Girls are made differently than boys. They have different hormones, looser ligaments and a wider pelvis. They also have a menstrual cycle and this plays a larger role than some may realize. Females need to have regular menstrual cycles to keep their bones healthy and growing at a normal rate.

When girls go through intense training, barely any breaks in the year from sports and possible diet changes, this makes having a regular period difficult. Because of this, females are placed at risk for sport injuries due to weak bones, less energy and fatigue.

Are girl’s muscles and bones weaker than boys?

During an adolescent growth spurt there is an imbalance of bone growth and bone strength, making female bones weaker than boys. Adolescent females do not use the muscles in the back of their thighs when landing from a jump as often seen in males. This increases risk for serious knee injuries. Females use the large quad muscle in the front of their thighs to land from a jump. Females also have less control of their muscles during adolescence.

What are common facts and injuries of the female athlete in different sports?

• Dance: 90 percent of dancers will get injured in their career: stress fractures and foot injuries are common.
• Cheerleading: Cheerleading has become a highly competitive, sometimes dangerous sport. Cheerleading has the greatest number of catastrophic injuries including head injuries (concussions), skull fractures, neck injuries, heat illness, and electrolyte imbalance.
• Gymnastics: Injuries in this sport produce the highest number of injuries requiring surgery. Commonly wrist pain, stress fractures of the spine and ankle sprain.
• Volleyball: These players typically have better form and less injuries. Common injuries include jumper’s knee and ankle sprains.
• Soccer: Huge female athlete participation with ACL strains being the most common injury.

The most common injury is an ACL (anterior cruciate ligament) injury in the knee:

• Females are four to five times more likely to have a non-contact ACL injury than males. This is sad because studies show that 65 percent of athletes (male and female) will no longer player soccer within seven years after an ACL injury.
• Adolescent female soccer players are at the greatest risk for negative long term effects, with more than 22 percent needing revision surgery or surgery on the other knee after an ACL injury.
• At least two-thirds of ACL tears occur when an athlete is cutting, pivoting, accelerating, or landing from a jump; tear occurs within the first 40 milliseconds after initial ground contact. This impacts the female athlete a great deal when you look at the sports many of them are competing in such as gymnastics and soccer.

Female athletes may be faced with more obstacles, but there are ways your female athlete can reduce the risk of injury, including:

• Do not allow knees to go inward during jumping, landing, cutting and pivoting.
• Land softly with knees slightly bent.
• Core/trunk control needs to be part of training.
• Increase awareness when adolescents have a growth spurt as they may be more at risk for injury.
• Monitor menstrual regularity.
• Maintain a balanced diet and stay hydrated.
• Train on dry/safe surfaces.

As a female athlete myself, I’m proud of the strides we’ve made toward equality on the playing field. But we also face new challenges as we compete at a higher level. Make sure to follow the above tips and stay safe.

SPORTS Symposium

Education is the key to keeping our young female athletes in their sport vs. being on the sideline with an injury. To learn more Cook Children’s has an annual SPORTS Symposium to educate those who work with our athletes: Coaches, athletic trainers, physical therapists and school nurses.

Please join us on July 21, 2016, to learn more about the female athlete in the morning and what is sending athletes to the ER in the afternoon.

Click here to register and attend the event. Click here to register for the Web cast.

Early Bird Special Ends June 30, 2016

You may have seen articles and video clips in the news lately discussing whether kids should be lifting weight.

“Is it safe?” “How much weight is too much?” “What is the injury risk?”

The longstanding belief has been that strength training could cause damage to the growth plates (or epiphyseal plates) in bones, but recent research is beginning to shift that thought. There’s even a book that’s recently been published by a famous Jeopardy contestant advocating for the importance of strength training in kids as it promotes healthy bone density and body composition as well as improved overall fitness and may even aid in injury prevention.

On paper, that sounds great! With childhood obesity rates continuing to rise, shouldn’t we be doing everything possible to make our kids healthier?

Let’s look at this from a few different angles…

First of all, physical therapists, physicians, athletic trainers and most clinicians are familiar with something known as the SAID principle. This principle states that when stressors or loads are applied on the body, there is a Specific Adaptation to Imposed Demands (SAID) that occurs over time.

And what does that mean? Basically, if you do an activity over and over again, your body will change to adapt to the activity.

For example, a baseball pitcher will have noticeable differences in muscle mass and range of motion in his throwing arm vs. his opposite side. Just as a marathon runner in the peak of season will have heightened endurance for long distance running but would most likely struggle with sprinting.

In the same way, if you spend long amounts of time in front of a computer screen, watching TV, or playing video games, your body and posture will adapt to that positioning over time. So if we can promote improved strength and cause positive changes in the body as kids are growing, why shouldn’t we be encouraging weight training?

FORM. FORM. FORM.

I cannot emphasize this point enough. When a new patient comes into the clinic, before I even bring them back, I like to create a picture in my head of what is going on. “Why does their back hurt?” “Why did they tear their ACL?” “Why do they keep spraining their ankle?”

It seems that 99.9 percent of the time, their problems can be traced back to not being taught proper form and never developing correct mechanics. It never ceases to amaze me when a high school athlete tells me he back squats almost double his body weight, yet when I ask him to show me a squat without weight, he has no core control, hip weakness causing poor knee alignment, and a complete lack of calf flexibility (among other things).

I cringe when I think of what he looks like with weight added. Then there’s the junior high athlete telling me he’s working on bench press, yet his core control is almost completely absent. And let’s not forget the adolescent girl who struggles to control her knee position when she stands up from a chair, but then is working on weighted squats and lunges as part of her off season training.

When we look at proper training, we should be teaching our kids how to recruit the appropriate muscles first before we ever add any resistance. Learning proper muscle recruitment and training the correct pattern is known as motor learning. Studies show that there’s a strong window of opportunity for this between the ages of 10 -13, but that doesn’t mean it’s not something that can’t be addressed at any age.

Show me a proper squat, lunge, bench press, dead lift … with good form repetitively before any weight is added. If you can’t do that, adding weight is only going to encourage bad habits and increase injury risks (just as the SAID principle states). How often do we hear stories of high school or college athletes who appear “strong” yet a simple direction change, and they fall to the ground and end up with a torn ACL?

So to summarize… yes, I am all for promoting physical activity in kids. Weight lifting has definite benefits, but it needs to be done in a controlled environment. Kids NEED to be taught how to lift weights correctly. If problems are identified or there is any pain, a referral to an appropriate health care provider like a sports medicine physician or physical therapist is crucial. The earlier that children learn correct motor patterns, the more successful they will be in future sports. And above all, physical activity should be fun.

About the author

Melissa Bro, PT, DPT, SCS, is a physical therapist for the Cook Children's SPORTS Rehab program. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind. As a part of Cook Children's integrated pediatric health care system, our patients have access to a multitude of pediatric specialty areas with board certified doctors, as well as laboratory services, nutritional consultations and sports medicine counseling.

Patients benefit from this integrated system because it allows our staff to use all of the system's resources during treatment. It also improves communication between the various departments whose physicians are focused on caring for children and adolescents.

But it’s the age when children began to look at pornography that may shock and concern you. Years ago, the accessibility to pornography was only on the home desktop computer that was monitored, but now, everyone in the house has a laptop, iPad and a smart phone. With children getting phones at a young age, they have access, away from the watchful eyes of their parents. So the temptation is now accessible.

Ernie Allen, former president and CEO of the International Center for Missing & Exploited Children, says the average age of U.S. children exposed to pornography is 12 years old and that one in three 10 year olds view porn.

Allen joined other health experts to speak in front of congressional staff members recently in Washington, D.C. to discuss children and Internet pornography, calling this issue a “public health crisis.”

Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, agrees with this assessment.

Elliott and her colleagues see children 10, and even younger struggle, with porn addiction. She says porn is so accessible with the Internet that it’s easy for children to view it with little preventing them from seeing it. She says some studies claim that pornography releases the same chemicals in the brain as cocaine addiction, making it one of the hardest to overcome.

“Kids can’t handle what they are seeing,” Elliott said. “It sends such a horrible message about the value of people and what a loving relationship truly is. Their frontal lobe has not developed enough to comprehend what they are viewing and it sends confusing messages on intimacy and what love truly is. Kids then have a hard time distinguishing what is healthy vs. what is not.”

Things have come a long way since the days of a son hiding his dad’s discarded Playboy under the bed or watching a teen flick on one of the movie channels. The Internet allows for quick and easy access to a whole new world of porn, including violent and dangerous acts that can do harm to a person.

“Kids are going to be curious,” Elliott said. “It’s important for parents to talk to their children about what’s healthy and developmentally appropriate for kids their age. It’s uncomfortable for some, but it’s a good idea to sit down with your children and talk to them about sex and healthy relationships. Parents should watch for the signs of what crosses boundaries and educate their kids too on what is out there and how harmful it can be. With my own children, I keep that dialogue going at all times and I’m not afraid to ask them very direct questions.”

So what are the symptoms of a child addicted to porn? Elliott said parents should watch for:

1. Children may isolate themselves from their parents and spend a lot of time in their bedroom or bathroom.
2. Evidence of pornography on their hard drive or web browser.
3. Clearing their history on their phone, tablet or computer.
4. Appears tearful, sullen.
5. Sleep disturbance with either falling asleep, staying asleep or exhaustion.

Elliott says the combination of children becoming desensitized to porn and the accessibility of social media can make for a scary combination, leading to a lack of inhibition and self-control. Elliott said the casual attitude about porn can lead some children to lack the ability to recognize long-term consequences with texting and sexting, Snap Chat, Vine, Facebook, Kik and ChatRoulette.

“Porn exposure can lead to desensitization just like exposure to violence has,” Elliott said. “When our children are exposed to these negative elements they begin to see that behavior is acceptable and normal. Frequent exposure to viewing violence has been shown to normalize that for kids as well as increasing trends in bullying and behaving violently as a way to solve problems. The concern is that children will grow up believing that pornography is normal, routine and that way relationships are, not to mention teaching them to exploit others.”

In a presentation she gives to parents, Elliott gives these numbers:

• Up to 39 percent of teens admit to sexting.
• Fifty-one percent of teen girls feel pressure to take and send explicit photos.
• Twenty-two percent of teen girls and 20 percent of teen boys send nude or semi-nude photos of themselves.

Resources for you:

• How pornography harms children
• Pornography's Progressive Pattern of Addiction
• The impact of pornography on children & youth
• So your kid is looking at porn. Now what?

I think in “Inside Out,” Riley’s family is always trying to be positive and give Riley joyful memories throughout her childhood. As the family moves and life starts to unfold negatively, we see other emotions; fear, anger, sadness and disgust, start creeping up in.

We see Joy work harder to keep Riley’s emotions as joyful as possible. Joy is an important part of our memories that we like to revisit. As a child life specialist at Cook Children’s, I try to help normalize the day and make joyful memories with patients and families.

These memories will help children cope with other struggles that they overcome and find joy in their life. As adults, we have a hard time with this because we have so many experiences with sadness, fear, anger and disgust it’s hard for us not to project our feeling on children especially when they are in the hospital.

Children that come into the hospital may experience different emotions, but joy can be found through these emotions, even when as adults we may think there is no joy.

Sometimes kids find so much joy that they don’t want to leave Cook Children’s because it has become a fun and not so scary place. We need to remember to look for joy with all that may go on in a hospital setting.

We might not think children do a great job at a procedure because maybe they cried. However, they may have held still and been able to recover with playing by the end of procedure. This can create a joyful memory with having families at the bedside showing comfort.

Sometimes going through these different periods of our life while growing up and experiencing many things good and bad allow our emotions to interact.

In “Inside Out,” we see that the character Joy realizes toward the end of the movie that you can mix your emotions and this can be considered normal. Joy realizes that you can cry tears of joy. So as a child life specialist we help families realize that tears in a difficult experience may help a child in the future to help to control his or her different emotions. The tears also allow us to look at our long-term memories and see how there might have been joy in that moment after all and change that core memory to be better than we thought.

This allows us to empower children with all these different emotions, especially joy, in their daily lives, in or out of the hospital. Joy is a great emotion which we all deserve to look for daily in our lives and others that live with us. What Joyful memory do you have?

Previous stories in our "Inside Out" series:

• Anger
• Disgust
• Sadness
• Fear

Heather Bayers is a Child Life specialist at Cook Children's. We know that a child’s illness or injury can impact a family physically, emotionally and financially. Fortunately, you don’t have to face these challenges alone. We provide a growing number of services for patients and families, all designed to help support, heal and encourage you through every step of your journey.

That was the overall message from Fort Worth, Texas Mayor Betsy Price and representatives from the city of Fort Worth, including Cook Children's, at a press conference to address city-wide support of drowning prevention measures.

Mayor Price said that the message of the day was that tragedy in the water only takes seconds and that drowning is a silent killer. "Children drown without a sound," she said.

The press conference called for awareness and a city-wide call-to-action to protect our children through education, prevention and response. Along with the Mayor and Cook Children's, representatives from the Fort Worth Drowning Prevention Coalition, the Fort Worth YMCA, the Fort Worth Firefighter Charities, the Fort Worth Fire Department and MedStar were all in attendance.

The event included a poignant speech from Denise Doherty, an RN and director of Emergency Services at Cook Children's. Doherty said her staff is "drained and heart broken" from the number of children and patients affected by this "very preventable tragedy."

In the past two months, Cook Children's has seen nearly a child a day for drownings. The month of July began with two drowning deaths and Cook Children's Trauma Department seeing 19 total drownings from July 1 to July 22, compared to 11 drownings and two fatalities last year for the entire month of July. June saw more than double the amount of non-fatal drownings from a year ago with 26. 

Parents have been urged to watch their kids. Now the message has a new sense of urgency - you must protect your children. 

"We've seen more than enough children die this year," Doherty said. "It has to stop. Can you imagine being a parent, sitting in the ED waiting room, praying that the life of someone you love so dearly is spared, especially since it was something that didn't have to happen? No parent wants to be saddled with that guilt. I think it's also appropriate for me to say that no one is immune, and yes, it can happen to you. Cook Children's has witnessed this in a very intimate way, even our own medical community has experienced this heartbreak."

Doherty added," Today, we're making a plea. It's not only time to watch your kids near the water, but it's time to protect them."

So what does it mean to truly protect your kids? Help us spread the word with these tips:

1. Get in the water. Be in arms reach of your child. Don't let your child out of your sight and be there to grab your children out of the water at any sign of trouble.

2. 100 percent adult supervision at all times. Be active in the pool with the children or watch like a lifeguard. Don't take your eyes off of your child. If you aren't in the water, be sure to watch your kids at all times. Don't spend time on your smartphone, talking to friends or walking away for even a moment. Do have a phone nearby in case of an emergency. But that's the only time anyone should be using one.

3. Watch them until they are safe and inside. Monitoring your kids includes accounting for everyone who had been in the water all the way to the house or apartment. Once you are inside, count again and make sure all the kids are safe and inside.

4. Be a water watcher. If you are at a party with a group of children, take 15-minute shifts watching the kids. Count heads above water and look for any that are motionless on the bottom of the pool. Give your undivided while you are the water watcher. Stay sober and be alert. You can't have a more important responsibility.

5. Life jackets. Not just any flotation device will do. Make sure your life jacket is U.S. Coast Guard approved. Check the tag to say so.

6. Swim lessons. Mom and dad, you need to know how to swim. If you don't know, take lessons with your child. Make sure your child knows how to swim too. If they are in the pool, they need to know how to get to safety. But this is only a layer of protection and doesn't take away from the fact that you need to be in arm's reach.

7. Know CPR. Local CPR lessons are given in your area. A quick Google search should help you find a class.

8. Use pool and child alarms to alert you if your child gets in the water without you.

9. Isolate your pool from the rest of your backyard with a permanent, four-sided fence with self-latching gates to prevent kids from accessing the pool area without an adult.

Previous articles on this topic:

• Drowning prevention - watch your kids
• Drownings double from a year ago 
• Be a water watcher. Adult supervisions saves lives.
• Is your baby ready for swim lessons?
• Drowning tragedy - 'I can't believe this happened to me.'
• Swimming with Type 1 diabetes
• Cook Children's drowning prevention page

For more information

Learn more about drowning prevention and water safety here. This page gives helpful information on keeping your kids safe during swim season, including proper fit for life jackets, pool safety videos and fences/alarms information.

She is obviously looking for some sort of action on my part other than my smiling and nodding affirmatively. Since she’s my number one girl, I’ve learned the idiosyncrasies of her developing speech and know exactly how to handle this request. But to the layperson (or even Daddy or Grammy), I’m fairly certain I would need to come to the rescue with my toddler translator skills.

Mamas, I know you’ve been there. Your 3 year old launches into a monologue you find equal parts incomprehensible and adorable. Adorable, that is, until the tantrums and frantic attempts to understand and obey her demands kick in. In my practice, I have observed some masterful decoding mamas and some skillfully adaptive little ones navigating the waters of communication breakdown. Let’s talk a little bit about speech sound development and when to fret.

Articulation is the movement of the tongue, lips, soft palate and jaw to make speech sounds. It’s also the driving force behind your toddler’s incomprehensible speech. As parents, we are so excited when our little bundles of joy begin talking, but oftentimes, that excitement is quickly replaced with frustration when we realize we can’t understand a lick of what they’re saying.

An articulation disorder occurs when a child has difficulty forming speech sounds, most likely due to a structural or motor-based deficit. Most children tend to have some difficulty with certain speech sounds. Because creating sounds is challenging, he may substitute easy sounds for tough ones (think dumb for thumb), delete sounds (ha for hat), or distort problematic sounds (this is most often noted when children have a “slushy” quality). An articulation disorder occurs if these substitutions continue past the expected age.

Are all sounds created equal? In short, no. Children master sounds gradually. Most children can pronounce all of the speech sounds of English correctly by age 8. While each child’s speech sound acquisition is different, the following are age ranges in which most children master certain sounds:

• Introducing the “early birds”: Most wee ones will use m, n, y, b, w, d, p and h correctly between 18-30 months. That may explain why mama, dada and ball are frequently reported as first words.
• Not to be outdone, the middle of the road sounds includes: t, ng, k, g, f, v, ch and j. You may hear your little one utter these sound appropriately as early as 2 or as late as 6 years of age.
• Finally, the late bloomers include: sh, zh, r, s, z and th. This final pack of sounds contains the frequent offenders when it comes to articulation disorders. They are challenging for children to master and can wreak serious havoc on the clarity of their speech. We expect children to master these sounds between the ages of 3-8. (Based on Shriberg, 1993)

As children get older and learn new speech sounds, they gradually become easier to understand by a wider variety of listeners. Developing clear speech is a journey for our littles, albeit a frustrating one at times. And like all journeys, no two are equal. Some children are clear as a bell by their second birthday while others need a bit more time. As parents, we typically understand our babes before the rest of the world and therefore, are awarded the esteemed role of toddler translator. In many situations, one parent has a better handle on their child’s speech sound system than the other. But, as a general rule of thumb (or rule of “fum” if you happen to be a toddler):

• By 2 years of age children can be understood by familiar adults most of the time.

• By 3 years of age children can be understood by unfamiliar adults most of the time.

• By 4 years of age children can be understood by unfamiliar adults almost all of the time.

• By 5 years of age children can be understood by unfamiliar adults all of the time.

(Based on Flipsen Jr, 2006)

Although a continuum exists when it comes to speech sound development, there are a few red flags to be mindful of when chatting with your child.

It may be time to check in with your pediatrician regarding an evaluation with a speech language pathologist if your child:

• Uses only vowel sounds and a few consonants or shows limited babbling at 18 months.
• Seems to have a “slushy” (think mouth full of marbles) quality to his speech.
• Is difficult to understand and has a history of frequent ear infections.
• Leaves off the beginning or ending sounds of words (hatàha).
• Leaves off entire syllables of words (pa for purple).
• Is not understood by people outside his immediate family by age 3.
• Seems to be frustrated by his difficulty with speech or appears hesitant to interact or respond to peers or adults.

So what can you do to help him along?

Above all, it is important to always show your child you value WHAT he is saying regardless of HOW he is saying it. Always reinforce his attempts at striking up conversation with you! When you hear one of those adorable substitutions, help him to learn by repeating it correctly (If he says “tar” you can say “yes! A car!”) and moving on with the flow of conversation. Play face to face with him so he can watch the way your mouth moves to make sounds. Emphasize beginning and ending sounds in your own speech so he can hear them and begin to realize they are part of the word, too. If all else fails, ask him to SHOW you what he needs. And take comfort in the knowledge that this process is a gradual one.

Oh, and my daughter? She wanted to watch Frozen on the big T.V. and relax a little bit. Obviously.

1. Shriberg, L.D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. Journal of Speech and Hearing Research, (36), 105-140.

2. Flipsen, P., Jr (2006). Measuring the speech intelligibility of conversational speech in children. Clinical Linguistics and Phonetics, (20) 4, 303-312.

3. http://www.asha.org/public/speech/disorders/SpeechSoundDisorders/

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

Time for school, which means shopping for school supplies, meet the teacher night and contracting parasites. Many diseases increase in frequency when you gather school aged children back together again for the start of the year (common colds and strep throat are great examples). Today, I am going to talk about three parasites that tend to cause outbreaks in school classrooms.

Head lice

Head lice are common; some consider their acquisition a rite of passage for elementary school. They are parasitic insects that live on the scalp and cause itching. They are not dangerous but very annoying and can be identified by finding their characteristic eggs (called nits). Less commonly, a caregiver can find live lice moving on the scalp. Treatment most often involves using medicated shampoo. A few tips on treatment:

1. There are many great over the counter shampoos. Follow the written directions closely as too much could be harmful and too little will not be effective. Contact your pediatrician if things are not improving.
2. Many doctors recommend clearing the nits off the scalp with a fine-tooth comb.
3. Many shampoos require a repeat dose in one week.

Scabies

Scabies are less common than head lice. but equally annoying and also not dangerous. The mites that cause scabies burrow down just under the top layer of skin and cause severe itching and a fine red rash. It is common to find the rash on the wrist and between fingers and toes. Diagnosis requires a visit to the doctor who generally makes the diagnosis based on the story and the characteristic rash. Treatment involves applying a cream to the skin to kill the mite.A few tips on treatment:

Apply the cream to all skin from the neck to the toes, not just the area with the rash.Leave the cream on for 8-12 hours (overnight works great).Wash all sheets and towels the next morning on the hottest cycle of your washing machine.Repeat the treatment in 1 week.

Cooties

Cooties are the most common parasite in the elementary age child. All children at one point or another have been exposed to and contracted cooties. Cooties are contracted by close contact with another child of the same age, but opposite gender. Diagnosis is sometimes difficult, but it is pretty safe to assume that all children ages 4-10 are infected at all times. There is no treatment for cooties although it is thought that passing them on to another child does provide some temporary relief.

Thankfully, there is a vaccination for cooties which your child's friend can provide by tracing a circle on your child’s arm and reciting, “Circle, circle, dot, dot…now you have the cootie shot."