SPORTS

A PARENTS’ GUIDE FOR

THE Y

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kidM A G A Z I N E

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A PARENTS’ GUIDE FOR

THE Y

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kidSPORTS MAGAZINEFall 2013

BalancingSports &Family

Feature Story

BalancingSports &Family

Feature Story

Caffeinated Sports Drinks

Foot and AnkleInjuries

Playing Sports with Asthma

Caffeinated Sports Drinks

Foot and Ankle Injuries

Playing Sports with Asthma

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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 ath-

letes. 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 priori-

ties. 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 caf-

feinated 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

thismonth’slineup3 The Effect of Caffeine on Kids

4 Balancing Sports and Family

6 Foot and Ankle Injuries

8 Hockey Injuries

10 Avoiding Eye Injuries

12 Athletes and Asthma

Welcome

SPORTS

A PARENTS’ GUIDE FOR

THE Y

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ATH

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kidM A G A Z I N E

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f your child is active in sports, there likely hasbeen or will be a time when he or she asks for

an energy drink or sports drink. They may haveseen their friends drinking one or they believe the ads that say the drink will improve energy, decrease fatigue and improve performance. As aparent you may be wary of how your child is hy-drating. So, let’s take a closer look at the differencebetween sports drinks, energy drinks and caf-feinated drinks in general.

A sports drink is aflavored drink thatcontains sugar tomaintain energy levelsduring exercise, pluselectrolytes, salt andpotassium, which arelost through sweat andnecessary to maintain-ing hydration. Sports

drinks are appropriate for children who are partici-pating in an hour or more of higher intensity exercisedaily. For the average child who may be physically active less than an hour per day, drinking water is thebest choice. Drinking a sports drink increases intakeof calories from sugar, which can lead to being over-weight and tooth decay.

Energy drinks are also flavored drinks that con-tain sugar, but they also contain stimulants, suchas caffeine, guarana, taurine, ginseng and crea-tine. The stimulants in energy drinks are toutedto increase energy levels and hence improve athletic performance.

The problem is that the effect of caffeine on

young athletes’ performance has not been studiedand many energy drinks do not list the caffeinecontent on their packaging. Though the UnitedStates has not determined guidelines for caffeineintake for kids, the Institute of Medicine statesthat, “stimulant-containing energy drinks have noplace in the diets of children or adolescents.”

The risks seem to outweigh the benefits giventhat there are side effects associated with caf-feine, which include:

• Increased heart rate and blood pressure• Jitteriness and nervousness• Upset stomach• Decreased attentiveness• Sleep disturbancesDepending on the amount of caffeine in an

energy drink and the volume consumed, caffeinetoxicity and addiction are possible.

The primary source of caffeine for childrencomes from soda (or pop). Though the caffeinecontent of soda is less than in energy drinks, it pro-vides no nutritional value. Drinking soda and en-ergy drinks means kids are missing out on essentialvitamins and minerals that they could get by drink-ing more nutrient dense drinks, such as 100 per-cent fruit juice and milk.

So, the recommendation is that sports drinksare suitable for active child athletes, while energy drinks and soda are discouraged andshould be replaced with water, 100-percentfruit juice and milk.

By Katherine Patton, MEd, RD, CSSD, LD, aCertified Specialist in Sports Dietetics for

Cleveland Clinic Sports Health. To schedule an appointment, call 877.440.TEAM.

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eatingright

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The Scoop on Caffeinated Beverages for Young People

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oday’s kids are more involved in school and

organized sports than ever before. During the school yearespecially, this means fewer din-ners as a family and less down-time as the whirlwind ofpractices, school homework andearly wake up calls get underway.

Cleveland Clinic child andadolescent psychiatrist MollyWimbiscus, MD, says, “Fami-lies love sports, but parentsjust need to be aware of thestress it can cause and do whatthey can to help their kids bal-ance priorities.”

Here, Dr. Wimbiscus pro-vides some advice on howfamilies can achieve that bal-ance between sports, familyand academic life.

KS: In your practice, do yousee sports activities being anissue for families?Dr. W.: Yes—especially forfamilies involved in travelingsports teams, multiple compe-titions and more than weeklypractices. The time commit-ment and interruption inevening and weekend activi-ties can be a real issue.

KS: So, what are the pros ofbeing involved in sports?Dr. W.: There are many goodthings about being involvedin sports, including socializa-tion with peers, a sense of be-longing, satisfaction in skillmastery, learning good sports-manship and working hard to-wards a goal personally and asa group. And of course, stay-ing active. With childhoodobesity an issue, and one inthree children not gettingenough exercise, it is a goodthing when kids get involvedin sports.

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Balancing Youth Sportsand Family Life

Q&A

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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 withacademic success and cause stress. Sometimesthe focus on the athletic competition can out-weigh the value of thesports activity. It can alsointerfere in family life,evening activities, diver-sity of activities and mas-tery in other areas. And itcan easily begin to inter-fere in sleep schedules ifchildren have eveningpractices and they have tofinish homework. This iswhy it is so important tobe disciplined about stay-ing on a schedule withpractices, homework andbedtimes.

KS: How can parents helptheir kids stay healthy?Dr. W.: Always monitor their functioning in academic, social and emotional spheres. If behaviors, sleep patterns, grades, social en-gagement and emotional responses begin tochange, discuss these changes with your child.Be open in talking with him or her and discussa plan to make things better. KS: Will kids talk about their feelings of beingoverwhelmed? Dr. W.: Each child is different. Some childrenmay love sports and not recognize the strain it iscausing them. Others may be capable of explain-ing the stress of their lives. It’s up to parents torecognize issues and talk with them about it.

KS: What recommendations do you have forfinding balance?Dr. W: Don’t forget your priorities. It is OK to

take a day off of the game or a practice if it is aspecial holiday or family event. Let the coachknow beforehand. Sometimes family and per-sonal priorities need to come first.

Many times, less IS more! When parents feelthe strain of having too many sporting events and

don’t get the personal andfamily time to check in andengage with their children, itmay be time to decide whatsports and activities are mostimportant and which ones canbe set aside for now.

Your pediatrician can help. Ifyou have tried working out theissues as a family, but stillhave questions and are notsure how to find that healthybalance, talk to your child’spediatrician for advice.

KS:What can a parent do tohelp their children?Dr. W: The time children spendas a family doing fun activities

can be just as valuable for self-esteem and skillmastery. Parents can model good sportsmanshipfor children in many settings. Engage in familyand neighborhood sports activities together suchas community runs, bike rides, swims, and/or hik-ing around your neighborhood or the Metroparks.

And finally, remember: Kids learn by example.Try to be a good role model for your kids by stay-ing active and living in a healthy and balancedway. 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 witha psychiatrist. For an appointment: with a pediatricpsychologist, call 216.636.5860; with a pediatricpsychiatrist, call 216.444.5437.

Molly Wimbiscus, MDChild and Adolescent Psychiatrist

oot and ankle injuries can be common amongchildren and adolescents, particularly those

who participate in contact sports like basketball,football and soccer.

The most-often seen sports-related foot and ankleinjuries are sprains and fractures, according to R.Tracy Ballock, MD, of the Cleveland Clinic Centerfor Pediatric Orthopaedic Surgery. Overuse injuriesare another area of concern.

SprainsMost ankle sprains happen when the young ath-

lete rolls over on the outside of the foot and the liga-ments that connect one or both of the shinbones tothe anklebone are stretched or torn. With an anklesprain, your child will have immediate pain andswelling. If he or she can’t bear weight or has nomotion, this may indicate a more serious injury.

The good news is that most sprains will heal ontheir own. A more serious sprain may require yourchild to wear an air boot until the tenderness hascompletely resolved. Your young athlete can usuallyreturn to sports with a protective ankle brace for upto one more month.

“A common mistake that I see is a child who re-turns to sports too quickly after an ankle sprain,which can lead to several months of chronic anklepain and instability,” says Dr. Ballock.

High ankle sprains are more serious than typicalsprains. This type of sprain occurs when the syn-desmosis—a tough sheet of connective tissue thatbinds the shin bones together between the knee andankle—is stretched or torn. High ankle sprains takelonger to heal and, in severe cases, may require sur-gery to insert a screw to stabilize the syndesmosis.

FracturesAnkle fractures (or breaks) in chil-

dren frequently involve the growthplates, which are the discs of cartilagelocated near the ends of long bonesthat allow the bones to increase inlength. The growth plate is morecommonly injured because the grow-ing cartilage is weaker than the sur-rounding bone and ligaments.

While most growth plate fracturesheal without complications, these in-juries need to be treated immediatelyand often require special attention toavoid future problems with growth.

A stress fracture is the earliest phaseof a bone fracture before the injury isvisible on an X-ray. Stress fractures aredue to the production of microscopiccracks within the bone.

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What to Expect Foot and Ankle Injuries

“If your child does not get sufficient rest, thesesmall cracks can coalesce to become bigger cracks,”explains Dr. Ballock. If your child has a stress frac-ture, it will be treated by a period of rest and immo-bilization in a walking boot until the pain andtenderness have completely resolved.

OveruseA stress fracture is considered an overuse injury.

Overuse injuries occur over time when your childparticipates in repetitive activity without enoughrest. Tendonitis is a common overuse injury involv-ing the foot and ankle. Your child’s symptoms inoveruse injuries happen more gradually, with vagueor subtle pain that is made worse with activity.

“Overuse injuries in children are unfortunatelybecoming all too common in our society,” says Dr.Ballock. “This phenomenon is directly related to theincreasing number of children involved in one sportyear-round, or competing on multiple teams during

the same season.“ So, what is tendonitis? This is excessive soft tissue

stress followed by insufficient rest, which wouldallow recovery. Achilles tendonitis, often associatedwith running or dancing sports, is the most com-mon in children.

For tendonitis, Dr. Ballock says several weeks ofrest and using a rubber heel lift inside the shoe canhelp relieve stress on the Achilles. It usually resolveswith three to four weeks of rest in a walking boot.

What can parents do to help their children avoidfoot and ankle injuries? Experts recommend thatyour child practice good sports technique and havea good period of rest to avoid too much repetition.But keep in mind, these injuries can still happenand your child will heal.

To schedule an appointment with Dr. Ballock or an-other pediatric orthopaedic surgeon, call877.440.TEAM.

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he fast-pace, hard-hitting and high-action inten-sity of hockey have made the sport more popular

among American youngsters than ever before. Thevery idea of a game being played on an ice surfacepractically guarantees a lot of action. And like any con-tact sport, injuries are a part of hockey at any level.

“It’s a high risk sport – you go very fast and there’scontact, so there is a risk for injury,” says orthopaedicsurgeon Anthony Miniaci, MD, with ClevelandClinic’s Center for Sports Health. According to Dr.Miniaci, the most common hockey injuries occur tothe shoulder, knee and ankle.

SHOULDERSShoulder injuries are fairly common, especially sep-

arations and dislocations.Injuries to the AC joint, which is located between

the clavicle (collarbone) and the acromion (roof of theshoulder bone), can occur when a player is hit againstthe boards, disrupting the joint and causing what iscommonly 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 foreither injury, with dislocations normally taking aslightly longer recovery time than separations (4-6weeks for a separation, up to 12 for a dislocation).

KNEESInjuries to the medial collateral ligament (MCL)

and anterior cruciate ligament (ACL) are the mostcommon knee injuries in hockey.

The MCL is the ligament on the inner part of theknee that prevents the knee from bending out, whilethe ACL is in the middle of the knee and prevents theshin bone from sliding out in front of the thigh bone.

ACL injuries are typically more serious than MCLinjuries. Fortunately for hockey players, there are lessACL injuries in hockey than soccer, football or basket-ball, says Dr. Miniaci.

“A skate is on the ice is often relatively frictionlessand can easily slide,” he explains. “That alone makesit very different from basketball, soccer or football,where you end up planting the foot into the turf andthere’s a lot of momentum pushing it the other way.”

ACL injuries occur in hockey, but the lack of repeti-tive jumping and landing leave the ligament less ex-posed to that type of injury. According to Dr. Miniaci,many MCL injuries in hockey occur when a playerrolls up on the outside of another player’s knee.

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What to Expect Hockey Injuries

Recovery time varies. MCL sprains can heal withrest, while serious ACL tears require surgery and atleast nine months of recovery.

ANKLESThe most common ankle injuries in hockey are

sprains – especially high-ankle sprains. A regular anklesprain involves the ligaments on the outside of theankle, while high-ankle sprains involve the connectingligaments that hold the tibia and fibula together.

High-ankle sprains are very common in hockey,says Dr. Miniaci, when the skate becomes jammed onthe 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 takea little more time.

See also Foot and Ankle Injuries article on page 6.

To schedule an appointment with Dr. Miniaci or an-other pediatric orthopaedic surgeon, call

877.440.TEAM.

Equipment changes and a push for less con-tact for younger players is helping to alleviatesome injuries in hockey.

In addition to orthopaedic injuries, concussions can happen in hockey for a vari-ety of reasons. Hits to the head, even inadver-tent, inevitably happen in a hockey games andcan cause concussions. Players often makecontact with the boards or fall to the ice aswell.

According to Anthony Miniaci, MD, changesin coaching, improvements in equipment and afundamental awareness have caused a measur-able decrease in many serious head and neckinjuries associated with hockey. Dr. Miniaci is withCleveland 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’vereally stressed an elimination of hits from behind now, and that’s caused a reduction inserious neck and spinal injuries as well.”

One major equipment change that hasaided in the reduction of head injuries is therequirement of youth players to wear a fullprotective cage on their helmets. Education and awareness are the best way toprevent serious injuries, says Dr. Miniaci.

“There is a push to get a lot of the contactout of the sport at the younger ages,” he ex-plains, “and hits from behind are being elimi-nated. People are more aware of it and themore aware you become of these things, themore you prevent them.”

For more on concussions, read this video transcript with pediatric physicians Paul Saluan,

MD, and Richard Figler, MD.

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An Effort to Minimize Head Injuries

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ach year in the UnitedStates, hospital emergency

departments treat more than40,000 sports-related eye in-juries.

Almost every sport poses the po-tential for an eye injury for yourchild. Any sport in which balls orflying objects are present can posepotential dangers to the eyes –and fingers and elbows can be fre-quent culprits as well.

Types of eye injuries Elias Traboulsi, MD, a pediatric

ophthalmologist at ClevelandClinic, breaks most eye injuriesinto two categories – injuries tothe orbit, and injuries to the eye-ball itself.

The most common of injuries are scratches onthe surface of the eye or bruises on the lid oraround the eye. While they are typically not that se-rious, they can lead to major issues for your child ifnot treated quickly and properly.

More serious eye injuries in sports are ones thatoccur to the eyeball, even though it is not necessaryto penetrate or perforate the eyeball to cause seriousinjury.

“Sometimes something will hit your child’s eyeitself without rupturing it or cutting it, and that willresult in bleeding or hyphema, which means bloodin the chamber of the eye,” explains Dr. Traboulsi.“That’s probably the highest on the list of problemsresulting from an eye injury.”

Hyphema usually resolves itself within a coupleof days, but children with bleeding in the eye

should be taken to an emergency room immedi-ately. Most of the time hyphema heals with no sig-nificant consequences, according to Dr. Traboulsi.Fortunately, injuries that actually penetrate or rup-ture the eyeball are unusual in most sports.

Preventing injuryThe best news is that almost all eye injuries are

preventable. “If your child has well-designed pro-tective eye gear, nothing is going to hit his or hereye 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 shapesand sizes for your young athlete, at your local sport-ing goods store or in many eye doctor’s offices.

“If your child is playing contact sports, sportsgoggles can be made with a prescription,” says Dr.

Avoid sports injuries with proper eye wearSafetyfirst

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If your child does suffer an eye injury duringsports, there are a few things you can do untilmedical help arrives. The first and most importantstep is to determine where the injury is.

“If the injury is around the eye and not in theeye, you can use ice to try to keep the swellingdown,” says optometrist Diane Tucker, OD. How-ever, if there is any suspicion that the eyeball itselfhas been injured, it is important NOT to put anypressure on your child’s eye. Do not apply ice inthese cases.

“Instead of putting a bag of ice on it, you shouldactually put a cup over your child’s eye and pre-vent anything from pushing on it,” says pediatricophthalmologist Elias Traboulsi, MD.

A foam cup with the top cut off, and the bot-tom placed over the eye will do the trick. Sun-glasses can also be used to shield the eye frombright lights.

Seek medical help immediately if any of the following symptoms occur:

• 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 ERshould not be very high,” warns Dr. Traboulsi. “Ifthere’s any suspicion at all of serious injury, theyshould go to the ER.”

What to do in case of an eye injury

Tucker. “Even swim goggles can be made with aprescription, and of course they make sports bandsthat hold the regular glasses on your child’s head.”

Dr. Tucker recommends eyewear with lensesmade of polycarbonate, an impact-resistant mate-rial that can protect your child’s eyes from fast-mov-ing objects. Polycarbonate also has built-inultraviolet protection, a must for outdoor sports.

Sports goggles should be properly fitted for yourchild, Dr. Tucker notes. “If frames are too large,their protection is limited,” she warns. “Framesthat are too small or that the athlete has outgrownare not safe either.”

Eyewear that is too small is uncomfortable, which

may cause your child to decide not to wear it. Tight-fitting goggles also obstruct peripheral vision.

Dr. Traboulsi has seen many injuries occur dur-ing practices and warm-ups, when athletes decidethey don’t need to wear their eye gear. “I wouldmake a plea to your child to wear eye gear whetherthey are practicing or in a game where they are obli-gated to do so,” he says. “They will be glad theydid.”

To schedule an appointment with Dr. Traboulsi,call 216.444.2030; to make an appointment withDr. Tucker, call 216.831.0120.

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ypically, we think about asthma being triggered by smoke, pollen and other

environmental factors, but exercise can be amajor trigger for many children. In fact, about80 percent of children with asthma experienceasthma symptoms when they exercise.

With fall sports underway, it’s particularly important for parents, coaches and teachers tounderstand and recognize exercise-inducedasthma (EIA). This is because playing wintersports compounds the problem, and upper respiratory infections can worsen asthma.

In general, sports that require short, intermittent bursts ofenergy, such as football,wrestling, gymnasticsand track are easier onthe airways than sportsthat require endurance,such as hockey, long-distance running and basketball.

How asthma worksWhen children (or

anyone for that matter)breathe normally, air iswarmed and moistened by nasal passages,preparing it for absorption through the lungs.When playing sports, however, children tend toinhale short, shallow breaths through theirmouths. This type of quick breathing takes incold, dry air and causes the airway muscles tocontract and spasm. When the airway becomesnarrow, this brings on asthmatic symptoms ofwheezing, coughing, chest tightness and short-ness of breath.

There are preventive actions one can take forexercise-induced asthma. With proper medica-tion and conditioning, kids with asthma will beable to participate fully in sports.

Relaxing the airwaysAsthma medications can prevent these airway

spasms. A short-acting beta-2 agonist (such as al-buterol), inhaled 15 to 20 minutes before exer-cise, can prevent spasms for several hours.Long-acting bronchodilators work for 12 hours.Long-term inhaled anti-inflammatory medica-tions may also be required to "quiet" the airways.

Control throughteamwork

Gaining and main-taining optimal con-trol over EIA oftenrequires teamwork.Letting the coachknow that your childhas asthma is so im-portant—and havingan inhaler close athand is key. All partiesshould know the

proper dosage and how to use it before and dur-ing an asthma episode. This will help keep yourchild’s asthma well-controlled, so that exercise isless likely to trigger symptoms.

Cleveland Clinic sports and exercise medicinephysicians are available to help you manage yourchild’s asthma. For an appointment, call877.440.TEAM (8326).

Keeping Exercise-Induced Asthma at BayAthletics & Asthma

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During exerciseChildren may not be in control of their

environment during a game, but they can

adapt the way they practice by:• Wearing a scarf and breathing through it to

pre-warm the air• Avoiding exercising outdoors in frigid

temperatures• Doing 10-minute warm-ups and cool-downs

to help their airway adjust to the coldertemperature

Cleveland Clinic’s Pediatric Sports HealthProgram brings together top orthopaedic surgeons, sports and exercise medicine physicians, physician assistants, nurses, physical therapists, certified athletic trainersand exercise physiologists. We are part of Cleveland Clinic’s Orthopaedic & Rheumatologic Institute and associatedwith Cleveland Clinic Children's. We seechild and adolescent patients at morethan 20 locations throughout Northeast

Ohio. Through our program, we offer a comprehensive array of services to meet the needs ofeach young athlete.

About Us

Our ServicesSports and exercise medicine physicians specialize in the nonopera-tive treatment of medical conditions your child may face, includingacute injuries (such as sprains and fractures), overuse-injuries, care for athletes with chronic or acute illnesses (such asasthma 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 arthoro-scopic surgery) whenever possible to minimize pain, scarring andrecovery 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 andsupporting goals to achieve successful weight loss or weight gain.

Making an AppointmentTo schedule an appointment, call 877.440.TEAM (8326). Same-day appointments are available.