Turn several hours of fun on the couch into several hours of active fun:

• Whenever your team makes a first down, celebrate with 10 jumping jacks, scissor jumps, sit-ups or pushups.
• When your team scores a touchdown, do a 30-second victory dance (exuberant celebrations on the field penalized, exuberant celebrations in the family room get an extra point).
• Speaking of extra points, hug or kiss a friend when your team scores an extra point (virtual mistletoe uprights).
• When your team scores a field goal, do a 60-second dance (they’re doing well, but need a bit of extra help).
• If there’s a safety, do something outlandish. Be creative.
• You can also score a pointby being up and moving during a commercial.
• Two extra points for vigorous halftime action.

Keep track of your score. You get two points for each activity, plus a bonus point for each if others agree that you are really going for it. Tally up the total, and we all win

A contagious skin infection that was once thought of as primarily limited to hospitals, prisons, and nursing homes is now showing up in healthy children, according to the Centers for Disease Control and Prevention. These skin infections are caused by tough-to-treat bacteria called methicillin-resistant staphylococcus aureus (MRSA, or resistant staph). As the name implies, antibiotics are not always effective at treating the infections, especially once they have spread too far in the body.

Most of these infections are mild, but some do progress to become extremely serious. They typically start out looking like a simple pimple, boil, or infected wound, but they might start to worsen with symptoms such as fever, pus, swelling, or pain. Rugby and RugratsRecently a rugby team shared this rash.

The biggest clusters of MRSA infections in children have been among students involved in competitive sports (such as fencing or football) where they might share equipment, or in sports (such as football or wrestling) where they have skin-to-skin contact. The National Federation of State High School Associations (NFHS) sent out a warning letter about MRSA to its members on October 14, 2003.

Although high school athletes have been the biggest focus of concern, high school students and athletes are not the only children at risk. Daycare – A Contact Sport with Shared EquipmentParents, kids, coaches – and yes, also daycare workers – should be aware of the possibility of serious skin infections and be on the lookout for any worsening skin problems.

The CDC recommends a number of measures for preventing MSRA infections, including attention to hand hygiene (use soap and water or alcohol based instant hand sanitizers), cleaning shared equipment (towels, helmets, or toys), covering cuts and scrapes with protective bandages until healed, covering possible infections with bandages, excluding from play those whose wounds or infections cannot be covered, and reporting to a healthcare provider any wound that is slow to heal or that appears infected.

The statistics are in, and happily there were no deaths from heatstroke among U.S. football players during the 2002 season (or so far in 2003), according to the National Center for Catastrophic Sports Injuries at the University of North Carolina. About 1.5 million children play full contact football each year in the U.S., and in most years a few are lost to preventable heat injuries.

Children should have access to all the water they want during practice and games. They should drink cool water at least every 20 minutes throughout strenuous exercise, or a cool electrolyte drink if the exercise lasts longer than an hour.

Kids also need time out of their helmets at least every 30 minutes to cool off. In 2002, five players died from football injuries.

One was a semi-pro player, three were in high school, and one was in a youth league. All of the fatal injuries were head injuries. All players need to be taught never to make first contact with the head, whether blocking or tackling.

In 2003, for the first time, a new generation of youth football helmets computer-designed to prevent head injuries is available for young players. I’m excited when children are involved in sports or physical activity, but we want to do all we can to make those activities both safe and fun.

Shoes protect the feet; helmets protect the head. Helmets can be very effective at preventing serious head injuries, but nevertheless, head injury during active play remains a leading cause of death among children. Why might this be?

A study in the August 2003 Pediatrics looked at hundreds of Massachusetts kids aged 4 through 18. When asked, most of the kids reported “always” or “almost always” using helmets when biking, skating, scootering, and skateboarding.

When kids are observed, though, the numbers are often much lower – in some studies, as few as 12 to 15 percent of in-line skaters were seen to be wearing helmets. Among kids that are wearing their helmets, poor helmet fit has been shown to be associated with a higher risk of head injury.

The kids in the Massachusetts study were asked to bring in their helmets to be checked. Ninety percent of them felt that it was “easy” or “pretty easy” to fit a helmet. The study found, however, that only a shocking 4 percent of the children had helmets in acceptable condition with a good fit. The biggest problems were helmets that rode too high on the forehead or that were too loose, allowing the helmets to slide forward and backward on the head.

Paying attention to be sure that the helmet rests low on the forehead and does not slide from front to back could be an important way to help keep your child safe.

Related concepts:
Head injury

Introduction to concussion:

Children’s energetic exploration of life often results in head “bonks.” Fortunately, most of them are not serious. Nevertheless, when we hear the awful thud of a child’s head, our breath catches for a moment…

What is concussion?

A brief, temporary loss of consciousness following a blow to the head is called a concussion. It is possible to have a mild concussion without losing consciousness completely. Any brief alteration in consciousness, vision, and balance following a head injury could be a mild concussion.

Who gets concussion?

Is toddlerhood a contact sport?
Almost every child experiences minor head injuries. They occur throughout childhood and adolescence. They are most common in infants and toddlers and then later when children engage in contact sports.

What are the symptoms of concussion?

The classic symptom of a concussion is a brief loss of consciousness. A mild concussion might only cause brief confusion or momentary amnesia. It can be normal to have a headache, feel sleepy, or vomit once or twice afterwards.
In a baby or toddler, a prompt cry after a head injury is reassuring. The following is a list of signals that tell you that you need to talk with your pediatrician, either initially, or again if they develop after the first conversation:
If your child is (or has):

• Under 6 months of age
• Unconscious, even briefly
• Crying for longer than 10 minutes
• Vomiting repeatedly
• Bleeding or clear liquid from the ears or nose
• Rapid swelling just above the ear
• Unable to walk or talk normally
• Unequal pupil size
• Severe, worsening headache (or irritability before a child can talk)
• Neck pain
• Seizures
• Skull indentation or large bump
• Great force of injury (car accident, long fall, baseball bat, etc.)
• Changes in behaviour, such as being sleepy and difficult to arouse>

If any of these symptoms or situations is present, call your physician right away. Your child may be fine but you should be in touch with an expert. If your child is unable to get up by himself immediately after the head injury, there may also be a neck injury. It might be best not to move him. Call 911 and wait for emergency help to arrive.

Is concussion contagious?

Concussions and head injuries are not contagious, although the risk-taking behavior that leads to them can be.

How long does concussion last?

The loss of consciousness from a concussion may last only a few seconds, but it can last considerably longer. If it lasts a few minutes or longer, the child will likely need to be hospitalized for observation or treatment.
New symptoms can develop after a head injury during the next 24 to 48 hours, especially if there is some internal bleeding.

How is concussion diagnosed?

The nature and extent of a head injury is first assessed based on the story and on the physical exam. If there is any concern that a serious injury may be present, additional studies, such as a head CT, may be needed.

How is concussion treated?

For most concussions, observation and rest is all the treatment that is needed. During the first night afterward, you’ll want to try to awaken your child once or twice to be sure that he awakens normally.
Some children need definitive treatment at a hospital or even in a pediatric ICU for severe head injuries.
With any concussion, the risk is much higher from a second concussion soon after the first one (called the second impact syndrome) because the healing brain is not able to regulate blood flow as well.
The Colorado Medical Society has developed guidelines for return to contact sports (or practice) following a concussion. In these guidelines, a Grade III concussion involves a complete loss of consciousness, a Grade II concussion involves only confusion and brief amnesia surrounding the injury, and Grade I involves a player who is only confused after a head blow.
A player with a Grade I concussion, and no symptoms when examined, may return to play after 20 minutes. A player with a Grade II concussion may return to play after there has been one week with no symptoms. A player with a Grade III concussion should not return for a full month (including no symptoms in the last week before returning).
Repeated concussions increase the risks of acute or ongoing problems. After a second Grade I concussion, the player should avoid contact sports for at least two weeks; after the second Grade II, for one month; and after the second Grade III, the season is over.

How can concussion be prevented?

Helmets for using a bicycle, scooter, or roller-blades, and helmets for contact sports can help prevent many serious head injuries. Make sure your child is properly equipped for his activities.
Stair gates for infants and toddlers and car seats or seat belts for everyone in the car are also important safety equipment.
“Rock-a-Bye Baby,” the lullaby about a baby toppling from a poorly placed cradle, warns parents of a real danger. Falls from open windows, rooftops, balconies, play structures, and other heights injure more children than any other cause.
Summertime is the greatest danger period, with more open windows and more outdoor play. Children love to climb, so furniture is best kept back from windowsills and balcony railings. Window guards and window stops can let fresh air in but keep a child from falling out. Don’t rely on ordinary window screens to keep your children safe. In addition, placing shrubbery or something soft under danger areas can lesson the injury if a child does fall.

Related A-to-Z Information:

Head Banging, Headache, Hemophilia, Vomiting

My 14-year-old son is gearing up for freshman high school football in the fall. Team weightlifting starts next week. Is it healthy? Can this stunt long-term growth?

The American Academy of Pediatrics has issued June 6, 2001 guidelines for strength training by children in adolescence. Weightlifting can increase strength in adolescents and preadolescents, and can increase muscle size in adolescents. It does not increase running speed, jumping ability, or overall sports performance.

It has not been proven to decrease sports injuries. Gains in strength or muscle size are lost after 6 weeks if training is stopped. Injuries to growth plates can occur, but can be prevented by avoiding ‘maximal lifts’ – trying to lift as much as possible one time.

The greatest benefits and smallest risks occur when 8 to 15 repetitions can be performed with a given weight before adding weight in small increments.

We know that repeated head injuries can lead to long-term neurologic damage. What happens when kids play football or hockey?

A study published in the May 2000 Journal of Trauma followed high school football and hockey players during actual games. The players wore helmets equipped with gauges to measure impacts. No injuries were recorded during routine play in this study (of course, serious injuries do occasionally occur).

Surprisingly, though, when high school soccer players wearing these same helmets headed the soccer ball, the force was 180% greater than in collisions during a football game. The acceleration of impact in routine heading of the ball was more than 50g — a level where repeated impacts can lead to neurologic damage.

I wouldn’t want my children to forcefully head a soccer ball.

The biggest safety concern in baseball is getting hit with the ball.

Traditional hardballs have cork centers that are wrapped in layers of wool. Safety baseballs have a polyurethane core and are the same size and weight as regular hardballs. Tests show that they have the same ‘ bounce’. But safety baseballs cause far less damage on impact.

For this reason the American Academy of Pediatrics recommends that they be considered for all youth baseball. With safety baseballs you don’t hear that wonderful ‘crack’ when the bat strikes the ball – but then again you avoid the ‘crack’ when the ball hits a child’ s head.

Seems like a good trade-off to me.