Athletic Preparedness

Now that Memorial Day and the summer is upon us, it’s already time to think about summer training for school sports in the fall and beyond.  We all want our children to enjoy the many physical, emotional, and character advantages derived from athletic competition.  But, deep down, we all want them to excel.

Certainly,training hard and competing aggressively are necessary components for achievement.  But I try and remind my patients that success begins outside of the playing field/arena:

Adequate sleep is fundamental.  Even adolescents need > 8 hours/night but many routinely get far less.  Besides mood stability, state of alertness, and overall feeling of wellbeing, sleep causes release of growth hormone which is essential for growth and repair of bones, muscles, and tendons strained during athletic activity.  This leads to faster post training recovery, injury healing, as well as more and better muscle development aiding skills development.  Conversely, sleep deprivation induces stress related cortisol  release which promotes all kinds of metabolic derangements like insulin resistance, fat accumulation, higher BP, and even immune compromise to name just a few.  Please note that long midday naps or extended weekend sleep time does not provide replacement “catch up” for regular good nights’ sleep.

Of course, nutrition is key.  No supplements are necessary and many actually cause harm.  The human body was designed to eat food.  Endeavor to provide a diet of 45-65% good carbohydrates (whole grains, fruit, dairy); 10-30% protein (lean meat, chicken, fish, eggs, beans, nuts); and 25-35% healthy (<10% saturated)) fats ( olive oil, nuts, beans).  Include Vitamin D 600 IU (dairy), calcium 1000-1300 mg/day (dairy, broccoli, spinach) and iron 8-11 mg/day for children and boys, 15mg/day for teen girls due to menstruation (eggs, leafy vegetables, whole grains, meats).  Avoid fatty meals before training as this delays gastric emptying which leads to bloating, cramps, and poor performance.  Schedule recovery foods like graham crackers, peanuts/peanut butter, yogurt or cheese, fresh or dried fruit for 1-2 hours after training/competing.  Avoid “wasted” calories  from candy, chips, soda/sport drinks, or baked goods–cookies and cake.

Hydration–consume 400-600 ml water before athletic activity.  Fluid replacement as per this table; for events < 1 hr water is sufficient; if > 1 hr fluids with sugar and electrolyte replacements are better.

The American Academy of Pediatrics has established guidelines on youth sports participation which encourages reasonable weekly and seasonal limits.  Cross training improves core muscle strength and stability, limits emotional burnout and injury by avoiding muscle and tissue overuse in one given sport.  Also, of course, it allows a kid to just have fun by varying his/her experience and social interactions.

Remember, the point of all youth sports is fun and growth.  If a kid has the aptitude and desire to “go the distance” either in sports competition or business, that comes from inside them and not from us.  But if they do want to win, I tell them, they need to be smart as well as good–odd hours, irresponsible partying,  bad food or fad diets, poor or overtraining is NOT the path to athletic success.

Send along questions or comments, and thanks for following.

Food Allergy

The approach to food allergies in children is undergoing a revolutionary change of late.  First, let’s define the problem:

  • 6% of children <2 yrs
  • 9%<5 yrs
  • 8% ages 6-10 yrs
  • 6 million children overall
  • 40% of affected children have severe allergy
  • 30% of affected children are allergic to multiple foods

The most common allergic foods in infants and toddlers are milk, eggs and peanuts.  In older children we also see symptoms from shellfish, soy, wheat, and other fish.

Food allergies cause symptoms in a variety of organ systems:

  • Skin–hives, itching, eczema
  • Respiratory–cough, congestion, wheezing, throat closing
  • GI-nausea, vomiting, diarrhea
  • Cardiac–dizziness, fainting, collapse

Also note that most of these symptoms–or adverse reactions that are similar–may be mimicked by unrelated conditions like food poisoning, lactose intolerance or idiosyncratic/specific food reactions. So not everything that occurs in relation to eating/food is”allergy.”

As recently as 2000, guidelines from the American Academy of Pediatrics recommended that parents delay the introduction of high incidence allergy foods until 1-3 years of age.  Since then, we’ve seen an almost 50% increase in the incidence of food allergies.

Now, thanks to the LEAP (Learning Early About Peanut allergy) study, that’s all changing.  Early introduction of peanut seems to be protective.  As little as 2 gm daily of peanut butter(about 2 tsp) was often effective.  The EAT (Early Allergy Treatment) study found similar results with other common allergy foods.  It appears these small doses of allergy-type foods may decrease the incidence of the condition by as much as 86%.  So now the medical community is “doing a 180”–going in completely the opposite direction from the previous recommendations.  Early introduction  of common allergy causing foods is becoming the way to go for at risk children/families.

Those at greatest risk include children with confirmed allergic siblings or parents or those who have severe eczema or asthma.  Please contact me if you are concerned about food allergies in your child.  We can explore and design a food introduction/desensitization program, or consult an allergist to guide us in that effort.

Thanks for following.


Meningitis Vaccine

There is an important new development in the fight against meningococcal meningitis.  While this most serious infection can occur in almost anyone, it has a peak incidence in children <1 yr and then in later teen years.  Those living in group residence situations–like college dormitories and military barracks–present a greater risk which is why we have focused our immunization efforts on that age cohort.

In 2013, there were 530 cases in the US (0.18/100,000 population).  10-15% will die from the infection and 11-19% more will suffer permanent injury like deafness, brain damage, or loss of limbs/digits.

Fortunately, we have been immunizing teenagers since 2004–age 11 and again at 16–with meningococcal vaccine generically named MPS4–covering 4 strains of the bacteria (A,C, Y, W-135).  Unfortunately, this vaccine does not cover the dangerous B strain (MenB) of the bacteria which is responsible for 1/3 of all meningococcal outbreaks.  And we have still seen outbreaks of MenB at colleges throughout the US.  Yearly there are still 110-188 cases of MenB.

Happily, we pediatricians can finally do something about this.  There are now 2  vaccines available that are effective at preventing MenB.  They are approved for usage in individuals aged 10-25, 2 doses administered at least 1 month apart.  Generally, most pediatricians are giving the shot at age 16 and thereafter.  The MenB vaccines have been in use since 2013 in Europe, Canada, Australia and Brazil.  Side effects are generally mild–muscle pain, redness, fatigue, headache, fever.  13-18% will experience joint pain or nausea and 7-8% will experience “severe” pain.  In one study of 3058 patients one child developed anaphylaxis.  All of those problems were otherwise self limited and resolved on their own with only supportive measures like acetaminophen.  Rarely, as with any vaccine, a patient may faint post-shot; while scary and upsetting, this too has no lasting adverse effects.

This is a real advance in our arsenal to stop a deadly disease.  Please call me with any questions or to schedule your child to receive MenB vaccine.  And thanks for following.