Photo courtesy of Amy Valasek
There are few sights sadder than the image of a child sporting a cast while his or her friends play unfettered.
Especially among children who play sports, there are a variety of potential maladies, from standard bone breaks to stress fractures. At best, they’re the cause of pain and temporary debilitation; at worst, they can have effects reaching later into the child’s life.
Fortunately, adequate preparation can significantly cut the odds of injury. Dr. Amy Valasek of Nationwide Children’s Hospital explains the risks and means of prevention.
Ask the Expert: Preventing ever-more-common ACL injuries starts with understanding them
What are some examples of activities that parents might not know put their kids at risk for bone injury?
Though any type of activity could cause bone injury or fracture, activities with more contact or impact, such as football or jumping on the trampoline, are a risk factor. Furthermore, repetitive activities increase bone injury risk. Children who are overcommitted in a single sport, meaning they play on multiple teams in the same season or annually, have increased stress on the same joint or bone. Repetitive exercise causes bone imbalance, leading to more breakdown than repair.
What behaviors and activities are particularly risky for the most-broken bones: wrist, clavicle and fingers?
High impact, high speed and high heights are risk factors. Any activity or sport with a risk of falls on an outstretched wrist/arm/hand can commonly lead to wrist, forearm or clavicle fractures.
Because ankles are also among children’s most-broken bones, are there types of footwear that are safer than others in terms of bones?
Research has not shown a specific shoe to prevent bone injury. Rather, properly fitting and laced shoes are the keys to success.
How common are stress fractures in children? How can they be recovered from, or at least prevented from causing further problems?
The incidence reported in the medical literature varies from 0.7 to 20 percent of athletic injuries in children under 18 years. Girls have higher rates of stress fracture than boys. The most common sports involved are cross country, tumbling and gymnastics. The most common sites are the lower leg, foot, hip and spine. The time missed from sport can be weeks or months; it can even be career-ending.
All stress fractures can be prevented. Fitness activity with variety and balance is the key to success. The medical recommendations to prevent stress fractures in children are:
1) No more than five days a week of the same activity.
2) Two days per week of rest from specific activity.
3) Avoid multiple team participation in a single season.
4) Avoid single sport/activity focus until at least 12 years of age.
5) Aim for 2-3 consecutive months off from a specific sport focus annually.
6) Eat healthfully. The goal is adequate caloric, calcium and vitamin D intake to fuel the body for daily activity.
How does care for an incomplete fracture differ from care for a complete one?
Complete fractures produce a fracture line through the entire bone cortex, whereas incomplete fractures do not. Children can develop either a complete or incomplete acute fracture pattern due to pliability of their bones. Some incomplete fractures develop over time in the setting of repetitive activity. An imbalanced state causes more bone breakdown than bone strengthening and leads to stress fractures.
What organized sports seem to cause the most bone injuries?
Contact sports increase the risk of acute trauma or fracture. A few examples are football, soccer, basketball, softball and baseball, gymnastics, lacrosse and hockey. Repetitive sports also increase the load on the bone and can lead to stress injury. A few examples are running sports, gymnastics, tumbling and repetitive throwing.
What is a growth plate injury, and what should parents know about the inherent risks?
Growth plates are very important structures in young bones. Growth plates appear as gaps in bone on X-rays. To the untrained eye, the gap might be mistaken for a fracture. Instead, the growth plate is where new cells transform from cartilage to bone. The growth plate continuously works to allow bones to lengthen until maturity. At times of rapid growth – growth spurts – the growth plate works extra hard and is weakened. Therefore, growth spurts are susceptible time periods for growth plate injury.
What are some new developments in the treatment of bone injuries?
Casts have become more tolerable thanks to waterproof lining. This waterproof lining lessens the itch and enables children to bathe without needing to cover the cast. However, not all fractures are stable enough for waterproof casts and require the old-fashioned type. Removable braces and boots are useful for stable injuries and are very convenient, too.
What are some fairly early effects of insufficient calcium in kids, beyond risk of osteoporosis later in life?
Insufficient calcium leads to poor bone health overall. Bone mass is built in the first two decades of life. Ninety percent of peak bone mass occurs by age 18 years in females and age 20 in males. Therefore, investment in strong bone health at a young age is critical to prevent fracture, stress fracture, osteopenia (lower-than-normal bone mineral density) and osteoporosis.
How does one get one’s children to consume enough calcium if those kids don’t like milk?
Calcium intake of 1,200 to 1,500 milligrams per day is recommended during the preteen years and continuing through adolescence. This can easily be accomplished with a well-balanced, calcium-rich diet. If children do not like milk, other sources are white beans, broccoli, cheddar cheese, low-fat yogurt, spinach, almonds, calcium-rich orange juice and 100 percent fortified grape juice. If calcium intake is still dismal, a supplement could be considered under the discretion of your child’s health care provider.
What if they’re lactose intolerant?
Many children with lactose intolerance can drink small amounts of milk without discomfort. Otherwise, families can choose lactose-free milks and yogurt available at local grocery stores. Additionally, a supplement could be considered under the discretion of your child’s health care provider.
Can a too-stringent diet negatively affect bone health? What problems might it cause?
Yes, both males and females are at risk. Females are more often affected, hence the term “The Female Athlete Triad.” The Female Athlete Triad consists of three interrelated conditions: low energy availability (low calorie intake), menstrual dysfunction and bone loss. Low energy availability can negatively affect hormones, leading to osteopenia and osteoporosis. A missed menstrual period may indicate the body is not receiving adequate energy to support proper health and current level of physical activity. The Female Athlete Triad can lead to stress fracture, fracture and potential reproductive consequences. For more information, visit www.femaleathletetriad.org.
EXPERT:
Amy Elizabeth Valasek, MD, MSc is a physician for Nationwide Children’s Sports Medicine and an assistant professor in the department of pediatrics at The Ohio State University College of Medicine. She is fellowship trained and board certified in sports medicine.
Valasek completed medical school at the University of Maryland in 2005. She completed her residency at Johns Hopkins Hospital in the Department of Pediatrics in 2008, and her sports fellowship at University of Maryland Family Medicine Department in 2009. She is a member of the American Academy of Pediatrics, American College of Sports Medicine and American Medical Society for Sports Medicine.
She has been at Nationwide Children's since August. She is also team physician at Bishop Ready High School in west Columbus.
