By: Dr. Mark Walter

www.vsas.com

There has been a definite increase in overuse injuries in children. Repetitive-stress injuries (RSI) used to be a relatively rare problem for the young, or so it seemed. This has all changed.

Of course, you would see an occasional Osgood-Schlatter’s or epicondylitis, but with the emergence of organized sports and their emphasis on repetitive drills, as well as the more recent trend toward sports specialization in young athletes, RSI is now a relatively common problem. Chiropractors are experts at treating these types of injuries. If managed carefully, most adolescent athletes can recover completely from these injuries.

Let’s take a specific example of a RSI: spondylolysis (stress fracture of the vertebrae). It is estimated that 15 percent to 20 percent of gymnasts develop this type of stress fracture. However, it affects many young athletes who perform any activity that requires repetitive hyperextension of the lower back. Dancers, divers, gymnasts, high jumpers, offensive linemen, pole vaulters, weight lifters and wrestlers all demonstrate an increased incidence of spondylolysis.

One of the reasons for this problem is that the pars interarticularis, the area that the stress fracture occurs,  does not fully mature until about 25 years of age. Unfortunately, in many sports an athlete is actually considered “old” and past their prime at age 25. The accepted theory is that repetitive activity from the paravertebral muscles pulls on the relatively fragile facet joint, which eventually causes fatigue and micro- or stress fracture.

Early on, most of these stress fractures are not visible on plain films. SPECT bone scans and CT are great tools for diagnosing this type of fracture. The bone scan will identify whether there is a stress fracture. Bone scanning achieves almost 100 percent sensitivity in finding stress fractures in the pars interarticularis. Unfortunately, these lesions can remain positive or reactive for a long time. Therefore, to best evaluate anatomic healing, CT is generally the best modality.

The typical protocol for ruling out a spondylolysis is to obtain a SPECT bone scan to determine whether there is a stress fracture. If the bone scan demonstrates a spondylolysis, a CT is requested to evaluate the anatomic involvement of the fractured bone.

Typically, patients with this injury wear a brace for 12 weeks and discontinue their sporting activity. Isometric exercises to maintain and strengthen the trunk muscles are performed, and once pain has subsided, gradual mobilization and isotonic exercises of the trunk muscles are included. If the CT scan shows signs of union of the defects, the brace can be removed, but sporting activity cannot be started for three more months. If, however, there is no evidence of healing, then more aggressive treatment such a surgical pinning may be necessary. If the CT scan demonstrates confirmed union of the pars interarticularis, the patient can gradually return to training.

Other kinds of RSI injuries that adolescent athletes develop include bursitis, tendonitis, epicondylitis, Osgood-Schlatter’s disease, patellar femoral syndrome, shin splints and stress fractures other than spondylolysis. Again, chiropractors generally are very good at treating these types of injuries, except in the case of occult fractures through the growth plate, the epiphysis. In those cases, surgical intervention is necessary.

Using a bone scan to determine if there is indeed a stress fracture is very helpful. Once a stress fracture has been ruled out, the clinician can confidently determine a treatment schedule for a young, healthy patient. The patient can be allowed to test their recovery with prudence. In the case of a stress fracture, the recovery time will most likely require that the patient be off training and out for the season.

Photo courtesy of Virtual Sugar

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Christine Wood, M.D.

www.kidseatgreat.com

The American Academy of Pediatrics now urges no television watching for children under two years of age and a maximum of one to two hours a day of good quality TV and video or computer games combined for older children.  More TV time means a higher risk of obesity in children.

My recommendations are to work hard to limit television under two years and time watching television or other computer games, etc. to no more than 2 hours combined.

Here are some general recommendations to help you set limits with your kids.

• Set clear limits on video, computer games and other forms of media.
• Have tokens that are given for 20 to 30 minute allotments of time that can be given at the beginning of the week to control total time on media.
• Choose public television over commercial programming.
• Tape programs for children and fast-forward through commercials.
• Have a library of favorite videos or check them out from the video store.
• Look for television channels that do not run any advertising for foods or products.
• Avoid having a television or computer or gaming system in the child’s room.
• Watching television often creates unrealistic expectations in the mind of the child and creates an appetite for passive entertainment, junk food, and name-brand “must-haves.”
• Research shows that violent programs and computer games can lead to more aggressive behaviors in children. Viewing repeated acts of violence desensitizes their perception of violence. Even during family programs, commercials may show violent previews for other programs and movies. With more concerns about real-life violence in children and teens, it gives us more reason to be watchful parents about the content and time spent watching television.
• Develop television substitutes such as reading, athletics, physical conditioning, and instructive hobbies, as well as allow them time for imaginative play.
• Allow discussion with children about the intent of commercials – they do not always have the best interest of the viewers in mind and they are marketing tools to create buying habits.

Have TV-free nights or weeks (if you dare!).  Have family game nights or take a family walk at the park.  Mom, Dad and the kids will be healthier!

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By Christine Wood, M.D.

www.kidseatgreat.com

What parent doesn’t dream of having an intelligent baby and child?  Are there things that a mother can provide in her diet and in her baby’s diet that may promote a smarter baby?  Studies have shown that breastfed babies have higher IQ’s than those babies fed formula. One of the nutrients that has received attention in breast milk as having a role in improving infant brain development is a class of essential fatty acids (EFA) called, omega-3 fats.  These beneficial fats are long chain polyunsaturated fatty acids and two of them have been studied in infants: docosahexaenoic acid (DHA) and arachidonic acid (ARA).  Contrary to popular belief, the body does need fat.  It must be the right kind, though.

Let’s look at the adult brain compared to the fetal brain.  The adult brain is about 2 percent of total body weight and uses 20 percent of total energy. The fetal brain is about 16 percent or more of body weight, uses about 70 percent of energy for growth.  The brain is made of about 60 percent fat. The fats required for the nerves found in the brain are primarily DHA and ARA. Since breast milk is made of 40 to 50 percent fat, we see how Mother Nature built in the right components for brain development.

There is an infant brain growth spurt from the last trimester of pregnancy until about 18 months of age.  DHA accumulates in the infant brain during this period at a rapid rate.  The accumulation of this fat depends on the pregnant mother’s intake of this important nutrient in her diet.  After the baby is born, if the mother is breastfeeding, the amount of DHA in breast milk will depend again on her dietary intake of this nutrient.  DHA is found in the diet in high amounts in fatty fish (like tuna, mackerel, anchovies, salmon, herring, sardines) and in flaxseeds, flaxseed oil, canola oil, fish oil, and walnut oil.  Unfortunately, there is growing concern that many of our fish today are contaminated with mercury which may be harmful to infant brain development.  Studies have shown that mercury exposure in infants and young children can cause problems with attention, learning and behavior.  (See “Fish Caution During Pregnancy and Breastfeeding” to learn more.)

Investigators are discovering the importance of different fats on infant brain development. How these fats affect attention, problem-solving ability, IQ, and visual function is the emphasis of recent research. Consider these studies:

• DHA appears to be important for visual development in premature infants.^[i]
• A study from Australia showed that supplementation of infant formulas with a dietary omega-3 did improve visual function to the level of those found in breastfed infants.^[ii]
• Another study showed that supplementation of formula with DHA and ARA from birth to 4 months of age resulted in higher problem-solving scores at 10 months of age.^[iii]
• The improved intelligence and academic performance of breastfed babies compared to formula-fed babies may be partially explained by the increased DHA content of breast milk.

As you can see in the box Essential Fatty Acids: Benefits and Food Sources, there are many other studies on the role of essential fats in adult and childhood health.

If you are pregnant or breastfeeding, you should make sure you are including these fats in your diet. Look for food sources as listed in the box and be generous with the plant-based forms of this fat (nuts, oils, flaxseeds and beans).   My recommendations are one tablespoon of flaxseed oil and a fish oil supplement with DHA and EPA. The total omega-3 as fish oil (DHA plus EPA) should total about one gram a day.  I recommend both because the flaxseed oil has a component that converts into the ARA, which is also an important part of the essential fats for infant brain.

If your baby is formula-fed, you should note that most formulas now contain these essential fatty acids. The DHA and ARA have been recently approved for use in infant formulas in the United States. The British Nutrition Foundation and the Joint Expert Committee on Human Nutrition of the United Nations Food and Agriculture Organization and World Health Organization (FAO/WHO) have recommended that DHA and ARA be included in all infant formulas. Studies show particular benefits for premature babies for their brain development and visual acuity.

Infants and children can safely receive these essential fatty acids in the form of flaxseed oil and other food sources listed.  Most children are not big fish eaters and so their intake of these essential fats can be very low, so supplementing their diet with these fats may be beneficial for their immune and cardiovascular system.

All in all, these fats are something that everyone should be receiving in some form as our diets of today have changed and generally contain a high level of fats that are not good for our bodies and not enough of these good essential fats.  Starting infants even before they are born will help them start out right for life!

[ii].Makrides M, Neumann MA, Gibson RA. Are long-chain polyunsaturated fatty acids essential nutrients in infancy? Lancet. 1995;345:1463-1468.

[iii].Willatts P, Forsyth JS et al. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age. Lancet. 1998;352:688-691.

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