But what is the healthiest way for young competitors to muscle up? If you are raising an athlete, chances are you’ve heard a coach tell your child to do just that. Bulk up. Gain weight. Get stronger. Improve your power.

The natural inclination of any driven young athlete can be to hit the weight room and add calories to pack on the pounds. But it’s not that cut and dry.

“When we tell a 14-year-old to bulk up, they’re immediately going to think that they need to start lifting heavier and heavier weights,” said Jacky Arrow, PT, DPT, SCS, COMT, Cook Children’s clinical coordinator of sports rehab. “They may start trying things they have seen others doing and that they may not really know how to do. Weightlifting is great, but it could lead to issues and injuries if it isn’t done appropriately, and done with supervision and the right technique.”

All Things Are Not Equal

Muscles aren’t one size fits all. Every sport and what it requires of the athlete and their body size, shape and structure is different. What football demands of a future Division-1 lineman isn’t the same as what baseball demands of a pitcher, or soccer demands of a goalie, or tennis demands of a pro.

“There’s an important need in all sports for a general level of physical preparedness,” said Savana Turner, ATC, a certified athletic trainer at Cook Children’s. “We need to move well, have good mobility in our joints, have good strength and good flexibility. Then, when we’re getting into the higher levels of sports, a sprinter needs a different level of power than maybe a baseball pitcher. They need to be working on very differentiated programs that have the same base level, but can be specialized more into strength versus power versus endurance, depending on what their sport requires.”

Things like age and genetics also factor into a kid’s ability to bulk up. A child’s body can only do so much until it reaches a certain maturity. While kids and teens can improve their performance in a given sport by learning how to most effectively use the muscles they have, it isn’t until they hit puberty that they can see a change in muscular size associated with their strength programming.

“No scientific evidence indicates that participation in a supervised resistance training program will stunt the growth of children or damage developing growth plates,” said Nicole Pitts, D.O., a sports medicine physician at Cook Children’s-Prosper. “Although there is no evidence-based minimum age for participation in a youth resistance training program, all participants should be able to accept directions and follow safety rules. Generally, when youth are ready for sports participation, approximately ages 7 or 8, they are ready for some type of resistance training as part of a well-rounded fitness program. Then, I would say, they can progress to heavier weight around puberty but should wait to do powerlifting or Olympic lifting until they reach skeletal maturity.”

For some, making a big jump in size just isn’t in the cards.

“Some kids are just not going to get big,” said Carolyn Mullins, PT, rehab services manager at Cook Children’s Medical Center. “It’s not in their genetic makeup, and they need to keep those things in mind and be safe about choices that they’re making. You can push and push but if your body’s not built to be a lineman, then your body just isn’t built to be a lineman, and there is not a safe way to do it.”

Before your athlete jumps into the weight room or adopts a diet plan, the most important thing to have in place is supervision. Lean on professionals to design a program that is appropriate for your child and considers their age, progression through puberty, body type and sport.

Know the end game, too, be it increased velocity for the pitcher or girth for the lineman. Is the goal to add weight or gain muscle? What is the definition of “bulking up” for your coach, trainer and sport? Are you looking for more upper body strength or lower body strength, and why? Understanding what you are trying to accomplish and having a plan supervised by a professional will help you reach your goal while minimizing your risk.

The Building Blocks for Bulk

You need three things to build muscle.

●     Strength and resistance exercises that challenge the muscle.

●     A well-balanced diet that includes muscle-feeding protein.

●     Time for muscle recovery and rest so that muscle fibers can rebuild, making you less prone to injury.

Dr. Pitts, who knows a thing or two about the needs of elite athletes as a former professional tennis player, recommends starting your muscle-building journey by using your own body weight as resistance. Once you’ve mastered that, you can progress to very light resistance using lower weights with high repetitions before puberty. As you get older, you can increase both of these.

A good muscle-building program will include both training and nutrition. Without adequate nutrition, you don’t have the building blocks to increase muscle strength and size. But the right nutrition without the right training and practice won’t get the job done either.

Food is Fuel

All calories are not equal when it comes to a well-balanced diet that promotes muscle growth. A diet full of sugary drinks, junk foods and fast food may help you pack on the pounds, but it can lead to fatigue and poor performance, even for kids who seem to have an endless well of energy.

“Our society has been greatly impacted by childhood and adult obesity, so general advice to ‘gain weight and bulk up’ can be very challenging to navigate,” said Rachel Hill, RD, CSO, LD, CNSC, a registered dietitian at Cook Children’s Medical Center. “Being an active teen does not eliminate the risk that comes with a weight that is too heavy for the child’s frame or eating a diet that far exceeds the body’s needs or is laden with junk foods. While the risks of eating a junk food diet may not be obvious to a teen at first glance, they are robbing their body of essential nutrients for optimal growth, development, function and performance.”

As a general rule, kids should eat a diet rich in whole foods that includes a mix of carbohydrates, protein and fat. Doing so will not only fuel your body with healthy, energizing calories but also give you the vitamins, minerals, fiber and other nutrients you need for peak performance. Once puberty hits, males often require more protein and females more iron.

“Athletes need about 1 to 1.4 grams of protein a day per kilogram of body weight to help with muscle building and repair,” Dr. Pitts said. “It’s a little bit more than their non-athletic peers. So for a 150-pound athlete, having about 80 grams of protein, or 20 extra grams of protein compared to someone else a day, is ideal. If you end up going beyond that, the body doesn't always utilize it. A lot of times athletes will take three times the amount of protein that they need a day.”

Beware of using supplements to add protein. This can actually add more protein than the teen body needs. Supplements also may contain substances like creatinine, which can cause renal failure if used improperly and is not recommended for teens, according to Dr. Pitts.

When it comes to powering the athlete, timing is key. What you eat before, during, and after activity helps fuel your performance and recovery.

“The foods we eat provide fuel for our bodies in the form of calories,” Hill said. “Calories come from three sources: carbohydrates, protein, and fat. While all three are important for a well-balanced diet, carbohydrates are most important prior to a workout to provide enough fuel for the workout. Without enough carbohydrates, the body defaults to breaking down muscle to fuel the workout. Incorporating a little bit of protein into the pre- and post-event snacks can also help protect muscle mass.”

Teen athletes should eat a meal or snack at least 30 minutes before and after exercise to fuel their performance and protect the hard-earned muscle mass they’ve built.

Take A Break

Allowing time for your muscles to rest and recover isn’t slacking, it’s actually muscle-building. If the muscle fibers broken down during activity aren’t given the chance to rebuild, you’ll actually interrupt the muscle-building process, end up losing mass and make yourself prone to fatigue-induced injury. If you are strength training, don’t work the same muscle group two days in a row. Put one to two days of rest in between. The American College of Sports Medicine recommends two to three non-consecutive days of strength training per week for teens.

Dr. Pitts also warns about specializing in a single sport too early. Branching out into other sports creates a well-rounded athlete with cross-trained muscles and skills. It also protects the athlete’s mind and body from burnout.

“Taking care of your body as a whole is really important and is a really difficult thing for a child or a teenage athlete to keep in mind,” Arrow said. “It’s that end-game mindset. Sleep. Drink water. Eat a well-balanced diet. Participate in a broad variety of activities. Taking time off from your sport and focusing on moving well over putting more weight on the bar is the key.”

The bottom line if your teen wants to be an athlete to be reckoned with? Train well. Eat healthy. Play hard. Rest. And, above all, enjoy the game!

Talking about hard things isn’t easy, especially for a child or teen. It’s scary to be vulnerable. But talking can bring clarity. Sharing your hurts, struggles and stress can be a release, and leaning on someone you love can lighten your mental and emotional load.

“Feelings really are visitors trying to tell you a story,” said Denise Coover, LCSW, a trauma informed care specialist at Cook Children’s Medical Center. “If you ignore the story it just keeps building and building and will demand to be heard. Think of holding in feelings like a trash compactor. You keep pressing it down, pressing it down, but eventually it explodes like a volcano. Usually with frustration, anger and aggression and that’s the danger. These things need to be expressed within a safe environment and relationship. That is key.”

Kids need adults—parents, teachers, counselors, pastors and mentors—to create an environment where they feel secure and free to unpack the things that weigh on their minds and hearts. Trusted adults can help release the pressure on the trash compactor, so to speak.

“By talking with someone we trust, we are able to process our feelings as they arise,” said Marissa Benners, Ph.D., LP, a psychologist at Cook Children’s. “It makes it easier to manage the everyday demands of life without the pressure of unresolved feelings weighing us down. Sharing our feelings with others gives us an extra person who can help us problem solve and figure out the best coping strategy.”

Michael Garcia, MS, LPC, is a trauma specialist for the Fort Worth Independent School District where he works with children in crisis every day. Without a trusted adult, he cautions that a child’s development could be influenced by less positive sources.

“A child who is struggling wants to be comforted and feel safe,” Garcia said. “A loving and caring adult provides the necessary attachment a child needs to learn how to effectively communicate needs, meet those needs and manage emotional regulation. A positive and connected caregiver greatly influences the child’s ability to navigate difficult challenges.”

But many parents have their own hurts, experiences, worries, commitments and unfulfilled expectations that are barriers to being a sounding board and source of strength for their kids.

“Parenting isn’t easy,” Garcia said. “As a matter of fact, it’s my most challenging undertaking. It’s not always easy to listen to our children with empathy and compassion when our heads are spinning with finances, deadlines, relationships, piles of laundry and a myriad of daily speed bumps.”

On the flip side, kids don’t want to be a burden to their parents who they see juggling the demands of daily life.

“Kids often tell me the adults in their lives don’t care, are too busy, have their own problems and they don’t want to cause more problems,” Garcia said. “A lot of kids are empathetic to what their parents are going through and don’t want to be another burden.”

In a recent focus group conducted by Cook Children’s, several teens said feelings of fear and insecurity also get in the way of opening up to others. They are unsure how their message will be received, and are afraid of getting in trouble, being misinterpreted and, especially these days, being canceled.

When adults allow the complications of daily life, difficult pasts, fear of other’s perceptions and shame to lead, the unwritten no-talk rule sets itself up as the standard in the home and muzzles any opportunity for communication, connection, teaching and healing. It’s one thing for a child to suffer. It’s another for them to suffer in silence. Pushing hard issues under the rug, or ignoring a child’s emotions—a natural sign that something is going on—won’t make things go away. Instead, it teaches kids to hide their struggles and sets up a breeding ground for shame, guilt, rejection, lack of trust and hopelessness.

So how can parents, teachers and child advocates be a trusted adult that welcomes the hard conversations? How can trusted adults encourage communication that sheds light on the root of the issue and helps them guide kids to problem solve through a situation?

Take stock. Garcia said we can’t be a trusted adult when we feel like we have nothing left to give. Ask yourself what you need as a parent so that you can be truly present with your kids. If you need help with your own struggles, reach out. Equipping yourself will help you take care of and equip your children.

“We are all doing the best we can, and we can do better,” Garcia said. “Kids need us to be present, loving, comforting, empathetic, compassionate and honest. They need to know that they can trust us with whatever storm is raining down on them. We have to take care of ourselves so that we can take care of our children.”

Harness your own emotions. Parents have emotions too. It’s easy and natural for those emotions to surface, especially when it comes to your children. But harnessing those feelings like anger and frustration in the moment can help you see and respond to the reality of the situation, rather than getting caught up in the emotion. Responding out of anger will only frustrate a child, but responding out of love, patience and wisdom will teach them important coping skills that will benefit them for life.

 “One of the most important factors in creating a safe space is responding to your child in a calm and compassionate manner,” Benners said. “When adults regulate their own emotions during conversations, it helps those around them feel more at ease or relaxed. Parents can help foster open conversation by being honest about their own feelings. By calmly expressing our feelings during periods of stress, for example saying, ‘I’m feeling very frustrated at the moment and I need a few minutes to calm down,’ we help normalize feelings and we teach our kids an adaptive way to express them and to ask for help.”

Watch their cues. Kids will demonstrate they need to talk through their emotions and behavior.

“When we bottle our feelings up, they tend to come out in other ways,” Benners said.

Stomachaches, headaches, fatigue, difficulty concentrating, sleep problems, irritability, meltdowns and oppositional behavior are all indicators that your child might have something weighing on their heart and mind.

Listen. This is the most important thing an adult can do for a child, according to Garcia.

“Trust comes from actively listening without judging,” he said. “Listening with empathy, compassion and curiosity is how we encourage kids to share openly.”

Embrace your child’s communication style. Kids communicate in different ways. The key is to figure out what works best for them at their current age and stage of life and go with it.

For younger kids, play is always a good communication tool.

“What kids can do in play, they can do in life,” Coover said. “I like to give a young child a toy, like a dinosaur, and throw out a scenario. Maybe T-Rex is bullying and saying you’re green, fat and ugly and pushing. If the child doesn’t have good coping skills, the dinosaur will just sit there.”

That’s when you can start talking to them about how they would handle the situation. Ask questions that help them think through how to respond. Could you tell mommy dinosaur? Can you walk away?

For older kids, especially teens, seizing the moment while you are doing another activity together is a great way to set the stage for conversation.

“I'm a big fan of asking kids questions when you're on a car ride,” Coover explained. “There's something about that side-by-side movement where they don't really have to look at you. Maybe music is playing. You get the vibration of the car. You're not really looking at them because you're concentrating on the road. Then, all of a sudden you can get all of this information from them.”

Striking up a conversation around the dinner table is another good way to check in. Coover suggests asking your child what was one thing that made them mad, sad, happy and worried that day to get the conversation flowing.

When a child can’t find the words to speak, let them draw it or write it.

“Some kids either don't have the verbiage to be able to say it or they're feeling insecure or are afraid you're going to get mad,” Coover said. “So they'll feel more comfortable writing it. I really like notebooks for pre-teens and adolescents. Like a regular composition book. Nothing fancy.

Tell your child, ‘if there's something going on you can write it and put it right here and I'll read it and respond to you.’ With little kids, if you have them come home and just draw about their day, it’s amazing what you’ll find out.”

Be an equiper, not a fixer. It’s easy for adults to want to fix a problem for a child. That takes a lot less time than letting a child express what they are thinking and feeling, but that’s not always beneficial.

“When we constantly fix things for our kids, their brains don't grow,” Coover said. “They become adults who can't manage any kind of problem in life because they've never had to. Someone has always stepped in and just took care of it for them. So their brain didn't grow in that way. They didn't create those neural pathways to know how to consider their solutions. I think it’s important that parents know that they don’t necessarily have to fix that feeling, but actually ask if their child wants advice or insight.”

Encourage them. Help them think through the issue, and make sure they know that you are here to help them figure things out.

Check in. No matter how you communicate with your child, it’s important to check in with them regularly.

“Allocate designated time with your children on a weekly basis,” Benners said. “Put your devices away and just focus on having fun together. Teens often feel like they don’t have much control over their lives, so allow them to choose an activity that appeals to them. During this time, don’t be overly intrusive by asking questions. Instead, follow your child’s lead and you may find that they will eventually open up on their own.”

When your kids know that you can be a trusted sounding board and source of wisdom for them, you’ll have the opportunity to equip them with the life skills they need for healthy living, hopefulness and resilience.

Rebecca Benson had a feeling the weather predictions would be wrong when she woke up Thursday, Feb. 11. As she suspected, no winter storm arrived overnight to cancel school for her two children. Like any other day, she quietly put on her scrubs while her family slept and left her North Fort Worth home in the dark. A diligent nurse at Cook Children’s Medical Center for six years, Rebecca didn’t want to be late for her 7 a.m. shift.

As she traveled down Interstate 35’s expressway, everything seemed normal – until it wasn’t.

“The roads were completely dry. There was not even a mist on my windshield, absolutely nothing,” said Rebecca. “All the bridges I went over were perfectly fine until I came across the big Trinity River bridge.”

Driving down the highway for nearly 20 minutes, she had no reason to suspect what lay ahead – black ice, and a crumpled mess of metal and people. Approaching a curve at the top of a hill, Rebecca’s car began to swerve. As she confidently corrected the wheel, she noticed shining taillights getting closer. It was a pileup that would ultimately involve more than 130 vehicles, killing six people.

“I look in front of me and see all of the carnage from the accident. There's absolutely nothing I can do,” she said. “It’s the expressway. There's barriers on both sides of you. You can’t go to a shoulder. You can't do anything.”

Knowing she was about to crash, she aimed her red SUV in between two semi-trucks.

“I put my foot on the brake, said a prayer, and I literally thought to myself, ‘I could very possibly die in two seconds,” she said.

Rebecca tried to relax her body to avoid broken bones and readied herself for impact. She hit the trucks so hard, her ponytail holder came out of her hair.

“I got through that and thought, ‘Okay, I'm alive. I'm not severely injured. And then I looked in my rearview mirror and see all of these lights coming right at me,” she said.

Rebecca says that’s when she realized she wasn’t out of the woods. The chances of her being injured or worse by the oncoming traffic were high. But thanks to her quick thinking before the crash, she had positioned her vehicle in what she calls “God’s triangle,” because the trucks stuck out past her SUV, protecting her.

“Everything that hit behind me, the trucks took the impact from that. Every time another semi would hit, you would hear and feel the car move. It was so unbelievably terrifying,” she said. “I've seen it on videos, but to actually be there, waiting to see if something even worse is going to happen was awful.”

Rebecca stayed in her SUV until she stopped hearing crashes. All four doors were blocked by the trucks, so she waited until someone opened the back hatch of her vehicle. She crawled out and surveyed the situation in shock.

“I'm like, ‘Okay, I'm a nurse. I got this. Who can I help? What can I do?’” Rebecca explained. “But Fort Worth Fire Department was working a wreck on the non-express side of 35 (when the pileup began) so they were already there. There was a car behind me that they were working on with the Jaws of Life to try to help somebody. Everyone from Fort Worth Fire was amazing.”

After the crash, Rebecca called her husband who was ready to come get her. She also had a text message from her coworker, Ed, warning her not to take I-35 because traffic was backed up. Knowing Ed was stuck nearby, she decided to find him and hitch a ride to work.

“I was like, ‘All right, I'm gonna hop the barrier and I'm walking your way because there's nothing I can do. But I can at least get in your nice warm car and be safe that way,” she said. “I walked up I-35 in the ice. It was the weirdest thing to be walking on a highway.”

When she found Ed and his girlfriend, Kim, she told them to take her to work. Rebecca explained that she could have gone to the reunification center set up by first responders and waited for her husband, but she knew that drive would likely take hours due to the shutdown. She also felt the need to do something other than think about what she had just survived.

“Being able to be at work and helping instead of reliving that,” she explained. “I was like, ‘I need to get to work and just see where I can help.’”

Rebecca acknowledges this is something she will be processing for a very long time. She allowed her husband to come get her a few hours later and take her to a hospital. Thankfully, she only suffered bruises. But she’s already dealing with survivor’s guilt, wondering why she was able to walk away when so many others couldn’t.

“My heart breaks for all the people who lost loved ones, and who have loved ones in serious condition,” she said. “It's horrible, awful, terrifying.”

Rebecca remembers seeing many people in scrubs as she was walking along the interstate and calls the situation a ‘perfect storm’ for health care workers, all trying to get to work at the same time. Asked if she felt like a hero, she adamantly says ‘no.’

“I feel like I'm absolutely blessed and had guardian angels surrounding me,” she said. “I did what any other nurse I know would do. I didn't save anybody. I didn't do anything extraordinary. I just did what I'm supposed to do.”

She says the experience also gives her hope. From the first responders to good Samaritans, she says she saw the good in people. Even when she was safely waiting with Ed and Kim, she remembers a man walking car to car with a box of granola bars for anyone who may have skipped breakfast and needed something to eat.

“It gave me a lot more faith in humanity.”