Sports training issues for the pediatric athlete

Exercise has many potential benefits for young children, and opportunities for activity programs should be made available to as many children as possible. With the marked increase in more intense exercise patterns and early specialization in sports, however, more injuries can occur. Efforts to train young athletes should be made with the understanding that the pediatric athlete is unique and should not be trained as a miniature adult.     

The young athlete

Youth sports are becoming increasingly popular in America. Previous studies have shown that children and adolescents are not small adults in their response to exercise and stress. Intensive competition and training may be associated with acute and chronic illness and injury. In addition, we comment on the injury risks that are generated by pressures to perform, injuries from urbanized non-team sports, and legislation underway to minimize these injuries. We also provide insight into psychological and sociological trends in the pediatric athlete and discuss the roles of the pediatrician, coach, trainer, and parent and the ways in which these roles impact upon injury and prevention in this population.     

The college athlete

Participation in sports is important to many college students. Student athletes come from different levels of previous sport experience as they enter collegiate athletics. The primary source of student medical care is the campus student health center. The health care providers at student health centers attend to many of the sports-related concerns of student athletes. Preparticipation evaluation provides an opportunity to assess the general health of the student athlete and to identify conditions that might increase the risk of further injury. Sudden cardiac death and sports-associated concussions have generated much interest and are reviewed in this article. Other areas reviewed here include use of drugs and supplements, ankle sprains, acute knee ligament injuries, back pain, and shoulder impingement syndrome.     

A pediatric overview of the spectrum of developmental disabilities

The developmental disabilities are specific diagnoses on a spectrum of chronic neurologic handicaps. Complete diagnosis and habilitation planning demands awareness of the underlying continuum of cerebral dysfunction common to all the disabilities. Careful attention to this continuum can result in the recognition of critically important associated deficits. Developmental dissociation is a useful developmental phenomenon in the early diagnosis of a particular disability. Developmental deviancy is an aid in early detection of milder disabilities or associated deficits. Professionals familiar with the entire spectrum are necessary to provide optimal care for developmentally disabled children.     

Basics of bone metabolism and osteoporosis in common pediatric neuromuscular disabilities

Bone modeling is a process that starts with fetal life and continues during adolescence. Complex factors such as hormones, nutritional and environmental factors affect this process. In addition to these factors, physical conditioning and medications that have toxic effects on bony tissue should be carefully considered in patient follow-up. Osteoporosis is a significant problem in pediatric population because of ongoing growth and development of skeletal system. Two types of osteoporosis are primary and secondary types and children with neuromuscular disabilities constitute a major group with secondary osteoporosis. Low bone mass in patients with cerebral palsy, spina bifida, and Duchenne muscular dystrophy cause increased bone fragility in even slight traumas. Maximizing peak bone mass and prevention of bone loss are very important to reduce the fracture risk in neuromuscular diseases. This article aims to review the determinants of bone physiology and bone loss in children with cerebral palsy, spina bifida, and Duchenne muscular dystrophy.     

The female athlete. Before and beyond puberty

As the twentieth century progressed, the female athlete became an accepted participant of sports at all levels. This article reviews various aspects of female sports participation. After an historical perspective, selected comments are provided on psychologic and physiologic aspects. Concepts of adolescent gynecology are reviewed, including breast and menstrual problems and pregnancy. Other areas reviewed include iron deficiency anemia, stress urinary incontinence, and sports injuries in female athletes.     

Young athlete with sudden cardiac arrest treated with therapeutic hypothermia

Reported herein is a coronary anomaly that occurred in a young adolescent athlete who presented with cardiopulmonary arrest. The patient was resuscitated and treated with therapeutic hypothermia. The patient had no associated neurological complications at follow up. Enhanced computed tomography of the heart indicated an anomalous left main coronary artery originating from the right coronary sinus and coursing between the aorta and the pulmonary artery. The patient underwent surgical intervention with coronary artery bypass grafting to prevent symptom recurrence.     

Maltreatment of children with disabilities

Widespread efforts are being made to increase awareness and provide education to pediatricians regarding risk factors of child abuse and neglect. The purpose of this clinical report is to ensure that children with disabilities are recognized as a population that is also at risk of maltreatment. Some conditions related to a disability can be confused with maltreatment. The need for early recognition and intervention of child abuse and neglect in this population, as well as the ways that a medical home can facilitate the prevention and early detection of child maltreatment, are the subject of this report.