. If that was the ultimate objective, Mallory and Liz wouldn’t have dared attempt to be so self-less. But, they were. They only thought of helping Sara, a girl they didn’t know, be able to credit the run she had earned. Fair is fair regardless of what team you are on.

The girls were sent to a spa by Ellen as a reward for this amazing demonstration of sport-womanship. Sara won player of the year and Mallory and Liz own an ESPY.  In the clip, I was impressed by the modesty of these players which makes all these rewards even more deserved. They didn’t go out to win anything – they just went out to play softball the best they could with the highest degree of ethics possible.

One mom’s comment sums of this situation the best:

 “I'm tired of seeing professional athletes that later are busted for drinking, drugs and other inapproprate actions. These are the role models I want my kids to look up to!”

I couldn’t agree more! Thanks, Ellen, for reminding us of what still is right in sports – and what we must make sure is present and accounted for in all sports leagues for kids of all ages...including the pros. 

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Do you remember Dr. Spock's motto, "Live long and prosper"? Great words to live by and a dream all parents have for their kids. However, today's kids may not get to adulthood without some sort of long-term problem created by the sports they love. A recent article in the The Boston Globe with some of the country's leading pediatric orthopedists drives that point home.

Aptly titled "Torn ACLs, other big Injuries hit little athletes," the article is a healthy mix of stories about real kids injured in sports with current statistics and recommendations to help potentially improve the future. The first paragraph is a sobering reminder of the type of overuse injuries are kids are facing these days in sports: a stress fracture of the lower back in a teen gynmast, a torn ACL in a pre-teen soccer player, a stress fracture in a runner's leg, a teen basketball player with a torn meniscus.

This list of injuries is not the result of selection bias by looking into the waiting room of a specialist's office. These are truly the type of injuries kids are suffering in sports today - and most start out being seen in pediatric offices just like mine. And, as the article acurately states, the number of kids injured like this due to sports is most certainly on the rise. In fact, 3.5 million kids were seen for sports related injuries in the last year alone. It used to be I'd see a handful of bad injuries for every sports season. Now I can count on seeing at least a few a shift. No longer can I assume an injuried child has "just a sprain" or "just a bruise". While some kids luck out with these minor injuries, many more do not and end up needing to be referred rather quickly to an orthopedist.

What always amazes me in the wake of a bad injury is when I'm asked when the kids can return to play. Honestly, that should be furthest from your mind as a parent. Kids who injure themselves this severely must be allowed to heal correctly and that does take time. Just think about the DL list for the pros. I blogged about this recently, in fact.

Even more concerning than the rate of rise of youth sports injuries is the type of injuries we are seeing. Many of these injuries are injuries we never used to see in kids that are occurring because kids' bodies are being pushed more intensely and at younger ages than ever before. This has simply got to stop! As Dr. Dr. E. Lyle Cain, an Orthopedist from Birmingham, AL, told The Globe, "Youth athletes are not the same as small adults." And some injuries "can cause permanent damage that affect their future growth."

We have to remember that everything our kids do in their childhoods impacts their future lives. Youth sports should be helping our kids become more fit and healthy and instead it is having the exact opposite effect.

The good news is we can stop this madness! How? Simple: change the pace of our kids' youth sports lives by trying to meet these goals:

1. We have to stop pushing our kids so hard, so young.

2. We have to let their injuries heal when they occur. 

3. We have to give them more variety in their sports and fitness program year ‘round. 

4. We have to let kids have time for recreational sports in the form of form of free play.

The last point is perhaps the most important for our kids' overall health and the point youth sports experts have been advising for a while now. Dr. Kocher told The Globe that increasing the amount of basic outdoor fun has another very important benefit for our kids: it is protective for ACL injuries: "A lot of the stuff kids used to do in free play was ACL prevention," he says. "Now they don't get that, and they jump into high-level soccer.""

Talk about cool - and not requiring a carpool or fancy sports equipment!!

Sports and fitness are important to overall health and development but have to be incorporated into childhood the right way. At the moment, the injury rate and types of injuries are telling us that the mix is all wrong. So, let's regroup and try a different path. Free time with more play path is honestly the only path our kids have not been allowed to be on much and the one we have to let them travel on more while they are still kids. Their health and well being, today, tomorrow and in the future count on you being able to find them that time.

This is a good thing, really. But, I do worry that some drinks have gotten a bad rap due to our quest for health.

Last year, the Associated Press reported that the vending machine industry is now stepping up to pull non diet sodas from their machines in public and private schools over the next 3 years. These measures plus State measures in place in 22 States will dramatically cut calories for many of our kids. So, as I started out saying, all good.

But, even better for me was the news in the same report that sports drinks will still be available in high school. Diet drinks will be there, too, but it is the sports drinks I want to see available. Surprising? Not at all when you consider the facts.

I'll touch on the soda issue very briefly because what I really want to talk about is sports drinks. The bottom line on soda for me is I can't really think of a good reason why young kids need to have soda. So, don't give it to them. For tweens, limit soda to once in a while and special occasions but steer them to the diet varieties to limit calories. They are going to be having soda when on their own with their friends so better to help them develop a taste for the diet version than the regular. And, we all know teens drink soda so diet is all that should be available and it is appropriate for them to have more choices even at school as they are almost adults.

As for sports drinks, I have no problem with them being banned for regular use - this is appropriate. Sports drinks were not designed to be utilized as a regular use drink and replace water and milk for our kids. Plus, like soda, sports drinks are empty calories when used as as regular drink.

However, if used as designed, as a rehydration solution, sports drinks do have a significant role for our young athletes, and one that is supported by science. Our young athletes work hard - they sweat and their bodies utilize a great deal of energy when they exercise and play team sports in school. This is true regardless of the outside temperature but even more true if the season is warm. When our kids' bodies work like this, and especially when the temps outside are warm, our kids sweat a great deal loosing sugars and salts as well as water. So, just drinking water along as is the practice now on many sideline won't cut it. Kids do need sports drinks to maintain their balance when all is said and done.

So, I worry that a flat of ban of sports drinks as "bad" is hurting our young athletes and I've seen many a middle school and high school athlete in my office very dehydrated after a game because all that was available on the sidelines was water. I encourage serious young athletes to preload with a sports drink and postload with one as well if all that is available during a game or practice is water to avoid becoming dehydrated and that seems to work well. In fact, I tell parents of all kids participating in youth sports to keep sports drinks at home and I review signs of dehydration to keep an eye on. While the goal is to avoid dehydration, better to treat as soon as you recognize than to miss altogether. If you are not sure what the signs of dehydration are in young athletes, click here.

This is really a long winded way of saying that not all drinks are bad if used at the right ages - and at the right times. And, perhaps it's time us parents acted as better role models at home and just stopped allowing our kids to drink certain drinks. Just a thought.

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(Post republished from Dr. Gwenn Is In)