Does your child look like one of these pictures when they head off to school?

Then this article is for you to improve the future of your child’s spine.

Backpacks are routinely bought because of how pretty they are, what super hero or cartoon character is on them, or how much can they hold. These are all very important to your child, but there are a few more criteria that parents should be looking at:

Top 10 things to know about a backpack to prevent injuries:

1. The American Academy of Pediatrics recommends that a backpack should not weigh more than 10 to 20 percent of the child’s body weight. If the child is complaining of discomfort, always keep it less than 10 percent of their body weight.
2. Put heavier items closer to the child’s body in the backpack, so that it does not pull the backpack away from their spine.
3. Parents should pick up their child’s backpack on a regular basis to feel its weight.
4. Backpacks should be worn with one strap on each shoulder, not hanging off one shoulder.  Use the abdominal strap if one is provided.
5. The backpack’s straps should be fitted snuggly over the child’s shoulders.
6. Make sure the backpack is positioned literally on the back - between the shoulders - and not resting on the child’s lower back or hips.
7. Have the appropriate size backpack. If the straps are tight and the back pack hangs down past the hips, the back pack is too big for this child.  It should rest above the hip line.
8. If your child has pain in their shoulders, neck or back- there are options with back packs with wheels.You might also ask the school to provide one set of books for school and one set for home.  These modifications sometimes require a physician note for the school.
9. If your child has more to carry than is recommended for the backpack, they can carry some items in their hands to balance the weight on the body. Make sure that they are not carrying more than 10 percent of their body weight.
10. If your child is complaining of pain after the backpack is removed and does not go away, seek a physician consult.

Please check out the below links to assist you with keeping your child happy and healthy this upcoming school year!

Dana S. Harrison, PT, MPT, Cook Children’s SPORTS Program/Rehab Manager

Related links:

• Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS)
• Backpack safety for pre-grammar school
• Backpack safety for elementary school
• Backpack safety for teenagers

About the author

Dana Harrison, PT, MPT is Cook Children’s SPORTS program/Rehab manager. 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.

You may not have really ever sat down to think about it, but good handwriting requires many things working together at the same time. Each of these things play an important role in the quality of handwriting your child puts on paper: strength of hands, arms, and core, bilateral coordination (both hands working together), visual perception (how your brain interprets what you see), visual motor (eye-hand) coordination, and fine motor precision (how fine-tuned fingers move together).

Here are some summer activities that DON’T involve pencil and paper that you can do as a family to improve or maintain your child’s handwriting skills:

• Go to the park and use the monkey bars and climbing walls -increases hand, arm, and core strength.

• Paint the side of the house with a bucket of water and a paint brush – increases strength of hands, arms, core and bilateral coordination and visual motor coordination.

• Water play with squirt bottles or water guns using index and middle fingers to squeeze handle – strengthens hands and fine motor precision.

• Soak a sponge full of water and then wring it out in another bucket or an older child could help wash the car – strengthens hands and bilateral coordination.

• Use side walk chalk on the driveway to make pictures, shapes, and/or letters – fine motor precision and feedback to where your hand is in space.

• Pop bubbles with one finger or two hands together– increases fine motor precision and bilateral coordination.

• Play the game “Hot Potato” with a balloon filled with air. See how long you can pass the balloon back and forth without the it falling on the ground. Add more balloons when one balloon is too easy. – Improves visual motor coordination.

• Create with playdough – Increases strength of fingers and fine motor precision.

• Swim freestyle, back stroke, breast stroke or butterfly (with adult supervision, of course!)– increases core, arm, and hand strength, and bilateral coordination.

• Water play in the shallow end with splash balls or a beach ball (again, with adult supervision) - increases visual motor coordination, strength, and fine motor precision.

• Go fishing at a lake, pond, create a pond using a tub, or Bass Pro Shop has a free fishing event Saturday mornings (check your local store): increases bilateral coordination, core strength and visual motor coordination

• Take Karate lessons– increases core and arm strength and bilateral coordination.

• Learn to play a musical instrument – increases visual motor coordination, bilateral coordination, and fine motor precision.

• Woodworking or gardening with an adult either at home or workshops for kids. Some Home Depots offer free workshops for kids on the first Saturday of the month (check your local store)– increases strength, visual motor coordination, bilateral coordination and fine motor precision.

Take advantage of the good summer weather and let your child learn while enjoying the outside!

About the Author

Marybeth Oliva is an occupational therapist at Cook Children's. Occupational therapy focuses on fine motor and functional skills to enhance development, restore function and to prevent disablility from pediatric conditions, illness and injury. At Cook Children's, we understand that no two children are alike. That's why we offer four types of therapy plans, tailored specifically for your child and his or her needs. We want to make every appointment unique for each family. 

“My daughter plays select soccer and can’t afford to take any time off for her injury without the risk of losing her starting position on the team.”

Statements like this are commonplace in my world as a sports physical therapist. And while I genuinely believe that parents and coaches have their minds in the right place when it comes to wanting their child to be the best, the idea that this means you must specialize in your sport early in life is not supported.

Early sport specialization is defined as choosing to play only one sport, often without any breaks during the calendar year, while the body is still changing and growing.

As we are in the thick of another year of the NCAA college football national championship and bowl games, let’s revisit last year’s undisputed national champions as an example of one sport vs. multiple sport athletes. In early 2015, a social media post went viral detailing Urban Meyer’s recruiting record during his time as head football coach at Ohio State. Of his total of 47 recruits, 42 were multisport athletes in high school. Only 5 of his recruits played football alone.

Did you know?:

• Three-time Super Bowl champion, NFL Hall of Famer and Dallas Cowboys Ring of Honor inductee Troy Aikman played shortstop and pitched on his high school baseball team. He was drafted by the New York Mets out of high school and came close to choosing baseball over attending the University of Oklahoma, and later UCLA, to play football.
• Two-time women’s soccer Olympic gold medalist and 2012 FIFA World Player of the Year Abby Wambach credits her success as a soccer player to playing basketball in her youth.
• Eight-time NBA All Star and two-time NBA MVP Steve Nash did not start playing basketball until he was 12 or 13 and instead thanks his soccer background for his success in basketball.
• Six-time MLB All-Star Joe Mauer of the Minnesota Twins played football, basketball, and baseball in high school and was named USA Today High School Player of the Year in multiple sports.

An athlete like Tiger Woods, who started playing golf before the age of 2, is an extremely rare occurrence. It is by no means the norm and should not be expected.

In theory, specializing makes sense. After all, practice makes perfect, right? Wrong! In reality, research has shown the following:

Early specialization leads to overuse injuries.

More and more orthopedic experts are speaking out to shine light on the world of pediatric sports injuries. They have become increasingly alarmed by the skyrocketing rates of injuries in kids and some go so far as to describe it as an epidemic. Each year, roughly 3.5 million children, 14 years of age and younger seek medical treatment for sports injuries.

Of these, at least half can be attributed to overuse injuries. Repetitive activity leads to increased stresses on a growing child’s bones and muscles and can result in injuries such as Little League elbow, Little League shoulder, shin splints, Sever’s disease, Osgood-Schlatter disease, runner’s knee, jumper’s knee, or even stress fractures in areas like the back (spondylolysis or spondylolisthesis), hips, and feet.

So what’s the first line of prevention? Rest. Children should have at least two months off each year to recover from their specific sport. And if we’re talking about baseball, it’s recommended for those athletes to have three to four months of absolutely no throwing or overhead sports.

Early specialization interferes with healthy growth and development.

Playing a competitive sport is stressful, and just as the body must adapt to the changes and demands physically, handling the stresses around winning, losing, practice schedules, traveling, etc… in addition to regular schoolwork can be emotionally draining as well. Children may also struggle with identity and view themselves as solely an athlete. Playing a wide range of sports promotes diverse relationships and allows for a wide variety of experiences.

Early specialization increases the risk of burnout.

Playing only one sport, especially at a competitive or select level, can lead to burnout as a result of stress and physical and emotional demands. A history of injuries can also increase that anxiety. If a sport stops being fun or a child feels pressured to succeed, it can certainly lead to a desire to quit.

Early specialization reduces the chance that children will maintain an active lifestyle as an adult.

In 2013, researchers from The Ohio State University released a study that found that children who specialized in one sport early in life were more likely to be inactive as adults. Committing to a certain sport at too young of an age can lead to early burnout, quitting, and being reluctant to then rejoin physical activities as an adult. A history of injuries also contributes to an aversion towards exercise and a preference for a sedentary lifestyle.

Early specialization doesn’t guarantee future athletic success.

Consider these statistics from the NCAA regarding athletes during the 2013-2014 school year.

                              Estimated Probability of Playing in College

                           Estimated Probability of Playing Professionally

When you look at the numbers, the odds of playing a sport in college and especially professionally just aren’t in your favor.

So what does this mean for our kids?

• No, we shouldn’t put them in a bubble and shield them from sports. Athletic activity is extremely important.
• Children should learn the fundamentals of various sports and enjoy the experience.
• Sports should be fun at every age.
• Sports should create positive habits for later in life.
• Sports shouldn’t cause repetitive injury.

And if your child happens to be one of the lucky few who go on to play in college or even professionally, a history of playing multiple sports is clearly of great benefit.

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.

I am shocked at the number of patients we see where bad posture plays a role in their pain and physical limitations. Whether it be sports injuries, overuse injuries or postural dysfunction, the trend is younger patients are starting to report more injuries. I see technology driving our kids to be more active in an online space than it does in a physical space.

So I would like to take a minute to address how to get our kids active again, but not just any activity. I want to talk about core activity.

What is the core?

The core is a muscular system that works synergistically to provide support and power generation to the body in all positions and with every activity. Think of a soda can to explain the core. The can has a front (deep abdominals), back (multifidi muscles), top (diaphragm muscle) and bottom (pelvic floor muscles). And just like the can, as long as no one pokes a hole in it, it is very strong. As soon as someone creates a weak spot in the can/core, it can easily be crushed.

When do you use your core?

The core should be used during all of life’s daily tasks, but we lose this ability as children when no one teaches us how to use the core during modern-day tasks such as playing on your Ipad or texting your friends.

How do I train the core of a child?

Return to the basics. Too often we see young athletes who have been given formal instruction in how to pitch a ball or perform a round-off back handspring, but little or no training on what it means to use their core functionally. Schools have our kids doing pushups before teaching how to plank. Physical therapy can definitely help patients of all ages with core training, but there are also some things you can do at home. For really young children (3-6yrs) this can mean returning to games that require you to hold positions, such as Twister or Untying the Knot. For slightly older children (7-12yrs), yoga or even just plank holds (3 positions) help build core strength and endurance. For our teens and young adults more formalized training for power generation and power transfer using the core can be very beneficial.

What does a strong core mean?

For your child a strong core means improved performance in their activities whether that is football, dance or band. It can mean no pain when sitting in class or when trying to be active with peers.

For parents, a strong core means fewer complaints from your child, better posture, and less risk of injury while your child is performing their activities.

If you or your child would like help with core training, please contact your physician and seek a referral to Cook Children’s Physical Therapy Department.

More SPORTS resources related to this topic:

• Top 10 questions parents have about sport injuries
• Young athlete's injury prevention guide

How do we know that parent-talk builds children’s brains? A study by Betty Hart and Todd Risley, “The Early Catastrophe: The 30 Million Word Gap by Age 3” showed that by age 3, children from lower socioeconomic backgrounds heard 30 million fewer words than children from prosperous backgrounds. This disparity of 30,000,000 words heard had effects on children’s IQ and test scores by the time they were in third grade. Why is this important? All children have the right to full access for learning; to grow their brain; to learn to talk, read and write. What parents and caregivers do and say has a profound impact on a child’s development.

Dr. Dana Suskind, a pediatric cochlear implant surgeon at the University of Chicago recently released her book Thirty Million Words: Building a Child’s Brain. At the center of her program are the “Three T’s.”

• Tune In
  • What does your baby/toddler like to do? Let’s say your little one is super interested in those pots and pans in your cabinet but you would rather baby play with the ball. Think about helping baby explore those pots and pans: making noise, pretending to stir, wearing the pan as a hat, etc. Make it all about baby’s interests.
• Talk More
  • What are you saying to your baby? For example, “Come over here and get this” could have many meanings. A richer language example could be “Walk to sister and get the ball!” By using ‘walk, sister, and ball’ baby hears specific words instead of more non-specific words (‘here’ and ‘this’). By using specific, rich language, baby’s vocabulary increases. We learn to talk based on what we hear. I often encourage parents to ‘be a thesaurus’ – constantly increasing the complexity and richness of their language.
  • Another tip is to teach verbs, verbs, and more verbs. Verbs carry far more meaning in communicating than nouns. For example, the word ‘drink’ will result in more action from parent than ‘milk’. Baby says ‘drink’ parent says, “Oh you want a drink? I have milk, juice, water, ____”. If baby says, ‘milk,’ parent says, “Here’s some milk.” ‘Drink’ can be paired with many other words as children start stringing words together: drink more, drink please, drink milk, drink all gone, drink spill, drink hot, etc.
• Taking Turns
  • From the moment parents meet their new baby, communication begins. Babies coo, giggle, scream, cry, and babble to communicate. Parents then respond with sounds, words, and actions. These early interactions are the beginnings of conversation. As very young children start using words, listen to what they have to say. The more you talk back and forth with them, the more words they learn. The more words they learn, the better readers they will be.

Talking to our babies and toddlers is something we can all do to help babies’ brains.

What can we do as parents and professionals to close that Thirty Million Word gap for all children? How can you use Dr. Suskind’s “Three T’s” strategies to grow your child’s vocabulary?

The more frightening thing is the amount of patients that we don’t read about who are undergoing the same surgery. More and more, young baseball players ages 15-19 years old are sustaining this same injury and having to undergo this surgical procedure.

Ulnar collateral ligament reconstruction used to be an injury that we saw in ball players later in their careers. John Smoltz played for the Atlanta Braves and was recently inducted into the Baseball Hall of Fame. His career benefitted from Tommy John surgery. Currently, he's the only player inducted into the Hall of Fame who received Tommy John surgery. But he warns against the number of young people receiving the surgery today, calling it an "epidemic."

"I want to encourage the families and parents that are out there that this is not normal to have a surgery at 14 and 15 years old," Smoltz said. "That you have time, that baseball is not a year-round sport. That you have an opportunity to be athletic and play other sports. Don’t let the institutions that are out there running before you guaranteeing scholarship dollars and signing bonuses that this is the way….

I want to encourage you, if nothing else, know that your children’s passion and desire to play baseball is something that they can do without a competitive pitch. Every throw a kid makes today is a competitive pitch. They don’t go outside, they don’t have fun, they don’t throw enough — but they’re competing and maxing out too hard, too early, and that’s why we’re having these problems. Please, take care of those great future arms.”

So are his concerns warranted? In short, yes.

A recent study showed that 15-19 year-olds accounted for 56.7 percent of the ulnar collateral ligament reconstructions performed in the U.S. between 2007-2011.

This is a scary statistic considering this means that over half the UCL reconstructions done in the U.S. are performed on patients who haven’t finished their freshman year of college. So why has this become so much more prevalent in younger athletes?

I think the simple answer is the volume of pitches being thrown. If we look at the trends with today’s young baseball players, more often than not they are playing year round, playing on multiple teams, and at times playing on multiple teams at the same time. At some point kids have to put down the baseball and give their arm a break.

Little leaguers who pitch have a major disadvantage compared to their major league counterparts: they are still growing. This means that each time they take the mound they are pitching with a new body. As kids grow taller, it means they have longer limbs that they have to control, and this takes more strength and more coordination, strength and coordination that often doesn’t keep pace with how fast the athlete is growing.

So how do we reverse the trend of these young baseball players dealing with this terrible injury? Here are four recommendations.

1.Decrease the volume of throws

2.Don’t pitch with fatigue

3.Don’t throw breaking pitches (until skeletally mature enough and skilled enough to do it correctly)

4.Delay specialization (play multiple sports)

Decrease the volume of throws

Decreasing pitch volume I feel is the most important of these three recommendations. It’s not just following pitch counts it’s avoiding playing multiple positions with a high volume of throws. I have had many patients come in and say “we follow all the recommended pitch counts,” but as I dig deeper I find out that, yes, they are following pitch counts, but the child is playing catcher when he isn’t pitching. The bottom line is that it isn’t just pitch count alone, it is the total volume of throws we need to think about.

Don’t pitch with fatigue

Making sure our players aren’t pitching fatigued is also a big part of keeping our young throwers safe. If a player is fatigued and continues to pitch, even if they haven’t reached their pitch count, they are putting themselves at risk. The National Athletic Trainers’ Association (NATA) Position Statement on Prevention of Pediatric Overuse Injuries cited a study showing that a greater percentage of pitchers with shoulder or elbow injuries started at another position and pitched with arm fatigue. So if a player has been out in the hot sun playing short stop in the first game of a double header it probably isn’t a wise decision for him to pitch in the second game

Don’t throw breaking pitches (until physically mature enough and skilled enough to do it correctly)

I think most parents of young baseball players have at least heard the recommendations to avoid curveballs and sliders until the player is older, but for some reason we still have young pitchers throwing these breaking pitches. Another study cited in the NATA Position Statement on Prevention of Pediatric Overuse Injuries showed the risk of elbow pain increased 86 percent in youth pitchers throwing sliders, and the risk of shoulder pain increased 56 percent for pitchers throwing curveballs. We as parents need to remember our kids are going to watch their favorite big league pitcher and want to throw all the same pitches it is up to us as parents to step in and say you aren’t ready for that.

Delaying Specialization

There is an interesting study finding that more of the successful, Hall of Fame–type pitchers come from up north, where Hall of Fame hitters come from all over — a lot of them from the South. The gist of the study was that because there are several months of the year in these northern states that it is too cold to be outside playing baseball these pitchers couldn’t participate in baseball year round. During the winter months they had to put the baseball down and do something else. Once again referring back to the NATA’s position statement they state, “Young athletes who participate in a variety of sports tend to have fewer injuries and play longer, thereby maintaining a higher level of physical activity than those who specialize before puberty.” Delaying specialization is also a big part of decreasing volume, because if kids are playing another sport they will get that nice break that they need from throwing.

This blog by no means touches on all the factors that lead to these injuries, and the four recommendations are by no means the complete list of ways to prevent these injuries, but following these recommendations is a good place to start to keep, our young ball players’ arms nice and healthy.

Resources

• Baseball Injury Prevention
• Top 10 questions parents have about sports injuries
• Young athlete's injury prevention guide
• Strength training in children/adolescents

Why is it important for my child to be treated for a finger injury?

Just because your child’s finger may not look like it is broken, it is still important to have it looked at by a professional. The bones of the hand are quite small, and fragile. But, the bones aren’t the only thing in the hand that can be injured. There are also several ligaments and tendons in the hand that are at risk for injury. A ligament connects bones to other bones and their job is to support the bones and joints, and in some cases, prevent certain movements. If a ligament is injured and not allowed to heal, it can cause the bones to be unstable which can lead to further injury.

When should I get help for my child that has injured their hand or finger?

• If your child’s finger looks like it is out of place.
• If there is any bruising, swelling, or pain that lasts more than a couple of days.
• If your child is unable to bend or straighten the finger.
• If your child is favoring that hand or finger and doesn’t want to use it in everyday activities.

If your child injures their finger and it looks to be out of place, you should seek immediate attention from a medical professional. Do not try to put the finger back into place on your own. You could cause further damage.

Primary headaches are the result of problems with pain sensitive structures in your head. These include migraines, tension headaches, chronic daily headaches, cough headaches and exercise headaches.

Secondary headaches usually point to an underlying condition activating the pain sensitive nerves in the head. These include sinus pressure, concussion, dehydration, ear infection, flu, tooth pain, etc. More serious causes of headaches can occur, for which you would need to see a doctor immediately.

Physical therapy is well suited to help patients with headaches. Most primary headaches can be related to or made worse by muscular tightness in the neck, base of skull, and head. This tightness can be due to trauma, joint stiffness, joint instability, poor posture or overuse. Physical therapists can address this muscular tightness in several ways. We work on increasing the flexibility of the muscles involved, improve the strength of the musculature in the area, and mobilize stiff joint segments. We also address the child’s posture and stability of the area by retraining the musculature to work in symphony with each other to achieve good posture and stability of the neck and shoulders during static and dynamic activities.

Here are four ways for kids to improve their headaches:

1. Be aware of your posture. How are you sitting when at school? Where do you do your homework or read? Is it on your bed, or couch, or on a desk? Try to improve your posture by sitting up straight, preferably in a chair that offers low back support and keeps you upright. Make sure that the computer or books are close enough that you can read easily without looking down or sticking your chin forward.
2. Take mini breaks throughout the day. A good rule of thumb is a 2 two- minute break for every 30 minutes. During this time, get up walk around your space, stretch.
3. Stretch. Your muscles tend to tighten down to match the movement they are allowed during the day. If they don’t move much, they will begin to tighten. Neck and shoulder stretches are important to loosen the muscles you use to hold your head up and use your arms during the day. The stretches should be held for at least 30 seconds for better results.
4. Build strength in the muscles of the neck and shoulders. The stronger your muscles are, the better they can handle the stresses of the day. Exercises could include chin tucks, shoulder shrugs, lat pulls, rowing, pushups and tricep dips.

If you have any questions, please feel free to contact your pediatrician.

About the author

Bruce Morgan, PT, is a SPORTS physical therapist at Cook Children's. 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.

From birth, your child is undergoing changes at a rapid pace and many factors may influence these changes, including your child’s genetic makeup, the environment in which you raise your child, nutrition, and medical care, to name a few. 

Though there are ranges in which kids attain developmental milestones, a delay in achieving certain skills does not necessarily mean that your child is ‘developmentally delayed.’ One should remember that "normal" is expressed in many different ways.

A child’s body systems can be categorized into motoric, sensory and cognitive components and can encompass a wide variety of changes, not to mention the defining personality and emotional changes that are occurring at the same time.

Typical development does occur in stages and can help you track your child’s progress, as listed below:

• Developmental milestones by age/dimension:
  • 3 months:
    • Physical development: Your baby is beginning to explore his/her environment and will start to push up on his/her arms and lift the head up against gravity for a short period of time.
    • Speech development: As you feed your baby, you will notice he/she will refine his/her ability to suck and swallow, will coo to the sound of your voice and smile, and turn his/her head in response to sound.
    • Play development: When playing with your baby, you will notice he/she will be able to follow toys with his/her eyes and reach for them. Your baby will also be able to position his/her head in the middle during interaction with people/environment.
  • 6 months:
    • Physical development: As your baby gets stronger, he/she will be able sit up with the use of his/her hands, will be able to explore his/her environment with rolling from back to stomach. When you hold your baby, notice that your baby can tolerate supported standing with full weight through his/her legs.
    • Speech development: What an exciting time for progress with your baby’s communication! Your baby will now start to babble in order to get your attention. Make sure to keep cereals and pureed foods handy, as your baby is now ready to eat these items.
    • Play development: ‘Tummy’ time is important during this stage of development and you will notice your baby reaching for objects when placed on his/her stomach, and will be able to hold onto his/her feet during play when placed on his/her back.
  • 9 months:
    • Physical development: Your baby is getting stronger during this age and should be able to sit up and reach for toys without a loss of balance, can transition from the floor to sitting, and can crawl using opposite hand/knee movement.
    • Speech development: During this time, your baby will be able to visually recognize familiar people and toys when named; and will now begin eating mashed table foods.
    • Play development: At this time, your baby will use both of his/her hands to play with toys, and will start mimicking others.
  • 12 months:
    • Physical development: During this time of rapid growth, your baby’s leg strength will truly begin to progress with pull-to-stand movements and walking alongside furniture with two-handed support. Your baby may begin to stand independently and take a few steps!
    • Speech development: Get ready to hear ‘mama’ and ‘dada’ frequently as your baby now will be able to call you by name and will be able to follow 1-step instructions!
    • Play development: With play, your baby will be able to use a pincer grasp to hold onto tiny objects/toys, and be able to grab and release toys/objects; at this time, your baby will also be able to start feeding himself using his/her finger.

Though the above characteristics of movement, speech, and play development are TYPICALLY observed in normal developing babies, do not be alarmed if milestones are not met right on time. Some kids develop at a more rapid rate while others may take more time.

There are some red flags to watch for and may indicate a possible need to make an appointment with your baby’s pediatrician, and potentially be referred to a developmental therapist (physical, speech, or occupational). These include (not inclusive of all signs):

• Stiff movements that are consistent throughout the first 3-6 months
• Decreased arm movement or asymmetrical arm movements that lasts through 9 months
• Rounded back
• Difficulty with or inconsistent visual tracking or lack of turning towards auditory stimuli
• Difficulty putting full weight through legs or needed hand support during sitting at 12 months
• Frequent toe-walking at 12 months onwards

Remember, each child is unique and though it is crucially important to monitor your child’s development, it is also important to allow your child to develop at his/her own pace and realize that ‘normal’ can be defined differently for each child.

[Source: Developmental milestones handouts (Cook Children’s), Pathways Awareness Foundation 2006, endorsed by the American Academy of Pediatrics, revised 09/10]

About the author

Radhika Trivedi, PT, MSPT, DPT, is a physical therapist at Cook Children's. Physical therapy focuses on large motor and functional skills to enhance development restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's offers Rehabilitation Services in Fort Worth, Hurst and Mansfield.

As parents before we just shrug off our children’s injury as nothing too serious, it helps to know exactly what a sprain is.

The American Academy of Orthopedic surgeons define a sprain as a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone to another.

Technically a torn ACL or a torn MCL in the knee is a sprained knee, but we never shrug those injuries off. So why are we so dismissive of ankle sprains? Admittedly a sprained ankle is typically not as severe of an injury as a torn ACL, because an ACL when torn will not heal on its own and requires a surgical reconstruction, but that is a topic for another blog.

Just as with any injury when dealing with an ankle sprain we need to start by determining the severity of these injuries. Ankle sprains are typically divided into three grades based on the severity and presentation of the injury.

Grade 1: Ligaments are stretched, but not torn, ligaments are tender to touch, but no laxity is noted, and the patient is able to walk with little to no pain.

Grade 2: Ligaments are stretched and at least partially ruptured, there is moderate pain and swelling, mild to moderate bruising, some range of motion loss, the patient has pain with walking, and there is mild to moderate laxity noted.

Grade 3: Ligaments are completely torn, there is severe swelling, severe bruising, significant loss of motion, the patient is unable to bear weight or walk on the ankle, and there is significant laxity noted.

The severity of the sprain will definitely influence how we treat these injuries.

So why is it important for my child to rehab an ankle sprain?

The number one predictor of ankle injuries is a previous ankle injury. So what this tells me is that more often than not we aren’t addressing that initial injury effectively. Each ligament sends information to the brain letting us know if our joints are in good alignment or not. This is why we don’t have to look at our feet when we walk to know that our foot is in a good position to take a step. Any time a ligament is torn or stretched we lose some of our awareness of where the joint is in space. If a ligament is completely torn or stretched we aren’t getting those signals until our joint is potentially already in a bad position. After injury we have to do something to make sure that we re-establish that joint awareness, and that is where Physical Therapy comes in.

How can physical therapy help my child recover from an ankle sprain?

Initial focus in physical therapy will reduce swelling and inflammation with RICE (rest, ice, compression, and elevation), and regaining ROM. While this first phase is very important, the portion of rehab that really helps to prevent recurring injuries is the strengthening and proprioceptive (or balance) training. The balance exercises are the exercises designed to retrain joint position awareness by training the muscles to recognize and stabilize where our joint is in space. The balance and strengthening exercises are what will truly help a patient return to higher level activities like jumping and cutting in sports.

When do I get help for my child who has an ankle sprain?

• Any time an injury causes notable laxity or instability on exam.
• Any time a patients is unable to walk without pain.
• Any time balance is negatively affected.
• That means grade 2 sprains and above should automatically get help and any grade 1 sprain with balance deficits should also do rehab. If there is ever any doubt, error on the side of caution and contact your physician.

At Cook Children’s, our SPORTS physical therapists are trained in proper rehabilitation of all grades of ankle sprains and work to restore full function and safely guide return to athletic activities. If your child has a history of frequent ankle sprains or you are concerned about risk of future injury, talk to your doctor about a referral to physical therapy.

SPORTS resources

• Ankle sprains
• Top 10 questions parents have about sports injuries
• Injury Prevention Guide
• Strength training in children/adolescents
• Young athlete's injury prevention guide
• Rise of overuse injuries in school-age athletes
• The basics of sports injury prevention for kids
• Preventing children's sports injuries
• Pain that won't go away

You may be thinking, “Am I the only parent in town dealing with dinner drama every night?”

The answer is no. It is reported 25 to 45 percent of typically developing children experience feeding and swallowing problems, while a staggering 30 to 80 percent of children with developmental delays struggle with mealtime (Arvedson, 2008).

Now for the million dollar question: what causes feeding problems? There are several factors that can impede a child’s ability to develop a happy, healthy relationship with food, including: sensory processing disorders, gastrointestional complications, prematurity, and dysphagia.

Food should be fun. And for most of us, it is just that. But children may not see eye to eye with us when it comes to mealtime, causing this to become a stressful time for the whole family. Little ones can be incredibly stubborn when it comes to food choices.

Most parents have described their children as picky eaters at least once or twice. However, it is important for parents to know the difference between “picky eaters” and true problem feeders and when to seek assistance.

Picky eating can be a typical stage in normal development. Ready for the skinny on picky eating?

A picky eater will typically:

• Accept approximately 30 foods. That may sound like a lot, but it’s really not.
• Tolerate a new food on his or her plate and may even taste it once or twice. This new food may become a new favorite. But then again, it might get tossed on the floor. This truly depends on the child’s sensory reaction to the food in question.
• Eat meals with his or her family, but requires different preferred foods.
• Eat only one food from each food texture category (puree, crunchy, solids,etc).
• Consume one preferred food consistently, and then suffers “burn out” and refuses to eat this food for a period of time (picky eaters will usually begin to accept this food again after a brief break).
• Eat new foods after frequent exposure.

So, how can you nudge your picky eater toward the leafy greens and save your sanity? Here are a few simple suggestions for success at the dinner table regardless of whether you’re serving pizza or brussel sprouts.

1.Develop a routine and stick to it. Offer meals and snacks at about the same time each day

2.Don’t force feed or bribe your child to eat. This will likely increase refusal behaviors or even worse, bring on a power struggle.

3.Offer a variety of foods, including 1 to2 of your picky pumpkin’s favorite items, at the family meal.

4.Persistence is key! Remember not to shy away when he shudders at his first taste of peas. You may need to offer those peas up to 20-25 times before he will tolerate them.

5.Explore food with your child. Talk about the way it looks, smells and feels. Invite her into the kitchen to help you prepare the foods. Bring her along to the grocery store or farmer’s market to choose a new fruit or vegetable. Star fruit? Why not?! Eggplant? Coming right up!

6.Make it fun! Serve fruits and veggies with dips. Use cookie cutters to make a Shamrock Sandwich for St. Patrick’s Day or Santa for Christmas. Eat dinner by candlelight. Serve breakfast for dinner. Better yet, have everyone put on their coziest jammies for a pancakes and PJ’s party. Get creative!

7.Practice what you preach! This means you, parents. If you want your little ones to eat salad for dinner, you will need to dive into that bowl of greens yourself and forgo the drive-thru on your way home. Our children are always watching and learning from our actions and habits.

8.Don’t become a short-order cook. If your child refuses the family meal, it can be tempting to head back to the kitchen to whip up the macaroni and cheese he is coveting. Resist! This may promote picky eating.

Now, let’s get down to business. While picky eating can be frustrating, it is a typical stage in normal development. However, problem feeding is a true disorder that requires specialized assessment and/or intervention and is downright disheartening for parents. A child that does not eat well can evoke feelings of anxiety, fear, and helplessness, leaving caregivers struggling for a solution.

A problem feeder may:

• Eat fewer than 20 foods.
• Refuse the bottle/breast or drink a small amount and then refuse during infancy.
• Refuse an entire texture category (for example, a problem feeder may refuse to eat all pureed foods).
• Not accept new foods on his plate and may cry, scream or tantrum at the sight of a new food. Problem feeders may even gag or vomit at the sight of an offensive foods.
• Be unwilling to try new foods, despite multiple exposures.
• Eat the same food over and over, but once he experiences “burn out,” he will most likely not go back to eating that food. This will cause him to slowly, but surely, shrink his group of tolerable foods.

If your child is showing symptoms of problem feeding, talk to your child’s pediatrician regarding a feeding evaluation by an occupational therapist or speech-language pathologist. A thorough evaluation is necessary to determine the best course of individualized treatment for your child.

Hang in there, parents. There IS hope! Our feeding therapists are trained to help your child with a wide array of feeding difficulties.

References:

http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965§ion=Incidence_and_Prevalence

http://www.sosapproach-conferences.com/articles/picky-eaters-vs-problem-feeders

Resources for Parents:

www.feedingmatters.org

www.yourkidstable.com

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.

One of the tops reasons is that younger kids are doing more than their growing bodies can withstand. Children are no longer just playing outside for fun. They are playing at a higher skill set than in the past, often times with parent coaches who aren’t formally trained to stretch their players in the correct manner. Make sure your young athlete stretches for his or her game.

Other causes of injury include weakness to the gluteus medius, loose joints, tight muscles, decreased balance and motor control and coordination.

I’ve spent the first two paragraphs talking about the injuries, but I actually feel the ACL has gotten a bad reputation because it’s a very important ligament that allows an athlete to run, jump and cut. Many non-contact ACL injuries can be avoided if athletes understand the issues that lead to ACL tears.

If you have a child who is an athlete, it’s important to know the proper way to stay safe during athletics and preventing ACL injuries. Below are 6 steps to preventing an ACL injury.

1.Strengthen your gluteus medius - The gluteus medius (located in the buttocks) weakness are common culprits in ACL injuries. This is one of the muscles that stabilizes your hips and in terms of ACL injuries prevents the knee from pointing too far inward when landing during jogging, hopping or cutting. A good way to know if this muscle is working the correct way is to watch the knees while performing squats or single leg squats. If the knees point inward past the inside of the ankle, the athlete may have weakness in his or her gluteus medius. To strengthen the gluteus medius, the athlete should perform exercises that cause his or her hip to come away from the body such as side steps, clamshells, or side lying leg raises.

2.Strengthen your hamstrings- Another important thing that should be looked at is the strength of the hamstrings (large muscles at the back of your thigh) in relation to the quadriceps (large muscles at the front of your thigh). When the quadriceps are significantly stronger than the hamstrings it can pull your tibia (shin bone) too far forward causing stress on the ACL. This is common with female athletes.

3.Stretch your quadriceps- When the quadriceps (large muscle on the front of the thigh) is too tight, it is similar to them being stronger than the hamstrings. It creates a forward pull on the tibia (shin bone). To stretch this muscle, grab the shin to bend the knee and hold it for 30 seconds repeat this 3 to 5 times. Make sure your young athlete stretches when he or she has been active. Stretching when not warmed up, is not as effective.

4.Work on your balance- Balance is another important part of any injury prevention program. People often think that their balance is poor but do not realize that it can be improved. Children who can’t stand on one leg for 1 minute without placing their toe to the ground, need to work on their balance. Have your child practice standing on one leg for a minute. Once this becomes easy, have your child try doing this with his or her eyes closed. For safety, always make sure your child has something steady to grab onto if he or she starts to lose balance.

5.Strengthen your core- Like the gluteus medius, the core assists with control of legs when athletes are active. It is important to have good control if you are an athlete. There are many ways to strengthen the core but some examples are planks, side planks and/or exercises on a stability ball.

6.Wear good shoes- Proper shoes are especially important if your child has flat feet. Shoes that are too flexible or without arch support may cause an increased risk of injury. If your child has flat feet ask the shoe salesman for shoes that help with control to help prevent injuries.

Following surgical repair, ACL injuries require 6 to 9 months of rehabilitation. However, athletes can prevent non-contact ACL injuries by strengthening their muscles properly, having a good stretching routine, working on balance, and wearing supportive shoes. Although it is important to properly maintain all leg muscles these are six of the most important ways to prevent an ACL injury.

SPORTS resources

• Anterior knee pain
• Top 10 questions parents have about sports injuries
• Injury Prevention Guide
• Strength training in children/adolescents
• Core beliefs
• Young athlete's injury prevention guide
• Strength training in children/adolescents (5-15 years)
• Rise of overuse injuries in school-age athletes
• The basics of sports injury prevention for kids
• When growing pains are not growing pains
• Preventing children's sports injuries
• Pain that won't go away

A great way to help children learn to listen and talk is reading aloud. Reading aloud to that growing baby in utero is a jump start to listening, talking and future reading. Reading aloud to children of all ages has huge benefits.

Research on reading aloud to children tells us that it:

• Is the single most important thing to help a child get ready to read and learn.
• Helps a child learn more, unique words. Children who know more words do better when starting kindergarten.
• Helps a child’s brain develop. Language development is vitally important from birth to 3 years.
• Helps a child love to read.
• Helps a child learn.
• Helps parents bond with their child.
• Sets an example for children that reading is important and fun.

The first three years of a child’s life is the most important time for learning. Reading aloud to children boosts their vocabulary, listening and talking skills.

Will watching TV help my child learn?

A parent may ask, “My child loves to watch TV for several hours a day! What is wrong with that?” Watching a little bit of TV isn’t a bad thing. It’s what a child misses by watching many hours of TV. It can cause problems. Children may miss playing games, drawing, hobbies, playing outside and talking with friends or family. Those activities help children learn about getting along with others, problem solving and having fun. Playing and having fun are main ways that young children learn.

Watching TV doesn’t require any interaction with others. It is passive, not active. The American Academy of Pediatrics says no more than 10 hours a week of TV, and no TV for children less than 2 years. This is based on research. When children watch more than 10 hours a week of TV, school scores start dropping.

How long should read aloud time be?

Families lead very busy lives in today’s world. It’s very easy to hand over smart phones or tablets to children for easy, engaging, digital entertainment. Children may learn to swipe screens before learning to turn a page. Reading becomes less important. There is not a set amount of time to read aloud to children. Even 15 minutes a day can make a big difference. Here’s a great example of how reading aloud can affect a child during the first 5 years:

15 minutes every day x 365 days x 5 years = 27,375 minutes OR 456.25 hours of reading aloud. That means the child hears reading aloud 456 hours before starting kindergarten. That’s a great jump-start to being a good reader.

Some ideas for fitting reading aloud into your day and week:

• Visit your local library. Get a free library card for you and your child. Check out books weekly. It’s FREE!
• Visit read aloud story time at the library.
• Read aloud at breakfast time.
• Keep books in the car to read while waiting at appointments.
• Make bedtime book reading a family tradition.
• Have a family story time every week.
• Keep waterproof books in the bath tub for a quick read during bath time.
• Read together as a family every day.
• Have older siblings read aloud to younger siblings.

Reading aloud should be FUN and FREQUENT! It is never too early or too late to start reading aloud to your child.

Resources:

1.Jim Trelease on Reading: www.trelease-on-reading.com

2.Read Aloud 15 Minutes: www.readaloud.org

3.Reach Out and Read: http://reachoutandread.org

4.Reading Rockets: www.readingrockets.org 

References:

1.Anderson, Richard C., http://files.eric.ed.gov/fulltext/ED253865.pdf

2.http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-and-Children.aspx.

3.www.trelease-on-reading.com/rah-ch9.html

4.http://www.wonderbabiesco.org/UserFiles/File/Graven%20and%20Browne%20Auditory%2008.pdf

About the author

Becky Clem, MA, CCC-SLP, LSLS Cert. AVT, is a Rehab Services education coordinator at Cook Children's. Cook Children's offers four types of therapy plans, and tailor them for your child's individual needs. Cook Children's services and specializations include:

• Audiology
• Cochlear implant
• Occupational therapy
• Physical therapy
• Speech therapy
• Transitional care
• SPORTS

Now she prays for Tre’s caregivers to make her son all better.

Tre, who is 9 years old, has been seen by the Rehabilitation Services team at Cook Children’s since his parents adopted him as an infant. Most of those issues centered on his articulation skills. Tre’s history with Rehabilitation Services started with audiology and other physician specialists; speech therapy services began at 7 years old working on articulation skills. 

Then about 15 months ago, Sara Adams, Tre’s speech pathologist, received a call from Jennifer to say her work with him would have to go on hold indefinitely.

Tre was involved in a horrible boating accident. He sustained a head injury and was in a coma at another hospital. But the miracle for the Faulkner family occurred and within two weeks, Tre was up and walking.

After his accident, Tre returned to therapy at Cook Children's Urgent Care and Pediatric Specialties – Mansfield and worked with Occupational Therapy, Physical Therapy and Speech Therapy to regain skills that were lost after his brain injury.

A year later, much of Tre’s care takes place at the Cook Children’s Rehabilitation Services at Mansfield. The focus is on Tre’s short-term memory loss and his severe ADHD, as a result of the injury.

“God has blessed us so much,” Jennifer said. “The Mansfield community has been with us since the beginning, I’m so thankful. I’m also thankful for the amazing care Tre has received since his injury. At Mansfield, Tre has really been helped in many ways, through his physical, occupational and speech therapy. They have helped him so much with his memory and his balance. It’s truly been miraculous.”

The rehab at Mansfield is working for Tre. Academically, Tre’s test scores are in the average range for a child his age. His mom says he’s learning and making strides every day.

And Tre’s doing very well physically. He recently received his gold belt in karate. Makes sense for a kid who has proven time and time again how tough he is.

“The progress Tre has made since his accident is truly remarkable,” Adams said. “Tre still has some struggles with his attention and memory that impact him every day. However, he continues to improve and learn how to work through these struggles. Tre’s sense of humor, determination, and supportive family are his greatest strengths. Tre is such a funny kid! He loves to tell jokes and riddles. One of his favorite jokes is: ‘Why don’t ducks tell jokes when they are flying? … They might quack up!’”

To see how far Tre’s come since his injury it’s hard not to smile at the miracle that’s occurred and the occasional duck joke.

For more information

At Cook Children's, we provide more than 60 pediatric medical and specialty clinic offices throughout Texas. Thanks to our skilled group of clinicians who support the leading-edge technology found among our specialty services, Cook Children's is the destination when it comes to taking care of your children.

Cook Children's Urgent Care and Pediatric Specialties - Mansfield is located at:

801 Matlock Road

Mansfield, TX - 76063

To make an appointment, call 817-347-8400.

Specialty services at Mansfield inlcude:

• Endocrinology and diabetes
• Gastroenterology and nutrition
• Nephrology and dialysis
• Neurosciences
• Orthopedics
• Pediatric surgery (inpatient/outpatient)
• Psychiatry and psychology
• Rehabilitation
• Urgent care

For the last 234 days, the Cook Children’s NICU had been our home and the nurses and doctors had become our family. I couldn’t believe that after all this time they actually trusted US to take Avery home and take care of her all by ourselves. I wasn’t sure we were ready.

Well, it turns out, we were ready. Have there been times when I secretly wanted to be back in the NICU, “co-parenting” alongside nurses and doctors who all have much more experience in taking care of babies like Avery than we do? Absolutely! But, we powered through the first few scary and lonely days and nights and are slowly getting into a groove. We are finally those sleep deprived parents we longed to be for so long. I spend most days with no makeup and covered in spit up and I’ve never been happier in my entire life.

Perhaps the hardest part about being home with Avery is the realization that this journey isn’t over and her early entry into this world will continue to make things hard for her over the next few years. It’s not as if something magical happened when we drove away from Cook Children’s to erase her medical history of the past 7 and a half months.

We have many doctors’ visits in our future. We have weekly in-home visits from nurses and physical and occupational therapists. And we are still on oxygen and have a G button. But, we’re home and Avery is doing great! I’ve had to throw out all the old preconceived ideas I had about being a mom and accept that this is what’s it’s like to be Avery’s mom.

As we look forward to celebrating our first Thanksgiving at home as a family, there are so many things to be thankful for. Being in the NICU for so long taught us to be thankful for the little things. For example, we’ve celebrated so many firsts since being home: Avery’s first car ride, bath, walk in the park, even something as mundane as her first trip to the pediatrician didn’t go unnoticed or unrecognized.

I’ve said it before and I’ll continue to say it, this has been the hardest thing I’ve ever had to go through in my life, but I wouldn’t change it for the world because it has made me a better person. It has made me Avery strong.

Avery, Shawn and I want to wish everyone a very happy Thanksgiving! We are so grateful to everyone who has followed our journey and been so supportive of us. Whether we know you personally or you’ve just followed our blogs to keep up with Avery’s progress, it is just so incredible to know of the many people we’ve had cheering us on. Hopefully, we’ve made you Avery strong as well!

Avery's Journey:

• Avery's story - part 1
• Avery's story - part 2
• Avery's story - part 3
• Avery's story - part 4
• Avery's story - part 5
• Avery's journey - part 6
• Avery's journey - part 7
• Avery's journey - part 8

In February 2014, five girls were in a horrific car wreck near the baseball fields in their hometown Muenster, TX – Abby Pagel was one of them. By the time her parents arrived at the scene, first responders were surrounding the wreck and Abby’s mother, Laura, was searching for her 17-year-old daughter.

“Abby was face down on the other side of the 12-foot fence,” said Laura, “The car was on one side and Abby was on the other. It was a miracle that any of these girls survived; I know they each had angels watching over them that night.”

After being transferred by Careflight to a hospital in Plano, Abby spent 12 days in the ICU with numerous broken bones, a small brain bleed, and was in a coma. She was then moved to an acute care center in Corinth and started to wake up, moving her legs and arms constantly.

Especially being from a small Texas town, the support Abby received from family and friends was immense. The first words Abby said were the names of the other four girls in the car wreck that day. She was more concerned if they were ok than the fact that she was in a hospital. Abby spent 13 days in the Corinth facility until the day she was moved to Cook Children’s Medical Center in Fort Worth.

Laura said, “Abby was in need of rehab and had the option of going to a couple different places. As soon as we saw Cook Children’s, we decided this is where we would be moving Abby to.” Within one day, Abby was being transferred to Cook Children’s.

“We arrived at Cook Children’s and were put in a private room. I had been sleeping on a cot in the other facilities, but there was a couch in Abby’s room. That night I slept on the couch and for the first time I didn’t get up in the middle of the night. The nurses took such great care of Abby,” said Laura.

As a senior in high school, Abby‘s biggest concern was that she would miss her senior class photo with the rest of the graduates in her cap and gown. “Her class said if she can’t come to us, then they are coming to Cook Children’s.” Laura told us, “Abby was able to leave the hospital to go to her senior class photo and it was the first time for many of the kids in her graduating class to see her since the accident.”

The Pagel’s spent 57 days at Cook Children’s before Abby was able to return home. While Abby is still going through physical therapy and recovering from the accident, she has made immense progress in the past few months. Abby returned home in time for her high school graduation. Abby walked across the stage and received a standing ovation as she accepted her diploma.

"To hear that Abby was able to walk across the stage for her graduation is a testament to what happens in the Neuro-rehab unit. At one point I wasn't sure if she would ever walk again,” said Fernando Acosta, Jr, M.D., Cook Children’s pediatric neurologist and Abby’s doctor. “The most important ingredient in her recovery is the incredible effort that Abby put in day after day, with her family's constant support. Their efforts are fortified and nurtured by the dedicated and highly trained and skilled multi-disciplinary staff that makes up the heart of the Neuro-rehab unit. I am thrilled to hear that she was able to walk across the stage and I am so proud of Abby and the rehab staff and all that they were able to accomplish, through their care, hard work, dedication and determination to a common goal."