For the second year in a row, Cook Children’s Emergency Department and Urgent Care Centers are seeing a big influx of parents bringing in children who have been exposed to COVID-19 but show no symptoms. This is causing long wait times at all locations and putting unnecessary strain on the health care system.

On Monday, Aug. 29, our Emergency Department (ED) staff saw 614 patients, which is equivalent to a patient checking in every 2 minutes for 24 hours straight. That’s nearly double the number of patients we typically see in the ED. Our seven Urgent Care Centers (UCC) saw 873 patients, which is also much more than usual.

“We are seeing patient volumes equivalent to our worst winters, and it’s taking a toll on our staff,” said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care. “We need everyone’s help by staying home if you only need a COVID test or if your child has mild symptoms.”

Currently, 23% of COVID tests at Cook Children’s UCCs are coming back positive. In addition to COVID, Dr. Starnes says they are seeing a lot of colds.

“If your child tests positive for COVID at home, you can trust the test. You don’t need to have a health care provider confirm the results,” Dr. Starnes said. “If a COVID test comes back negative, it’s safe to monitor minor symptoms at home and re-test in 48 hours.”

Parents and caregivers are encouraged to reach out to their primary care physicians if their child is not feeling well.

Cook Children’s experienced a very similar situation in August 2021, likely triggered by kids going back to school.

Please avoid the emergency room and UCCS for COVID-19 testing. If your child has been exposed to COVID-19, please use an at-home test or schedule an appointment with a testing location such as a pharmacy.

“If your child needs emergency care treatment, our Emergency Department is here for you. That’s why we’re here,” said Natalie Carpenter, director of Emergency Services at Cook Children's. “But please don’t come to the emergency department for a simple COVID test.”

The ED should only be used for COVID-19 symptoms such as:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

If you are going to the ED, please limit the number of people you bring with you (if possible).

Where do you go when your child needs to be seen by a doctor?

Here’s a guide:

• Go to the emergency room if your child has trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition. 
   
• Call your health care provider if your child has ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns. The pediatrician’s office can help you decide what steps to take. 
   
• If you can’t get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

Free COVID Tests Still Available to be Delivered to Your Home

Every home in the U.S. is eligible to order three rounds of at-home COVID-19 test kits from the government. You can easily sign up at covid.gov/tests and have the tests delivered to your home. The last day to order tests is Friday, Sept. 2.

For detailed information about what to do if your child tests positive or negative, download the PDFs attached to this article. 

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