It is Safe to Play Outside in this Heat?

We all know about the scorching temperatures across the country. Even here in Denver where it’s relatively mild until August, we’ve already been dealing with 100 degree heat!

Every year there are heat-related deaths on the sports field.  This happens particularly in August when the heat is at its worst and fall related sports are getting into full swing.  How does this keep happening you ask?  Well … state high school sports associations have been slow to adopt rules to make practices safe in extreme heat (although things are dramatically better than they used to be).  And of course, kids sports prior to high school age are often not legislated at all in terms of rules regarding practicing/playing in the heat.

So when does it become unsafe to practice outside?  And what precautions should be taken? Generally, when the heat index (which takes into account relative humidity) climbs above 100, practicing and playing outside assumes a much larger risk of dehydration, heat illness, and heat stroke.  When the heat index is 90-100, ample water should be provided, and athletes should have unrestricted access to it (for example, there shouldn’t only be one water break per practice).  And the heat index should be re-checked one or more times during a practice or game if the heat index is approaching 100.

If the heat index is 100-104, you should begin to think about canceling outdoor activities.  Water breaks should be mandatory every 30 minutes, and toweling down with ice cold towels should be encouraged.  And when the heat index is 105 or above, play or practice should be stopped and moved inside.  Two-a-day practices (common practice in fall sports like football) should be reconsidered when the heat becomes an issue, and certainly, practicing when it is cooler earlier in the morning is a smart idea.

What are the consequences or the heat and how do athletes get in trouble?  Severity of heat related medical problems ranges from dehydration, to muscle cramps, to heat exhaustion, to heat stroke.  With each step, an athlete gets progressively sicker and important attention needs to be paid to an athlete progressing towards heat stroke.  The biggest indicator that an athlete is headed toward trouble is if he or she starts acting abnormal (aka altered mental status). They may become combative, aggressive, and clearly not act like themselves.  If medical personnel are available at that point, the athletes temperature should be taken and they should be immediate immersed in an ice bath if possible.  And call 911!

The heat shouldn’t be ignored when your child is playing a sport outside. As a parent, you definitely have a role if you think limits are being pushed in play or practice!

Rachel Brewer, MD

Ankle Sprains

Ankle sprains are one of the most frequent presenting problems that we see in kids and adolescents.  The important thing is to recognize when you should take your child to be evaluated if they experience an ankle injury and also understand how to treat and rehab the injury at home.

First, like I’ve said before …. young kids don’t sprain stuff.  What does that mean?  It means that their bones are the weakest link since their growth plates are still open, and that the growth plates get injured with a joint injury, not the ligaments.  You can “sprain” a ligament, not a bone.  Once a child’s growth plate closes, they are more apt to truly sprain a joint.  Ligaments get “sprained,” and muscles get “strained.”

Ok, so your kid twists his ankle at soccer practice.  Should you run to the ER?  If the foot or ankle appears deformed or pale, yes.  That means there likely is a serious fracture.  If your child has immediate swelling in his ankle and can’t bear weight, it is also important to be seen.  However, call your pediatrician first if it is after-hours and they can determine if it is ok to treat the injury at home overnight and be seen the next day.

Bottom line is that most ankle injuries in kids warrant an x-ray – especially if they are young enough where there growth plates in the ankle are still open (prior to puberty).

If your child is diagnosed with a true ankle sprain (again, this is likely in adolescence), then there are several things you can do at home to speed along recovery.  You may have heard of RICE therapy.  This stands for rest, ice, compression (with a brace or ace bandage), and elevation.  This also works for ankle sprains.  Swelling in ankle sprains can be very impressive, and RICE therapy helps swelling go away faster (anti-inflammatories like ibuprofen can also help).  If your child cannot bear weight because of pain, they may need crutches for a couple days.

Kids are generally pretty good at letting pain guide them in terms of being able to bear weight on their ankle if they experience a sprain.  Once they are able to bear weight (when pain has improved), it is ok to progressively start to walk normally again.  If you rest the ankle too long with non-weightbearing that can lead to stiffness and more pain.

Rehab is key to getting through an ankle sprain.  Rehab means moving the ankle, getting the strength back, and also getting back your balance.  This handout shows some great things you can do at home.  Remember, flexibility, strength, and balance are all part of rehab.  Sometimes ankle sprains are severe enough that it working with a physical therapist is required (you can be referred by your pediatrician or sports medicine doctor).

Experiencing an ankle sprain is the biggest risk factor for having another one in the future.  A brace called an ASO (a lace-up ankle brace) is very helpful at preventing ankle sprains.  It is important to wear the brace during any cutting/pivoting sports.  Once you “stretch” the ligaments during an ankle sprain they never “tighten” back up – that’s why wearing a brace is very important!  You can get a lace-up brace from your pediatrician or sports medicine doctor.

Rachel Brewer, MD

Overuse Injuries in Kids: Is There Such a Thing as Too Much Sports?

With an obesity epidemic in this country, the question of whether kids are being too active rarely comes into play. However, if your child is over-scheduled with sports leagues or is over-training in the same sport, he or she is at risk for an overuse injury. Here’s some common questions/answers to this topic:

What is an overuse injury? Overuse injuries are chronic injuries that occur with repetitive stress on the musculoskeletal system over a course of time without allowing for adequate recovery. Pediatric athletes are prone to overuse injuries causes by stresses placed on growing bones.

What are common overuse injuries in kids? The most common overuse injuries in kids are tendinitis, stress fractures, knee cap pain (patellofemoral pain), and apophysitis (inflammation where muscles attach to bone).

How much is too much? The answer to this question differs for every child. It usually becomes clear when a child is over-training. Fatigue, pain, or disinterest in his or her sport are common signs that a child is developing an overuse injury. Generally, they do not have adequate rest between sports activities.

How do I make sure my child does not acquire an overuse injury? Make sure your child has built in rest days in the weeks of scheduled sports activities (don’t forget that PE also counts as an activity). Also listen to your child if he or she complains of pain or fatigue.

What is the treatment for an overuse injury? Rest is the first line of treatment. Each overuse injury has more specific treatment, but generally the treatment includes physical therapy, ice, anti-inflammatories (like ibuprofen), and possible bracing or orthotics.

Every sport has common overuse injuries. For instance, young baseball pitchers are prone to acquiring “Little League Elbow” (a type of apophysitis). It is important that you are aware of what the most common injuries seen in the sport your child participates in. Included in the links and resources section is a website with sports specific resources and injury prevention information (STOP sports injuries).

Rachel Brewer, MD

Hot Topic – Concussion in Young Athletes

Concussions are a hot topic in the media lately, and you can’t watch the news or Sportscenter without hearing about an athlete who is affected by a head injury. Concussions not only affect pro athletes, but they are also common in kids who play contact sports. It is very important for parents to understand what a concussion is and how it is treated.

A concussion is a brain injury caused by a direct blow to the head. You don’t have to lose consciousness to have a concussion. Even “getting your bell rung,” or what you think is a mild bump to the head can be serious. The most common signs and symptoms of a concussion are headache, dizziness, nausea, confusion, behavior or personality changes, difficulty sleeping, and sensitivity to light and loud noises. There are many more symptoms of a concussion, and they can occur directly after the injury or days later. Bottom line – if you feel like your child is not acting like his or herself after a head injury, seek medical attention right away.

There is no simple test for a concussion. We use many tools to determine if a child has a concussion including neurocognitive tests, evaluation of signs and symptoms, and the physical exam. Getting a CT scan of the head is only indicated if we suspect a more serious diagnosis (such as a brain bleed or skull fracture) – a CT is normal with only a concussion.

Just like you rest any other part of the body when an injury occurs, a concussion requires “brain rest.” This means limited stimulation with school, TV, computers, video games, texting, etc. When symptoms improve, the medical team, family, and school work together to get your child back to these activities gradually. The tests used to diagnosis a concussion are also used to determine when it is safe for a child to return to play. In general, kids take longer to recover from a brain injury than do adults (usually 3-4 weeks). Kids are not all the same in how long it takes them to heal, but each should be symptom free before returning to play.

There are definite risks for letting your child return to sports without letting a brain injury resolve, which include prolonged concussion symptoms, possible death due to more severe brain injury, or long term cognitive effects. Also, if a child sustains one concussion they are at higher risk of sustaining another concussion in the future.

Again, as a parent, it is important to recognize that a concussion is a serious diagnosis and that if your child is not acting like his or herself after a bump or blow to the head that you seek medical attention. Included in the links section is a great website by the CDC for education on concussions for young athletes, coaches, and parents.

Rachel Brewer, MD