Exercise Safety

Head injuries fall into two categories:

1. external injuries, usually involving the scalp
2. internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain

Fortunately, most childhood falls or blows to the head cause injury to the scalp only. While these can be scary-looking, they usually aren’t dangerous. An internal head injury could be more serious because it may cause bleeding or bruising of the brain.

External (Scalp) Injuries

The scalp is rich with blood vessels, so even a minor cut there can bleed a lot. Sometimes the scalp’s veins leak fluid or blood into (and under) the scalp. This appears as a “goose egg” or swelling on the head. It may take days or even a week to disappear.

What to look for and what to do:

• Call the doctor if your child is an infant; has lost consciousness, even briefly; or if a child of any age has any of these symptoms:
  • won’t stop crying
  • complains of head and neck pain (younger or nonverbal children may be more fussy)
  • vomits several times
  • won’t awaken easily
  • becomes hard to console
  • isn’t walking or talking normally
• If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow:
  • Apply an ice pack or instant cold pack to the injured area for 20 minutes every 3 to 4 hours. If you use ice, always wrap it in a washcloth or sock; ice applied directly to bare skin can injure it.
  • Watch your child carefully for the next 24 hours. If you notice any of the signs of internal injury, call your doctor right away.
  • If the incident happens close to bedtime or naptime and your child falls asleep soon afterward, check in a few times while he or she sleeps.
• If color and breathing are normal, and you don’t sense a problem, let your child sleep (unless the doctor has advised otherwise). There’s no need to keep a child awake after a head injury.
• Trust your instincts. If you aren’t comfortable with your child’s appearance, partly awaken your child by sitting him or her up. Your child should fuss a bit and attempt to resettle. If he or she still seems very drowsy, try to awaken your child fully. If your child can’t be awakened or shows any signs of internal injury, call the doctor or 911 for an ambulance.

Internal Injuries

Cerebrospinal fluid (CSF) is a clear fluid that cushions the brain from damage. But a severe blow to the head can still knock the brain into the side of the skull or tear blood vessels.

Some internal head injuries can be serious and possibly life-threatening. These include a broken skull bone, torn blood vessels, or damage to the brain itself.

It can be hard to know how serious a head injury is, so it’s always wise to call your doctor.

Symptoms and What to Do

Call 911 if your child shows any of these symptoms after a head injury:

• unconsciousness for more than a few seconds
• abnormal breathing
• obvious serious wound
• bleeding or clear fluid from the nose, ear, or mouth
• disturbance of speech or vision
• pupils of unequal size
• weakness or paralysis
• neck pain or stiffness
• seizure

If your child is unconscious:

• Do not try to move your child in case there is a neck or spine injury.
• Call for help.
• Turn a child who is vomiting or having a seizure onto his or her side while trying to keep the head and neck straight. This will help prevent choking and provide protection in case of neck and spine injury.

If your child is conscious:

• Do your best to keep your child calm and still.
• If there’s bleeding, apply a clean or sterile bandage.
• Do not attempt to cleanse the wound, which can make bleeding worse and/or cause serious complications if the skull is fractured.
• Do not apply direct pressure to the wound if you suspect the skull is fractured.
• Do not remove any object that’s stuck in the wound.

Concussions

Concussions — the temporary loss of normal brain function due to an injury — are also a type of internal head injury. Repeated concussions can permanently damage the brain.

In many cases, a concussion is mild and won’t cause long-term damage. Kids who get a concussion usually recover within a week or two without lasting health problems by following certain precautions and taking a break from sports and other activities that make symptoms worse.

Playing sports is one of the most common causes of concussions. To help protect your kids, make sure that they wear the proper protective gear, and don’t let them continue to play if they’ve had a head injury.

If your child sustains an injury to the head, watch for these signs of a possible concussion:

• “seeing stars” and feeling dazed, dizzy, or lightheaded
• memory loss, such as trouble remembering what happened right before and after the injury
• vomiting
• headaches
• blurred vision and sensitivity to light
• slurred speech or saying things that don’t make sense
• problems concentrating, thinking, or making decisions
• difficulty with coordination or balance (such as being unable to catch a ball or other easy tasks)
• feeling anxious or irritable for no apparent reason

If you suspect a concussion, call your doctor right away.

Preventing Head Injuries

It’s impossible to prevent kids from ever being injured, but there are ways to help prevent head blows.

Make sure that:

• your home is childproofed to prevent household accidents
• your kids always wear the proper headgear and safety equipment when biking, in-line skating, skateboarding, snowboarding or skiing, and playing contact sports
• kids always use a seatbelt or child safety seat
• your child takes it easy after a head injury, especially if there is a concussion
• your child doesn’t go back to rough play or sports until the doctor says it’s OK. If your child reinjures the brain while it’s still healing, it will take even longer to completely heal.

Our bodies create a tremendous amount of heat. Normally, they’re cooled through sweating and by heat radiating through the skin.

But in very hot weather, high humidity, and other conditions, this natural cooling system may begin to fail, letting heat in the body build to dangerous levels. The can cause heat illness, such as heat cramps, heat exhaustion, or heatstroke.

Heat Cramps

Heat cramps are brief, painful muscle cramps in the legs, arms, or abdomen that may occur during or after vigorous exercise in extreme heat. The sweating that occurs with intense physical activity causes the body to lose salts and fluids. This low level of salts causes the muscles to cramp.

Kids are particularly at risk for heat cramps when they aren’t drinking enough fluids.

Although painful, heat cramps on their own aren’t serious. But cramps can be the first sign of more serious heat illness, so they should be treated right away to help avoid any problems.

What to Do:

A cool place, rest, and fluids should ease a child’s discomfort. If possible, give fluids that contain salt and sugar, such as sports drinks. Gently stretching and massaging cramped muscles also may help.

Heat Exhaustion

Heat exhaustion is a more severe heat illness that can occur when someone in a hot climate or environment hasn’t been drinking enough fluids. Symptoms can include:

• increased thirst
• weakness
• fainting
• muscle cramps
• nausea and/or vomiting
• irritability
• headache
• increase sweating
• cool, clammy skin
• elevation of body temperature, but less than 104°F (40°C)

What to Do:

• Bring your child to a cooler place indoors, an air-conditioned car, or shady area.
• Remove your child’s excess clothing.
• Encourage your child to drink cool fluids containing salt and sugar, such as sports drinks.
• Put a cool, wet cloth or cool water on your child’s skin.
• Call your doctor for advice. If your child is too exhausted or ill to drink, treatment with intravenous (IV) fluids may be necessary.

If left untreated, heat exhaustion can develop into heatstroke, which can be fatal.

Heatstroke

The most severe form of heat illness is heatstroke. Heatstroke is a life-threatening medical emergency.

In heatstroke, the body cannot regulate its own temperature. Body temperature can soar to 106°F (41.1°C) or even higher, leading to brain damage or even death if it isn’t quickly treated. Prompt medical treatment is required to bring the body temperature under control.

Factors that increase the risk for heatstroke include overdressing and extreme physical activity in hot weather with inadequate fluid intake.

Heatstroke also can happen when a child is left in, or becomes accidentally trapped in, a car on a hot day. When the outside temperature is 93°F (33.9°C), the temperature inside a car can reach 125°F (51.7°C) in just 20 minutes, quickly raising body temperature to dangerous levels.

What to Do:

Call for emergency medical help if your child has been outside in extreme temperatures or another hot environment and shows one or more of these symptoms of heatstroke:

• severe headache
• weakness, dizziness
• confusion
• nausea
• rapid breathing and heartbeat
• loss of consciousness
• seizure
• no sweating
• flushed, hot, dry skin
• temperature of 104°F (40°C) or higher

While waiting for help:

• Get your child indoors or into the shade.
• Undress your child and sponge or douse him or her with cool water.
• Do not give fluids unless your child is awake, alert, and acting normally.

An Ounce of Prevention

To help protect kids from heat illness:

• Teach kids to always drink plenty of fluids before and during activity in hot, sunny weather — even if they’re not thirsty.
• Make sure kids wear light-colored, loose clothing and use sunscreen when outdoors.
• On hot or humid days, make sure your kids only participate in heavy activity outdoors before noon and after 6 p.m.
• Teach kids to come indoors, rest, and hydrate immediately whenever they feel overheated.

No parent wants to see their sports-loving child sitting on the sidelines, but knee injuries put thousands of young athletes on the bench every year. It’s not unusual for kids to fracture, sprain, strain, or dislocate the knee joint while playing on the field or just goofing around with friends.

Most kids just need a few days or weeks of rest to recover from a knee injury. Severe cases can require surgery and a longer recovery before kids are walking again and back on the playing field.

How the Knee Works

To understand how injuries happen, it helps to know how the knee works. The knee is the largest joint in the body; it provides stability and allows the legs to bend, swivel, and straighten.

The knee joint is at the ends of the femur (thighbone) and the tibia (shinbone); it is protected by the patella (kneecap). The ends of the femur and tibia and the back of the patella are covered in articular cartilage, which acts as a cushion to keep the femur, patella, and tibia from grinding against each other. On the top of the tibia, extra pads of cartilage called menisci help absorb the body’s weight. Each knee has two menisci — the inside (medial) meniscus and the outside (lateral) meniscus.

The muscles around the knee include the quadriceps, a large muscle at the front of the thigh, and the hamstrings, located at the back of the thigh. The quadriceps help straighten the leg and the hamstrings help bend the knee.

Several tendons — cables of strong tissue that connect muscles to bones — work together to help move the knee. The tendons in the knee are the quadriceps tendon, the patellar tendon, and the hamstring tendons. All work together to allow the leg to extend.

Ligaments are cables of strong tissue that connect bones to bones. The four main ligaments in the knee that help connect the femur to the tibia and keep the knees stable are:

1. medial collateral ligament (MCL): connects the femur to the tibia along the inside of the knee. It keeps the inner part of the knee stable and helps control the sideways motion of the knee, keeping it from bending inward.
2. lateral collateral ligament (LCL): connects the femur to the tibia along the outside of the knee. It keeps the outer part of the knee stable and helps control the sideways motion of the knee, keeping it from bending outward.
3. anterior cruciate ligament (ACL): connects the femur to the tibia at the center of the knee. It helps control the knee’s rotation and forward motion.
4. posterior cruciate ligament (PCL): connects the femur to the tibia at the back of the knee. It helps control the knee’s backward motion.

Types of Knee Injuries

Because the knee is such a complex joint with many moving parts, knee injuries are quite common. Frequent causes of injuries are overuse (from repetitive motions, as in many sports), sudden stops or twists, or direct blows to the knee.

Common injuries among kids include:

Sprains

Knee sprains usually involve damage to the ACL and/or MCL. The most serious sprains involve complete tears of one or more of the knee ligaments. Symptoms of knee sprains include:

• a popping or snapping sound in the knee at the time of injury
• pain that seems to come from within the knee, especially with movement
• not being able to bear weight on that leg
• swelling
• the knee feels loose or unstable

Strains

A strain happens when a child partially or completely tears a muscle or tendon. With knee strains, kids may have bruising around the knee in addition to the symptoms mentioned above for sprains.

Tendonitis

Tendonitis happens when a tendon gets irritated or inflamed. It is often caused by overuse or poor training (such as lack of strength exercises or stretching). A child with tendonitis might have pain or tenderness when walking or at rest, or when bending, extending, or lifting a leg.

Meniscal Cartilage Tears

Damage to the menisci is a very common sports injury, especially in sports where kids have sudden changes in speed or make side-to-side movements. Meniscal injuries can occur together with severe sprains, especially those involving the ACL. Meniscal injuries can cause tenderness, tightness, and swelling around the front of the knee. Sometimes fluid collects around the knee (known as effusion).

Fractures and Dislocations

A fracture is a cracked, broken, or shattered bone. Kids may have trouble moving the bone and are likely to have a lot of pain. Patellar dislocation happens when the patella is knocked off to the side of the knee joint, by twisting or some kind of impact. Sometimes it will go back to its normal position by itself, but usually needs to be put back in place by a doctor. Symptoms include swelling and pain in the front of the knee, an abnormal bulge on the side of the knee, and inability to walk on the leg with the affected knee.

Articular Cartilage Injuries

Sometimes a small piece of bone or articular cartilage softens and/or breaks off from the end of a bone, causing long-term knee pain. This is called osteochondritis dissecans (OCD). Symptoms include pain; swelling; an inability to move the joint; and stiffness, catching (“locked knee”), or popping sensations with knee movement.

Chondromalacia pattellae happens when the cartilage in the patella softens or wears away because of injury, muscle weakness, or overuse, and the patella and the thighbone may rub together. This causes pain and aching, especially when a person walks up stairs or hills.

Bursitis

A bursa is a sac filled with fluid located over a bony prominence to prevent friction. If a bursa in the knee becomes irritated and swollen from overuse or constant friction, it can develop into a condition called bursitis. Symptoms of bursitis in the knee include warmth, tenderness, swelling, and pain on the front of the kneecap.

Osgood-Schlatter Disease

Osgood-Schlatter disease is a painful disorder caused by repetitive stress on the front end of the tibia where the patellar tendon connects to the bone. Most common in athletes 10 to 15 years old, its symptoms include a bump below the knee joint that’s painful to the touch and painful with activity. Pain is relieved with rest.

Diagnosis

Most knee exams involve lying down flat on a table while the doctor manipulates the knee to see how stable it is and if any part of the joint hyperextends or dislocates.

Imaging tests (like an MRI, X-ray, or CAT scan) also might be done to confirm a knee injury and determine its severity.

Treatment

Any child with a knee injury should rest the knee as much as possible.

Immediately after the injury, apply ice to the area for 20-minute intervals to reduce swelling and use compression bandages for comfort. A child can usually bear weight as tolerated, and should elevate the leg (above the heart) on pillows or other soft objects to reduce pain and swelling.

Doctors call this method of treatment RICE:

• Rest
• Ice
• Compression
• Elevation

The doctor might prescribe painkillers or anti-inflammatory pills or liquid if your child has severe inflammation and pain.

After initial treatment, some kids may wear a knee immobilizer (a brace or a sleeve that’s wrapped around the knee to keep it from moving too much) for a few weeks while the knee heals, and might need to use crutches to get around.

More serious knee injuries can require surgery to reconstruct the knee if the child has torn ligaments or tendons or bone fractures.

During arthroscopy (a minimally invasive surgical technique) surgeons make a small opening in the knee and insert an arthroscope, a tiny tube-like tool, into the joint. The arthroscope has a lighted video camera on the end that is wired to a TV screen to give the surgeon a magnified view while operating.

Most of the time, the doctor is able to fix the problem during an arthroscopy. But if the injury is too complex, the surgeon will have to switch to “open” surgery, which requires a larger incision to see the area with the naked eye.

Regardless of whether a child has arthroscopy or a traditional open surgical procedure for a knee injury, the recovery period will be several weeks to a couple of months.

Rehab Therapy

Most kids who recover from a knee injury will need some sort of rehabilitation (“rehab”) therapy to help heal the knee and to:

• restore range of motion
• regain strength in the knee, thigh, and shin muscles to prevent atrophy (the breakdown of muscle tissue)
• reduce pain and swelling
• improve balance
• regain functional performance for activity

Most kids undergo rehab at a center three times a week, with daily exercises they practice at home. Accelerated rehab programs involve more frequent therapy, but will not necessarily speed up recovery.

While most sports are off limits — especially the one that caused the injury in the first place — kids can do some low-impact activities that may be fun and even therapeutic, like swimming, bike riding, or protected running. Talk to your doctor about which of these might benefit your child and when normal activities can be resumed.

Preventing Knee Injuries

Preventing knee injuries is a lot less painful and a lot less hassle than undergoing surgery.

If your kids play sports, be sure they always wear appropriate protective equipment during practices and competitions. Kneepads and shin guards when appropriate (as well as helmets and other protective gear) will help prevent injury. Also be sure that they wear supportive shoes that are in good condition and appropriate for the sport.

More tips for avoiding sports injuries:

• During workouts, always make sure kids warm up and cool down.
• Encourage kids to do regular strength training to support muscles, and stretching or yoga to improve flexibility.
• Practice your sport on the training surfaces that aren’t too hard. Running and jumping on asphalt can be tough on the knees.
• When jumping, make sure your child bends the knees while landing. This takes pressure off the ACL and prevents injury.
• If kids cut laterally or pivot frequently (as in soccer), encourage them to crouch and bend at the knees and hips to reduce the chance of an ACL injury.
• For kids who play just one sport, conditioning and training year-round — even if it’s at a lower intensity than during the competitive season — can help them stay in shape and reduce the chances of injury.

About Knee Injuries

Knee injuries are common among active kids and teens, especially athletes. A torn medial collateral ligament (MCL) — a ligament that helps give the knee its stability — is one of the more serious injuries.

Kids who tear their MCL tend to play contact sports, like football and soccer. More severe injuries happen when the outside of the knee is struck, causing it to unnaturally bend inward (toward the other knee). MCL tears can also happen when the lower leg twists or bends out too far. This creates tension on the MCL, a rope-like band, and it stretches or breaks in half.

Children with a partially or completely torn MCL might have swelling and pain in the first 24 hours of injury. Fortunately, this injury can heal on its own from 1 to 6 weeks of resting the joint.

Most kids and teens will still need to undergo rehabilitation (“rehab”) therapy to help regain strength in the joint.

What an MCL Does

The MCL is one of the four main ligaments in the knee joint. It’s located on the side of the knee that’s closer to the other knee. One end of the ligament is attached to the femur, while the other end is attached to the tibia.

With the lateral collateral ligament (LCL), which is in the same location on the outside of the knee, the MCL helps prevent the knee joint from bending too far from side-to-side.

Signs and Symptoms

A child with a partially or completely torn MCL may or may not have symptoms, depending on the severity of the injury.

Pain and swelling can be intense initially, and some kids and teens with more severe injuries will have instability when walking, feeling “wobbly” or unable to bear weight on the affected leg.

Many kids and teens, especially those who are familiar with the injury or have torn a ligament before, report hearing a “pop” sound — the sound of the shinbone popping out of and back into the knee joint.

A child who has injured a knee — whether on the field or at home — should stop all activity, to prevent further injury, and seek immediate medical care. In the meantime, keep the area iced — place the ice in a plastic bag, wrap the bag in a cloth, and hold it to the knee for 20 minutes at a time. Also, keep the knee elevated as much as possible to reduce swelling. As long as walking isn’t painful, it’s OK to walk with an MCL tear. But if standing or walking causes any pain, don’t let your child put weight on the knee.

Diagnosis

At the doctor’s office or emergency room, doctors will perform physical exams and imaging tests to determine if there’s a knee injury and, if so, how severe it is.

To help diagnose an MCL injury, doctors do a Valgus test. The child lies down flat, and the affected leg is moved out to the side, and the knee is flexed about 30 degrees. The doctor places one hand on the back of the knee joint and the other on the top side of the ankle. The doctor then rotates the shin bone and pushes the foot outward, to see how far the MCL will extend. Too much flexibility can signal an injury.

To properly diagnose MCL injuries, doctors usually perform these tests in combination or in addition to other physical exams.

While X-rays might be taken to determine the extent of the injury, they only look at bone and can only confirm the presence of bone fractures in the knee. An MRI, which looks at soft tissue (like ligaments and muscles), can confirm a partial or complete MCL tear, so some doctors will order one to confirm a diagnosis.

Types of Injuries

Doctors categorize MCL injuries according to the following criteria:

• Grade I tear. This is a slight tear (or stretch) of the MCL. Both ends of the ligament are still attached to the bone, but part of the ligament may sag and be less tight. Recovery usually takes 1 to 2 weeks; therapy may not be needed.
• Grade II tear. This is a slightly more severe tear of the MCL, with part of the ligament sagging. Pain and swelling is usually more severe than with a grade I tear. Kids usually need 3 to 4 weeks of rest and sometimes therapy.
• Grade III tear. With this type of injury, the MCL breaks in half. Kids and teens often can’t bend the knee or put weight on it without pain. They might be unstable while walking, and the knee may sometimes “give out.” Doctors may recommend a temporary knee brace for this injury as well as rehab therapy for 6 weeks or longer.

Treatment

Treatment of MCL injuries requires initial rest of the joint, along with icing, elevation, and compression bandages to help ease discomfort. It’s OK for your child to put weight on the knee as long as it’s not painful. Depending on the severity of the injury, doctors may recommend crutches, limiting physical activity, and a temporary knee brace. Putting too much pressure on the knee can cause reinjury. Over-the-counter or prescription painkillers and anti-inflammatory medicine can help kids and teens deal with the pain and feel more comfortable.

Doctors usually recommend rehabilitation therapy to help heal the knee and to:

• restore range of motion
• regain strength in the knee, thigh, and shin muscles (and prevent atrophy, the breakdown of muscle tissue)
• reduce pain and swelling
• improve balance

Most kids undergo rehab at a center three times a week, with daily exercises they practice at home. Accelerated rehab programs involve more frequent therapy, but that won’t necessarily speed recovery.

While most sports are off limits — especially the activity that caused the injury — kids and teens can do low-impact activities that may be fun and even therapeutic, like swimming, bike riding, or protected running. Talk to your doctor about what activities might benefit your child.

Helping Your Child Cope

Being told that you can’t do the things you love — like running or playing football, field hockey, or softball — can be a devastating blow to any child. Kids and teens recovering from an MCL injury, especially a severe one, may feel angry, frustrated, and even depressed, especially if they’re no longer participating in team sports with their friends.

But in the meantime, there are ways to still feel like part of the team. Keeping score, being a coach’s assistant, or bringing water to the games may help. If your son or daughter doesn’t want to do these things, suggest starting a hobby, like playing the guitar, painting, drawing, or another activity that won’t put too much strain on the knee. Low-impact activities, like swimming, are another option.

In time, kids and teens can again do the things they love. But if your child continues to feel angry or depressed during recovery, encourage him or her to talk to a school psychologist or counselor, who can help your child cope and look ahead to better days.

Good news: Osgood-Schlatter disease (OSD) is far less frightful than its name. Though it’s one of the most common causes of knee pain in adolescents, it’s really not a disease, but an overuse injury. OSD can be quite painful, but usually resolves itself within 12 to 24 months.

About Osgood-Schlatter Disease

Osgood-Schlatter disease is an inflammation of the bone, cartilage, and/or tendon at the top of the shinbone (tibia), where the tendon from the kneecap (patella) attaches. Most often only one knee is affected.

OSD usually strikes active adolescents around the beginning of their growth spurts, the approximately 2-year period during which they grow most rapidly. Growth spurts can begin any time between the ages of 8 and 13 for girls, or 10 and 15 for boys. OSD has been more common in boys, but as more girls participate in sports, this is changing.

Teens increase their risk for OSD if they play sports involving running, twisting, and jumping, such as basketball, football, volleyball, soccer, tennis, figure skating, and gymnastics. Doctors disagree about the mechanics that cause the injury but agree that overuse and physical stress are involved.

Growth spurts make kids vulnerable because their bones, muscles, and tendons are growing quickly and not always at the same time. With exercise, differences in size and strength between the muscle groups place unusual stress on the growth plate at the top of the shinbone. (A growth plate is a layer of cartilage near the end of a bone where most of the bone’s growth occurs. It is weaker and more vulnerable to injury than the rest of the bone.)

Most parents call the doctor after their child complains of intermittent pain over several months. The pain may be anywhere from mild and felt only during activity to severe and constant.

Other symptoms may include:

• pain that worsens with exercise
• relief from pain with rest
• swelling or tenderness under the knee and over the shinbone
• limping after exercise
• tightness of the muscles surrounding the knee (the hamstring and quadriceps muscles)

Symptoms that aren’t typical of OSD include pain at rest, thigh pain, or very severe pain that awakens kids from sleep or makes them cry. If your child has any of these symptoms, talk to your doctor.

How Is It Treated?

OSD usually goes away when a teenager’s bones stop growing, usually between 14 and 18 years. Until then, only the symptoms need treatment. Rest is the key to pain relief. Parents find it a cruel irony that the most active kids are most likely to get OSD — and also the ones least likely to rest the affected area.

In mild cases, doctors advise that kids limit the activities that cause pain. They might be able to continue their sports as long as the pain remains mild. When symptoms flare up, a short break from sports might be necessary.

After your child gets back in the game, shock-absorbent insoles can decrease stress on the knee. Applying moist heat for 15 minutes before or icing for 20 minutes after activity can minimize swelling. Wrestling gel pads and basketball knee pads (available at sporting goods stores) can protect a tender shin from bumps and bruises. A good stretching program, focusing primarily on the hamstring and quadriceps muscles, before and after activity is important. Your doctor might also suggest over-the-counter pain medicines, such as ibuprofen, or prescription anti-inflammatory medicines.

More severe cases require more rest, usually a total break from sports and physical activities. Active kids may find this very difficult, but the knee cannot heal without rest. Some teens wind up with a cast or brace to enforce the doctor’s orders. After a prolonged time off, kids will need to ease back into activity carefully, usually with physical therapy to learn stretching and strengthening exercises.

Long-term consequences of OSD are usually minor. Some kids may have a permanent, painless bump below the knee. In rare cases, they may develop a painful, bony growth below the kneecap that must be surgically removed. About 60% of adults who had OSD as kids experience some pain with kneeling.

Playgrounds and outdoor play equipment offer kids fresh air, friends, and exercise. So it’s important for parents to make sure that faulty equipment, improper surfaces, and careless behavior don’t ruin the fun.

Each year, more than 200,000 kids are treated in hospital ERs for playground-related injuries. Many of these accidents can be prevented with the proper supervision.

You can make the playground entertaining and safe for your kids by checking equipment for potential hazards and following some simple safety guidelines.

And teaching kids how to play safely is important: If they know the rules of the playground, they’re less likely to get hurt.

Adult Supervision

Adult supervision can help prevent injuries by making sure kids properly use playground equipment and don’t engage in unsafe behavior around it. If an injury does occur, an adult can assist the child and administer any needed first aid right away.

Kids should always have adult supervision on the playground. Young kids (and sometimes older ones) can’t always gauge distances properly and aren’t capable of foreseeing dangerous situations by themselves. Older kids like to test their limits on the playground, so it’s important for an adult to be there to keep them in check.

Before you visit a playground, check to make sure that play areas are designed to allow an adult to clearly see kids while they’re playing on all the equipment.

Playground Design Safety

The most important factors in evaluating the safety of any playground are proper surface, design and spacing, and equipment inspection and maintenance.

Surfaces

A proper playground surface is one of the most important factors in reducing injuries — and the severity of injuries — that occur when kids fall from equipment. The surface under the playground equipment should be soft enough and thick enough to soften the impact of a child’s fall.

Here are some things to consider:

• Concrete, asphalt, and blacktop are unsafe and unacceptable. Grass, soil, and packed-earth surfaces are also unsafe because weather and wear can reduce their capacities to cushion a child’s fall.
• The playground surface should be free of standing water and debris that could cause kids to trip and fall, such as rocks, tree stumps, and tree roots.
• There should be no dangerous materials, like broken glass or twisted metal.
• The surfaces may be loosely filled with materials like wood chips, mulch, sand, pea gravel, or shredded rubber. Wood chips containing chromated copper arsenate (CCA) treatment are not recommended since the material can pose a potential health hazard.
• Surfacing mats made of safety-tested rubber or rubber-like materials are also safe.
• Rubber mats allow the best access for people in wheelchairs.
• Loose-fill surface materials 12 inches deep should be used for equipment up to 8 feet high. The material should not be packed down because this will reduce any cushioning effect.
• No surfacing materials are considered safe if the combined height of playground and the child (standing on the highest platform) is higher than 12 feet.
• The cushioned surface should extend at least 6 feet past the equipment. Additional coverage may be needed, depending on how high a slide is or how long a swing is.
• If there is loose-fill over a hard surface (like asphalt or concrete), there should be 3-6 inches of loose-fill like gravel, a layer of geotextile cloth, a layer of loose-fill surfacing material, and then impact mats under the playground equipment.

Keep in mind that even proper surfacing can’t prevent all injuries. Also, the greater the height of the equipment, the more likely kids may get injured if they fall from it.

Design and Spacing

Playground equipment should be designed for three different age groups: infants and toddlers under 2, 2- to 5-year-olds (preschoolers), and 5- to 12-year-olds (school-age kids).

In the safest playgrounds, play areas for younger children are separated from those meant for older kids and signs clearly designate each area to prevent confusion.

Younger children should not play on equipment designed for older kids because the equipment sizes and proportions won’t be right for small kids, and this can lead to injury. Likewise, older kids shouldn’t play on equipment designed for younger ones. Smaller equipment and spaces can cause problems for bigger kids.

Here are some things to check for to ensure the equipment is designed and spaced to be safe:

• Guardrails and protective barriers should be in place for elevated surfaces, including platforms and ramps.
• Play structures more than 30 inches high should be spaced at least 9 feet apart.
• Swings, seesaws, and other equipment with moving parts should be located in an area separate from the rest of the playground.
• Swings should be limited to two per bay.
• Tot swings with full bucket seats should have their own bay.
• Swings should be spaced at least 24 inches apart and 30 inches between a swing and the support frame.
• Be sure there are no spaces that could trap a child’s head, arm, or any other body part. All openings on equipment (for example, rungs on a ladder or bars on a guardrail) should measure less than 3½ inches or they should be wider than 9 inches.
• Climbing nets should have openings that are either too small to allow a child’s body through or large enough to prevent entrapment of the head. Net perimeters which are 17-18 inches pose entrapment hazards.
• Playground equipment with moving parts — like seesaws and merry-go-rounds — should be checked for pinch points that could pinch or crush a child’s finger or hand.

Maintenance and Inspection

Whether your kids play on a home or public playground, it’s important for you to take a general look at the equipment to make sure that it is clean and well maintained.

• There should be no broken equipment.
• Wooden equipment should not be cracking or splintering.
• Metal equipment should not be rusted.
• The fence surrounding a public playground should be in good condition to prevent kids from running into surrounding traffic.
• Surface materials on the playground should be maintained regularly so that the surfacing is loosely packed and covers all appropriate areas — especially the fall zones surrounding playground equipment.
• Playground equipment should be made of durable materials that won’t fall apart or worn down too much by the weather.

Check for objects (like hardware, S-shaped hooks, bolts, and sharp or unfinished edges) that stick out on equipment and could cut a child or cause clothing to become entangled.

All hardware on equipment should be secure, with no loose or broken parts. Plastic and wood should show no signs of weakening, and there should not be any splintered or rusted surfaces.

If the local playground has a sandbox, check for hazardous debris such as sharp sticks or broken glass, and be sure that the sand is free of bugs. Sandboxes should be covered overnight to prevent contamination from animals, such as cats.

Help keep your playground clean and safe by picking up trash, using the equipment properly, and reporting any problems to the city, town, or county parks department, school, or other organization that is responsible for the upkeep of the playground.

If a part seems broken, loose, or in need of other maintenance, designate it as off-limits immediately and report the problem to the appropriate authorities.

Teaching Kids About Playground Safety

Safe playground equipment and adult supervision are extremely important, but it’s only half of the equation: Kids must know how to be safe and act responsibly at the playground.

Teach your kids to:

• Never push or roughhouse while on jungle gyms, slides, seesaws, swings, and other equipment.
• Use equipment properly — slide feet first, don’t climb outside guardrails, no standing on swings, etc.
• Always check to make sure no other kids are in the way if they’re going to jump off equipment or slide, and land on both feet with their knees slightly bent.
• Leave bikes, backpacks, and bags away from the equipment and the play area so that no one trips over them.
• Always wear a helmet while bike riding, but take it off while on playground equipment.
• Never use playground equipment that’s wet because moisture makes the surfaces slippery.
• Check playground equipment in the summertime. It can become uncomfortably or even dangerously hot, especially metal slides, handrails, and steps. So use good judgment — if the equipment feels hot to the touch, it’s probably not safe or fun to play on. Contact burns can occur within seconds.
• Wear clothes that do not have drawstrings or cords. Drawstrings, purses, and necklaces could get caught on equipment and accidentally strangle a child.
• Wear sunscreen when playing outside even on cloudy days to protect against sunburn.

Safe Equipment Guidelines

Because swings, slides, and climbing equipment are so different from one another, each requires a different set of safety considerations. And some kinds of equipment are not safe for playgrounds, no matter how careful kids are.

Swing Safety

Swings are the most frequent source of childhood injuries from moving equipment on a playground. But a few simple precautions can help keep kids safely swinging in the breeze:

• Swings should be made of soft material such as rubber or plastic, not wood or metal.
• Kids should always sit in the swing, not stand or kneel. They should hold on tightly with both hands while swinging, and when finished swinging, stop the swing completely before getting off.
• Children should stay a safe distance from other kids on swings, being careful not to run or walk in front of or in back of moving swings.
• Kids should never ride with more than one child to a swing. Swings are designed to safely hold only one person.

Seesaw Safety

Because seesaw use requires cooperation between kids, they’re generally not recommended for preschoolers unless the seesaw has a spring-centering device to prevent abrupt contact with the ground. Regardless of design, both seesaws and merry-go-rounds should be approached with caution.

Other safety tips to keep in mind:

• Seesaw seats are like swings: one child per seat. A child who is too light to seesaw with a partner should find a different partner — not add another child to his or her side of the seesaw.
• Kids should always sit facing one another, not turned around.
• Teach kids to hold on tightly with both hands while on a seesaw, not to touch the ground or push off with their hands, and to keep feet to the sides, out from underneath the seesaw.
• Kids should stand back from a seesaw when it’s in use. They should never stand beneath a raised seesaw, stand and rock in the middle, or try to climb onto it while it’s in motion.

Slide Safety

Slides are safe if kids are careful when using them. Guidelines to keep in mind:

• Children should take one step at a time and hold onto the handrail when climbing the ladder to the top of the slide. They should not climb up the slide itself to get to the top.
• Kids should always slide down feet first and sitting up, never head first on their back or stomach.
• Only one child should be on the slide platform at a time, and kids shouldn’t slide down in groups.
• Kids should always check that the bottom of the slide is clear before sliding down. When they reach the bottom, they should get off and move away from the end of the slide so it’s clear for other kids to slide down.

Climbing Equipment Safety

Climbing equipment comes in many shapes and sizes — including rock climbing walls, arches, and vertical and horizontal ladders. It’s generally more challenging for kids than other kinds of playground equipment.

Be sure your kids are aware of a safe way down in case they can’t complete the climb. The highest rates of injuries on public playgrounds are associated with climbing equipment, which is dangerous if not designed or used properly. Adult supervision is especially important for younger kids.

Climbing equipment can be used safely if kids are taught to use both hands and to stay well behind the person in front of them and beware of swinging feet. When they drop from the bars, kids should be able to jump down without hitting the equipment on the way down. Remind kids to have their knees bent and land on both feet.

• Too many kids on the equipment at one time can be dangerous. Everyone should start on the same side of the equipment and move across it in the same direction.
• When climbing down, kids should watch for those climbing up; they should never race across or try to reach for bars that are too far ahead.
• Children younger than age 5 may not have the upper-body strength necessary for climbing and should only be allowed to climb on age-appropriate equipment. Preschoolers should only climb 5 feet high and school-age kids should only climb 7 feet high.

Track Ride Safety

Track rides are a form of upper-body equipment where kids hold on to a handle that slides along a track once they lift their feet. These rides require significant upper-body strength and are recommended for school-age kids and above.

• Track rides should not be included in play areas for toddlers and preschoolers.
• There should be no obstacles along the track path, especially in take-off and landing areas.
• If two track rides are next to each other, they should be spaced 4 feet apart, minimally.
• The handle should be between 64 inches and 78 inches from the surfacing.
• Nothing should be tied or attached to any part of the track ride.
• Rolling parts should be enclosed to avoid crush injuries.

Log Roll Safety

Log rolls require kids to grasp handles, then balance on top of the log as they spin it with their feet. This helps older kids to develop balance skills and increase strength.

• Log rolls are recommended for school aged-kids and above.
• All log rolls should have handholds to assist balance.
• The highest point of the log roll should be 18 inches above the protective surface.

Soft Contained Playgrounds

There are specific recommended safety checks for soft contained playgrounds:

• Make sure there are no tears or frays in the safety netting, cargo webbing, and ropes.
• The floor surface should be made of mats in good condition that are not torn and are placed tightly together.
• Look for the posted safety rules and size recommendations for the activity. Keep older kids away from areas designated for smaller children and vice versa.
• As in any other playground, kids should not wear clothing with loose strings, necklaces, or earrings.
• Many slides are contained in tubes, so a child going down will not see if there is anyone at the bottom of the slide. Kids should stay clear of the area at the bottom of slides and not climb up a slide.

Sprayground

More and more cities are opening spraygrounds, which are water playgrounds. At a sprayground, kids can spray each other with water cannons and get sprayed by dozens of water jets that squirt from different colored nozzles and hoses.

• Be sure to read posted signs for rules, age recommendations, and safety information. Often, no lifeguard is on duty.
• Protective footwear like water shoes with non-skid soles are a good idea to help prevent falls and other injuries. Remember to bring swimsuits, towels, sunscreen, and hats.
• Kids should not drink or inhale aerosols of water to minimize risk of water-borne illnesses.

Unsafe Playground Equipment

These types of equipment are not safe for playgrounds:

• animal figure swings
• glider swings that hold more than one child at a time
• swinging ropes that can fray, unravel, or form a noose (any kind of rope attached to play equipment poses a strangulation hazard, so never let your child tie jump ropes or leashes onto the equipment)
• exercise rings (as used in gymnastics) and trapeze bars
• monkey bars
• trampolines

Parents should not place plastic climbing equipment indoors. Even carpet does not give enough protection from falls. This type of equipment is intended for outdoor use on safe surfaces.

Play is an important part of kids’ physical, social, intellectual, and emotional development. Following these safety tips will help your kids play as safely as possible.

Causes of Sports Injuries

Participation in any sport, whether it’s recreational bike riding or Pee-Wee football, can teach kids to stretch their limits and learn sportsmanship and discipline. But any sport also carries the potential for injury.

By knowing the causes of sports injuries and how to prevent them, you can help make athletics a positive experience for your child.

Kids can be particularly at risk for sports injuries for a variety of reasons. Kids, especially those younger than 8 years old, are less coordinated and have slower reaction times than adults because they are still growing and developing. Also, kids mature at different rates, with differences in height and weight between kids of the same age. And when kids of varying sizes play sports together, there can be an increased risk of injury.

As kids grow bigger and stronger, the potential for injury increases, largely because of the amount of force involved. For example, a collision between two 8-year-old Pee-Wee football players who weigh 65 or 70 pounds each does not produce as much force as that produced by two 16-year-old high school football players who may each weigh up to 200 pounds.

Also, kids may not judge the risks of certain activities as well as adults would, which can lead to injuries.

Preventing Sports Injuries

You can help protect your kids from being injured by following some simple guidelines:

Use of Proper Equipment

It’s important for kids to use proper equipment and safety gear that is the correct size and fits well. For example, they should wear helmets for baseball, softball, bicycle riding, and hockey. They also should wear helmets while they’re inline skating or riding scooters and skateboards.

Ask your child’s coach about the appropriate helmets, shoes, mouthguards, athletic cups and supporters, and padding. For racquet sports, field hockey, lacrosse, basketball, softball, and baseball, ask about any protective eyewear, like shatterproof glasses.

Protective equipment should be approved by the organizations that govern each of the sports. Hockey facemasks, for example, should be approved by the Hockey Equipment Certification Council (HECC) or the Canadian Standards Association (CSA). Bicycle helmets should have a safety certification sticker from the Consumer Product Safety Commission (CPSC).

In the United States, the National Operating Committee on Standards for Athletic Equipment (NOCSAE) sets many of the standards for helmets, facemasks, and shin guards. Besides meeting the NOSCAE standards, all equipment should be properly cared for so it stays effective over time.

Maintenance and Appropriateness of Playing Surfaces

Check that playing fields are not full of holes and ruts that might cause kids to fall or trip. Kids doing high-impact sports, like basketball and running, should do them on surfaces like tracks and wooden basketball courts, which can be more forgiving than surfaces like concrete.

Adult Supervision and Commitment to Safety

Any team sport or activity that kids participate in should be supervised by qualified adults. Select leagues and teams that have the same commitment to safety and injury prevention that you do.

The team coach should have training in first aid and CPR, and the coach’s philosophy should promote players’ well-being. A coach with a win-at-all-costs attitude may encourage kids to play through injury and may not foster good sportsmanship. Be sure that the coach enforces playing rules and requires that safety equipment be used at all times.

And make sure your kids play sports that match their skill level, size, and physical and emotional maturity.

Proper Preparation

Just as you wouldn’t send a child who can’t swim to a swimming pool, it’s important not to send kids to play a sport that they’re unprepared to play. Make sure that they know how to play the sport before going out on the field.

Kids should be adequately prepared with warm-ups and training sessions before practices and before games. This will help ensure that they have fun and reduce the chances of an injury. They also should should drink plenty of fluids and be allowed periods of rest during practices and games.

Common Types of Sports Injuries

Three common types of sports injuries in kids and teens are acute injuries, overuse injuries, and reinjuries:

Acute Injuries

Acute injuries happen suddenly and are usually associated with some form of trauma. In younger children, acute injuries often include minor bruises, sprains, and strains. Teen athletes are more likely to sustain more severe injuries, including broken bones and torn ligaments.

Severe acute injuries that can happen at any age include: eye injuries, including scratched corneas, detached retinas, and blood in the eye; broken bones or ligament injuries; brain injuries, including concussions, skull fractures, brain hemorrhages; and spinal cord injuries.

Acute injuries often happen because of a lack of proper equipment or the use of improper equipment. For example, without protective eyewear, eye injuries are extremely common in basketball and racquet sports. And many kids playing baseball and softball have suffered broken legs or ankles from sliding into immobile bases.

Overuse Injuries

Overuse injuries are caused by repetitive actions that put too much stress on the bones and muscles. Although they can happen in adults too, they’re more problematic in young athletes because they can affect bone growth.

All kids who play sports can develop an overuse injury, but the likelihood increases with the amount of time a child spends on the sport.

Some of the most common types of overuse injuries are:

• anterior knee pain: Anterior knee pain is pain in the front of the knee under the kneecap. The knee will be sore and swollen due to tendon or cartilage inflammation. The cause is usually muscle tightness in the hamstrings or quadriceps, the major muscle groups around the thigh.
• Little League elbow: Repetitive throwing sometimes results in pain and tenderness in the elbow. The ability to flex and extend the arm may be affected, but the pain typically happens after the follow-through of the throw. Besides pain, pitchers sometimes complain of loss of velocity or decreased endurance.
• swimmer’s shoulder: Swimmer’s shoulder is an inflammation (swelling) of the shoulder caused by the repeated stress of the overhead motions used with swimming or throwing a ball. The pain usually begins intermittently but may become continuous pain in the back of the shoulder.
• shin splints: Shin splints are characterized by pain and discomfort on the front of the lower parts of the legs. They’re often caused by repeated running on a hard surface or overtraining at the beginning of a season.
• spondylolysis: Spondylolysis often results from constant overextension, which puts too much stress on the bones of the lower back. This can cause persistent lower back pain. Spondylolysis is commonly seen in kids who participate in soccer, football, weight lifting, gymnastics, wrestling, and diving.

Overuse injuries can be caused or aggravated by:

• growth spurts or an imbalance between strength and flexibility
• inadequate warm-up
• excessive activity (for example, increased intensity, duration, or frequency of playing and/or training)
• playing the same sport year-round or multiple sports during the same season
• improper technique (for example, overextending on a pitch)
• unsuitable equipment (for example, nonsupportive athletic shoes)

Reinjuries

Reinjury happen when an athlete returns to the sport before a previous injury has sufficiently healed. Athletes are at a much greater risk for reinjury when they return to the game before recovering fully. Doing so places stress upon the injury and forces the body to compensate for the weakness, which can put the athlete at greater risk for injuring another body part.

Reinjury can be avoided by allowing an injury to completely heal. Once the doctor has approved a return to the sport, make sure that your child properly warms up and cools down before and after exercise.

Sudden exertion also can cause reinjury, so your child should re-enter the sport gradually. Explain that easing back into the game at a sensible pace is better than returning to the hospital!

Treating Sports Injuries

Treatment of sports injuries depends on the type of injury.

For acute injuries, many pediatric sports medicine specialists usually take a “better safe than sorry” approach. If an injury appears to affect basic functioning in any way — for example, if your child can’t bend a finger, is limping, or has had a change in consciousness — first aid should be given immediately. A doctor should then see your child. If the injury seems to be more serious, it’s important to take your child to the nearest hospital emergency department.

For overuse injuries, the philosophy is similar. If your child complains of pain, it’s the body’s way of saying there’s a problem. Limit activity until your child sees a doctor. The doctor can then determine whether it’s safe to return to play or if your child needs to see a sports medicine specialist. Doctors usually can diagnose overuse injuries by taking a medical history, examining the child, and ordering X-rays, if needed.

It’s important to get overuse injuries diagnosed and treated to prevent them from turning into larger, chronic problems. Doctors may advise young athletes to temporarily change or stop an activity to limit stress on the body. In some cases, it might not be possible to return to the sport without risking further injury.

Because overuse injuries are characterized by swelling, a doctor may prescribe rest, medicines to ease inflammation, and physical therapy. When recovery is complete, your child’s technique or training schedule might need to be adjusted to prevent the injury from flaring up again.

There’s a reason why baseball has been called our national pastime for decades. It’s as American as hot dogs and apple pie. It’s been a summer tradition in big cities and little towns across the U.S.A. for generations. It’s a great team sport, and it’s fun.

Why Baseball Safety Is Important

Baseball is by no means a dangerous sport. But it can present a very real risk of injuries from things like wild pitches, batted balls, and collisions in the field.

At the high-school level, some pitchers can throw fastballs that reach 80-plus miles per hour, speedy enough to cause painful welts, broken bones, even concussions. Excessive pitching and improper throwing mechanics can lead to major league arm problems, and base runners and fielders frequently collide while running at top speed.

Gear Guidelines

As with all sports, wearing and using the right gear can go a long way toward preventing injuries. The amount of equipment required for baseball isn’t on par with football or hockey, but it is every bit as important. Players need to be sure they always have all the gear required by their league.

Most leagues will insist on the following:

• Batting helmets must be worn whenever a player is at bat, waiting to bat, or running the bases. Some leagues may even require pitchers to wear them. Helmets should always fit properly and be worn correctly. If the helmet has a chin strap, it should be fastened, and if the helmet has an eye shield or other faceguard, this should be in good condition, securely attached to the helmet.
• A catcher should always wear a helmet, facemask, throat guard, full-length chest protector, athletic supporter with a cup, shin guards and a catcher’s mitt whenever they are catching pitches, whether it’s in the game, in the bullpen or during warm-ups.
• Baseball spikes should have molded plastic cleats rather than metal ones. Most youth leagues don’t allow spikes with metal cleats.
• Some leagues have guidelines dictating what kind of bat a player can use. Some aluminum bats may be banned for hitting batted balls too hard. Be sure to check the league’s policy before choosing a bat.
• All players should wear athletic supporters; most, particularly pitchers and infielders, should wear protective cups. Rules regarding which players must wear cups vary from league to league.
• Additional gear that some players like includes sliding pants, which are meant to go under baseball pants to protect against scrapes and cuts; batting gloves, which can keep hands from getting sore while hitting; shin and foot guards, which are designed to protect against balls fouled straight down; and mouthguards.

Breakaway Bases

Base paths are one of the most common places injuries happen. This is especially true when players slide into a traditional stationary base, which puts a rigid obstacle in their path as they slide. Sliding into a fixed base can result in foot, ankle, and lower-leg injuries.

As a result, doctors have started recommending that leagues install breakaway bases in all of their playing fields. These bases, which snap onto grommets on an anchored rubber mat, can be dislodged when a runner slides into one, lessening the chances that a base runner will get injured. During the course of normal base-running, the base is stable and does not detach.

Before Starting the Game

Ideally, kids should get plenty of exercise before the season begins and be in the best shape possible before swinging a bat for the first time. This will not only lower the risk of injury, but it will also make them better ballplayers.

Just as with any other sport, warming up and stretching before a baseball game is very important. However, remember that in baseball, kids should pay particular attention to their throwing arm. Most will require plenty of warm-up before they can safely attempt a long, hard throw.

Different players have different preferences when it comes to warming up their arms. Some like to make short throws, while others prefer to start with long, easy tosses. Regardless of how a player chooses to warm up, the idea is to start with soft throws meant to stretch muscles and loosen up joints. As the arm warms up, the intensity of throws should be gradually increased until the player is throwing as he or she would during a game situation.

Make sure that all bats, balls, and other equipment used during warm-ups are safely put away before play begins, and always inspect the playing field for holes and debris, especially broken glass.

During Game Play

Painful collisions can and do occur in baseball. With attention focused on the ball, it’s easy to lose track of where people are. If there’s any doubt as to who should field a ball, one player should call for it as loudly as he or she can to let the others know to back away. Players should practice doing this with teammates to get used to listening for each other’s voices.

While batting, it’s important for kids to stand confidently in the batter’s box and not be afraid of the ball. That being said, baseballs are hard objects. Getting hit with a pitch hurts. Kids should know how to safely get out of the way if a pitch is headed toward them. The best way to do this is to duck and turn away from the pitcher, exposing the back and rear end to the pitch instead of the face and midsection.

On the base paths, players should practice running the bases with their heads up, looking out for other players and batted balls. They should also know how to slide correctly. Many leagues make it illegal for kids to slide headfirst, as this can lead to head injuries and facial cuts.

Excessive Pitching

Pitching, particularly for adolescent arms that are still growing, puts an enormous amount of strain on joints and tendons. Injuries to wrists, elbows, rotator cuffs, ligaments, and tendons can result from excessive pitching but can be largely avoided if players and coaches follow a few simple guidelines:

• Make sure pitchers adhere to league rules regarding the maximum number of innings they’re allowed to throw. This will generally range from four to 10 innings per week. If a kid plays for more than one team, include all innings pitched each week, not just the ones for each team.
• Most leagues follow rules regarding the number of pitches kids can throw in a game. Keep in mind that even major league pitchers have strict pitch counts to keep their arms healthy. Here are the pitch count limits recommended by U.S.A. Little League and the American Sports Medicine Institute:
  • 7-8 years old: 50 pitches a day or 75 pitches a week
  • 9-10 years old: 75 pitches a day or 100 pitches a week
  • 11-12 years old: 85 pitches a day or 115 pitches a week
  • 13-16 years old: 95 pitches a day
  • 17-18 years old: 105 pitches a day
• Pitchers under 14 should limit total pitches to less than 1,000 per season and 3,000 per year.
• All players should take at least 3 months off per year from overhead sports (i.e., sports that involve a lot of overhead arm movements like baseball or volleyball).
• If pitchers feel persistent pain in their throwing arm, they should not be allowed to pitch again until the pain goes away.

A Few Other Reminders

• Make sure a responsible adult is on hand any time a baseball game is played, whether it’s a parent, coach, or umpire. In the event someone gets seriously hurt, an adult should be around to take an injured player to the emergency room.
• Make sure first aid is readily available.
• Steroids or human growth hormones aren’t just illegal — they’re dangerous.

From the asphalt courts of Harlem to the high school gyms of Indiana, basketball is a way of life for millions of American kids and teens. It may be fun to play and great exercise, but basketball is also a contact sport, and injuries occur frequently. Also, since basketball players play year-round, indoors and out, many get repetitive stress injuries like tendonitis.

To keep your kids as safe as possible, make sure they follow these tips.

Why Basketball Safety Is Important

Fortunately, very few basketball injuries are life threatening. Some (like broken bones, concussions, and ligament tears) can be quite serious, though. And while playing through the pain can lead to serious muscle and joint problems over time.

Sprained ankles are the most common basketball injuries, but jammed or broken fingers, bruises, bloody or broken noses, and poked eyes are all too common as well. When playing outdoors, abrasions (particularly to the palms and fingers) are always a risk.

Indoor ball presents its own hazards in the form of walls and bleachers, and players are bound to collide going after loose balls and rebounds wherever they play.

Gear Guidelines

Two people, a ball, and a basketball hoop are just about everything needed for a basketball game. But this doesn’t mean that kids don’t need to pay attention to what gear to wear, especially on their feet. When taking the court, they should always be wearing:

• Basketball sneakers. The right shoe can go a long way toward reducing ankle, foot, and leg injuries. For added ankle support, some players choose to play in high-top sneakers, but low-rise shoes will suffice. All basketball shoes should have a sturdy, non-skid sole and should be the right size and securely laced at all times while playing. Kids should never play basketball in open-toed shoes, clogs, or heels (it sounds ridiculous, but it’s been known to happen).
• Athletic support. Wearing a protective cup is usually up to personal choice unless the particular league requires it, but boys will appreciate having a good athletic supporter when running down the court or jostling under the net. Girls should consider a good sports bra, and many players of both sexes choose to wear supportive athletic shorts beneath their basketball shorts.
• Mouthguard. Some youth leagues may require players to wear a mouthguard. In any case, kids should strongly consider wearing one anyway to guard against broken teeth, mouth, or tongue injuries.
• Other gear. Players who wear glasses, and many who wear contacts, will want to use protective eyewear made of shatterproof plastic. Kids with prior injuries can benefit from fitted knee, ankle, or wrist braces to support their joints while playing.

Where to Play

Since basketball can involve anywhere from two to 10 players, it can be played in small spaces as easily as giant arenas. Driveways, playgrounds, and gyms are all potential courts and present basketball players with an ever-changing variety of surfaces.

Regardless of where the game is played, players should always inspect the court beforehand and make sure it is free of debris, particularly broken glass and loose gravel. The court surface should also be free of any cracks, holes, or irregularities that could lead to sprained or twisted ankles.

For night games played outside, the court should be well lit and in a safe area. Indoor courts should have plenty of distance between the edges of the court and any walls, bleachers, or other obstacles. Basket stands and any walls near them should be well padded and properly secured. Extra equipment, like balls, gym bags, and other gear, should be stored where they won’t interfere with players going after loose balls.

Before Tip-Off

As with many sports, basketball requires running, jumping, and other athletic movements. Staying in good shape year-round will not only make kids better at these actions, it will help them reduce their risk of injury and improve stamina to allow them to play harder for longer periods of time. Make sure your kids get plenty of exercise before the season starts, and make sure they eat a healthy diet.

Kids should warm up and stretch before playing. This doesn’t mean just shooting a few hoops or dribbling with both hands. They should do some jumping jacks or run in place for a couple of minutes to warm up muscles before stretching.  Dynamic stretching uses many muscle groups in a sport specific manner and can be incorporated into a warm-up. It’s a good idea to stretch after a game or practice, too.

Kids should practice shooting, dribbling, layups, and running the court before they try to duplicate these maneuvers during a game. Knowing what to do and how to do it will make movements less awkward and less prone to injury. And naturally, a player should know the rules and how to play safely before competing against others.

During Game Play

Once the ball is put in play, things will start to move quickly on the court. Knowing where teammates and opponents are at all times will help kids avoid potentially painful collisions.

Fouls are also a very common source of injuries. Many injuries can be avoided by playing within the rules, with no shoving, tripping, or holding, and always obeying the officials.

Make sure your kids know that if they get tired during the course of a game, they should ask to come out for a breather. Also make sure they know how to stay well hydrated. Heat-related illnesses and dehydration are risks, particularly on sunny outdoor courts on hot days.

Kids who feel pain in any of joints or muscles should stop playing right away and not resume playing until the pain goes away or clearance is given by a doctor.

Finally, a player should know where the ball is at all times. This may seem obvious, but many players get hurt by being hit with the ball when they aren’t looking. Basketballs are hard enough to easily break a nose or a finger.

Excessive Play

With summer AAU programs, school and church leagues, travel teams, camps, and all-star games to choose from, lots of kids and teens spend the whole year playing basketball. This can lead to more than just burnout. Sprains and sprains, tendonitis, growth plate injuries, and stress fractures can become very painful and debilitating if untreated.

Encourage your child to always tell a coach or parent when experiencing any pain, and never ignore any tweaks, spasms, or discomfort while playing. Ignoring overuse injuries will only make them harder to recover from in the long run.

If you or your child feel that he or she is playing too much basketball, work with coaches to try a reduced or modified schedule.

A Few Other Reminders

• If it’s on-court and serious, make sure a responsible adult — be it a coach, parent, or referee — is on hand. Kids probably won’t need adult supervision for games of one-on-one or two-on-two in your driveway or a pick-up game at the playground, but full-court, five-on-five basketball is a different story.
• Make sure first-aid equipment is on hand — along with someone who knows how to use it.
• Tell kids not to chew gum, toothpicks, or have anything else in the mouth while playing basketball. They could present a risk of choking.
• Remind your kids to never fight with other players or teammates. This will not only get a kid kicked out of any sanctioned basketball game, it will also increase the likelihood of injury.

With all this in mind, kids can get out there on the court and have fun working on their skills and leading their team to victory. With a little forethought and some common sense and etiquette, they can stay safe and in the game.

With non-stop action and high-speed team play, hockey is a great sport for kids. Sometimes called “the fastest game on ice,” it’s a great way to get exercise, and with youth and adult programs throughout the country, chances are no matter what your child’s age or skill level, there is a league near you to play in.

As fun as it is, though, hockey carries a very real risk of injury. To keep your kids as safe as possible, follow these tips.

Why Hockey Safety Is Important

At its highest levels, from high school to college to the NHL, hockey allows “checking,” an action that involves a player colliding with an opposing player to stop his forward momentum. This can lead to numerous injuries from players hitting one another or colliding with the ice surface or the boards that line the rink. Even in so-called “no-check” leagues, there will always be a lot of contact. Falls are very common, and ice is just as hard as concrete to land on.

In addition, with every player carrying a stick and wearing sharpened skates, accidents are bound to occur. There’s also a good chance that sooner or later kids will get hit by the puck, which is made of hard rubber and can leave a nasty bruise if it catches them in the wrong spot. And, since hockey involves strenuous physical activity, pulled muscles and sprains are a hazard for players who don’t warm up and stretch properly.

Getting In Gear

Before kids start playing hockey, it’s very important to get them all the right equipment and make sure they know how to put it on and use it correctly. Skates and a helmet are a good place to start, but there is a lot more they’ll need to wear to keep themselves safe.

Never let your child play a game of hockey without:

• Helmet — When it comes to preventing serious injuries, this is the most important piece of equipment. Helmets should be certified by the Hockey Equipment Certification Council (HECC) and should include a full facemask with a protective chin cup and a chin strap. Make sure to get your kids a helmet that fits properly, and insist that they always keep the chin strap fastened and tightened to ensure that the helmet stays in place.
• Skates — As with helmets, be sure to get your kids skates that fit well. They’re going to lace them up tight, so the wrong size skates can really hurt their feet. Skates should offer plenty of ankle support and have a steel or hard plastic toe cup. It’s also important to keep skates sharp so they perform better and are less likely to get caught in ruts in the ice.
• Shoulder pads, elbow pads, knee and shin pads — These are all specific to hockey. Soccer or lacrosse equipment won’t give the protection needed. Lower leg (knee and shin) pads should have a hard plastic exterior and reach the top of your child’s skates.
• Hockey pants — Also called breezers, these should reach to the knee and offer padding in the front, rear, and sides of the upper legs and midsection.
• Gloves — Another sport-specific item, hockey gloves should allow for mobility while protecting well past the wrist.
• Athletic supporter and cup — These are incorporated into most hockey undershorts these days but can also come from other sports.
• Neck protector — Although some leagues don’t require them, neck protectors are helpful at guarding against wayward hockey sticks and skate blades.
• Mouthguard — These not only protect the teeth, but also the lips, cheeks, and tongue, and can help prevent jaw injuries.

Goalie Gear

Charged with putting their bodies between flying pucks and the goal, hockey goalies need a whole different set of equipment to keep themselves safe. Helmets, skates, neck guards and athletic protectors and cups are all different for goalies than they are for other positions.

In addition, goalies should always wear:

• Leg pads — These should always be the correct length and be thick enough to protect against even the hardest slapshot.
• Arm pads and chest protector — Arm pads should reach all the way to the wrist. Chest protectors should wrap slightly around the sides to keep a child’s entire front well armored.
• Blocker glove — This glove should allow your child’s fingers to grip the stick easily but be very thick and cover most of the forearm.
• Catcher glove — Similar to a first baseman’s glove in baseball, catcher gloves should have thick padding over the wrist and palm and should also come well up the forearm.

Before the Puck Is Dropped

Everything kids do during a hockey game will be done while they are skating, so be sure they know how to skate well before they play a game. Most rinks offer learn-to-skate classes and open skating sessions when they can practice. Kids should know how to stop, turn, and get up when they fall. It’s also helpful for them to know how to skate, stop, and turn while skating backwards.

Once you feel they’re good enough skaters and they’ve got the proper equipment and know how to use it, they’ll be ready to hit the ice. Before games, hockey players generally skate around the rink a few times to warm up. Kids should use this time to loosen their joints and stretch their muscles. Some skaters warm up and stretch before getting on the ice.

Important muscle groups to stretch before a game include:

• Hip and groin — Kids can stretch out the groin area while skating by bending knees and extending one leg out to the side.  The front of the hip can be stretched by dragging one foot behind and getting low to the ice.
• Back and torso — Shooting the puck, which your child will hopefully be doing a lot of, subjects midsections to a strenuous twisting motion that most people aren’t used to doing. Trunk twists while holding the stick in front, and toe touches can also be done while skating around the rink.
• Hamstrings — Have kids use the side boards of the rink to swing legs forward and back to help stretch hamstrings and hip flexors.

Keeping it Safe During a Game

There’s a reason why tripping, hooking, slashing, high-sticking and cross-checking bring penalties. Hockey sticks can easily go from being a piece of equipment to being a dangerous weapon. Be sure that your kids know all the rules governing the use of sticks and follow them to the letter. You wouldn’t want them to get hit by someone else’s stick, and no one wants to get hit by theirs.

Other penalties designed to keep the game safe involve roughing, boarding, and checking from behind. These all have to do with players colliding with one another. If your kids’ league allows checking, make sure they know the difference between a legal check and an illegal one, and be adamant that they never hit anyone from behind. If they play in a “no-check” league, it means just that: no checking.

As far as fighting is concerned, players in the NHL may throw off their gloves and start punching one another, but if your child does it, he or she can expect to pay a harsh penalty. Almost every youth league will kick players out of the game and suspend them for at least one more game for their first fighting penalty. They won’t just be hurting themselves; they’ll be letting their team down. Don’t allow fighting of any kind.

Also, never let your kids play a game of hockey without adult supervision. Even if they follow every safety tip, accidents can still happen. There should always be a stocked first-aid kit and a responsible adult on hand in the event of an injury or other emergency. Likewise, be sure to have their games officiated by certified referees who are familiar with the specific rules of the league.

Pond Hockey

Playing a game of hockey with friends on a frozen pond can be lots of fun, but ponds present their own unique set of safety problems. An adult should always check the ice to make sure it’s thick enough to support the weight of kids before they’re allowed play, and they should stay away from any parts of the pond or lake where it looks like the ice may be thin. Tell your kids that if a puck goes in a suspect area, they should just let it go. They can always get another puck. It’s not worth the risk of hypothermia or drowning for them to go after it.

Frozen ponds also go hand in hand with very cold temperatures. Be sure your kids wear plenty of warm clothing in addition to all their hockey gear anytime they play outdoors, and if they’re playing on a sunny day, be sure they use sunscreen on their faces. The sun’s rays reflecting off ice and snow can be very intense.

Now that you know the best ways to keep your kids safe, encourage them to get out there and hit the ice. Hockey is a great game that they’ll want to play for as long as they can. Just remember that accidents and injuries can still occur no matter how prepared they are. Make sure your kids follow these tips, though, and you can minimize their risk significantly.