Gymnastics: Ensuring a Safe and Enjoyable Experience for Kids

Gymnastics offers a fantastic opportunity for kids to develop strength, flexibility, balance, and coordination. However, it’s crucial to take steps to prevent common injuries and health issues so that your child can enjoy a positive and fun experience in the sport.

Tips to Avoid Gymnastics Injuries

To help minimize the risk of injuries, young gymnasts should have the following:

Qualified Coaches
Coaches should be experienced and knowledgeable about gymnastics techniques, rules, and safe movement practices. They should be aware of the physical and emotional development stages of children and be certified in CPR and first aid.

Spotters
Proper supervision and spotters should always be present to assist and ensure that movements are performed safely.

Gym Rules
There should be no tolerance for “clowning around” in the gym, especially near safety equipment like foam pits or trampolines.

Proper Equipment
Safety gear should be well-maintained and correctly fitted, including:

• Clothing that allows for easy movement (no facial or mouth piercings).

• Wrist pads/braces to support the wrists and alleviate pain.

• Heel supports, such as those in an ankle brace or with a built-in heel cup, to cushion the heels for athletes who perform barefoot.

• Grips to protect the palms—basic protectors for beginners and dowel grips for advanced gymnasts.

• Regularly checked and maintained apparatus like beams, vaults, bars, rings, and floor mats.

Emergency Plan
Every team should have a clear emergency plan that is practiced regularly, including first aid procedures and emergency contact information. Each season, team members should receive a written copy of the plan, and parents should review it with their children.

Common Gymnastics Injuries and Their Prevention

Wrist Injuries
Due to the significant force exerted on the wrists during activities like walking and jumping on hands, gymnasts often experience wrist pain. Common injuries include growth plate injuries, stress fractures, cartilage tears, and scaphoid fractures. Treatment typically involves rest, ice, compression, and elevation (RICE). To reduce the risk, athletes should gradually increase activity intensity, use proper skill progression, warm-up, condition, and wear wrist braces.

Elbow Injuries
Elbow injuries such as sprains, fractures, or dislocations can occur from landing on an extended elbow. Repetitive stress can also lead to conditions like osteochondritis dissecans, causing pain, locking, or swelling. RICE is the initial treatment, and a doctor should be consulted if the elbow is swollen or painful the next day.

Ankle and Foot Injuries
Ankle sprains are common in gymnastics, and a strength training program that includes balance and resistance exercises is recommended for both prevention and treatment. Sever’s disease, which causes heel pain due to growth plate inflammation, can be mitigated by using ankle braces or heel cups. Conditioning with sneakers can also limit barefoot activities.

Knee Injuries
Gymnasts often experience knee injuries, such as ACL tears from dismounts or floor exercises. Incorporating ACL prevention programs that teach proper landing techniques and strengthen the hamstrings into training can reduce the risk. For young gymnasts experiencing knee pain, RICE is the first step, but a doctor should be consulted if the knee is swollen, they cannot walk, or if a pop is felt during the injury.

Low Back Pain
Spondylolysis, a stress fracture in the lower spine, is common among athletes who engage in jumping, tumbling, and back-bending activities. Gymnasts with persistent low back pain should seek medical attention, as additional tests may be required to diagnose this condition.

Blisters
Gymnasts frequently develop calluses or blisters, known as "rips," from training on bars, horses, or rings. Preventative measures include using chalk to reduce friction, wearing leather grips, and regularly shaving any calluses that form.

Other Health Considerations for Young Gymnasts

Relative Energy Deficiency Syndrome (RED-S)
RED-S occurs when athletes burn more calories than they consume, leading to potential issues with reproductive health, bone health, and psychological well-being. Rapid weight loss or unusual eating behaviors should be closely monitored, as they may indicate an eating disorder.

Burnout and Mental Health
Gymnasts, especially those who train for long hours or specialize at a young age, can experience burnout due to the demands of the sport. Depression may also arise if an athlete is forced to stop training due to injury or if they are pushed too hard. It’s important to ensure that athletes enjoy their time in gymnastics and are free to step away if they choose.

Final Thoughts

By ensuring proper supervision, following safety guidelines, and maintaining good communication, gymnastics injuries can be minimized. For further advice on injury prevention and safe training practices, consult your doctor, a sports medicine specialist, or a physical therapist.

Understanding Tongue Tie in Infants: Impact on Breastfeeding and Other Concerns

Breast milk is the ideal nutrition for growing babies, but breastfeeding can sometimes be challenging, especially in the early days. One common issue parents face is their infant's difficulty latching onto the nipple, which can cause pain for the breastfeeding parent and concerns about whether the baby is getting enough milk.

Tongue tie, or ankyloglossia, has been highlighted as a potential cause of breastfeeding difficulties. However, experts caution that tongue tie might be overdiagnosed, leading to unnecessary surgeries while overlooking other reasons for nursing challenges.

What is Tongue Tie?

Tongue tie occurs when the band of tissue connecting the tongue to the floor of the mouth is unusually short or tight, limiting the tongue's range of motion. This condition affects an estimated 4% to 10% of newborns.

Is Tongue Tie Responsible for Nursing Problems?

Although traditionally believed to cause breastfeeding issues, research has yet to establish a clear connection. Despite this, tongue-tie release surgeries, known as frenotomies, have surged by 110% since 2012. This trend has sparked debate among healthcare providers and parents.

Concerns that untreated tongue tie could lead to speech, sleep, and dental issues later in life may also be driving the increase in surgeries.

Diverse Opinions Among Experts

Healthcare providers, including breastfeeding experts, otolaryngologists, pediatric dentists, lactation specialists, and primary care doctors, often use different criteria to diagnose tongue tie and recommend surgery.

Research Findings on Tongue Tie and Breastfeeding

There is a lack of definitive studies on tongue tie in nursing infants, but current research shows:

• Less than half of infants with physical signs of tongue tie struggle with breastfeeding. A U.S. study of 115 babies referred for tongue-tie surgery found that 63% did not need the procedure to resolve nursing issues.

• A muscle under the baby's tongue can stretch and lengthen with continued feeding, potentially alleviating nursing problems.

• Healthy nursing may depend more on movements in the middle of the baby's tongue, making the tip less crucial (and surgery less effective). This insight comes from advanced imaging studies of milk flow in infants' mouths.

Tongue-Tie Surgery and Nipple Pain

While more studies are needed to understand the role of tongue tie in nursing, research indicates that tongue-tie release can reduce nipple pain, at least in the short term. For parents experiencing severe pain during breastfeeding, the procedure might offer relief.

Long-Term Impact of Tongue-Tie Surgery

If you’ve heard that early tongue-tie surgery can prevent future issues, consider these key points:

• Tongue tie will not delay speech development, though it may affect articulation. Children who can't easily touch their tongues to the roof of their mouth may struggle with certain sounds. Speech therapy can help if needed.

• There is no evidence that tongue-tie surgery improves dental health or prevents sleep apnea. These conditions have complex causes, and surgery alone cannot protect against potential future problems.

• Claims that frenotomy can alleviate reflux, fussiness, bedwetting, and other issues lack evidence.

Lip Ties and Cheek Ties: Not Linked to Breastfeeding

Surgery for lip ties or cheek ties does not improve breastfeeding, even though lip-tie surgery is often combined with tongue-tie surgery. The bands connecting the lips and cheeks to the mouth's interior do not play a direct role in latching or sucking.

Making an Informed Decision About Tongue-Tie Surgery

Breastfeeding issues have various causes and solutions. For accurate diagnosis and treatment, coordinated care involving your baby’s pediatrician, lactation coaches, feeding therapists, and surgeons is essential. This team approach helps prevent misdiagnosis and unnecessary procedures.

Why Coordinated Care Matters

Coordinated care allows for thorough evaluation, testing different approaches, and close follow-up. It helps avoid unnecessary tongue-tie surgeries, which could worsen feeding issues, affect function later in life, and increase medical costs.

Monitoring newborns with potential tongue tie involves careful examination of sucking reflexes, tongue movement, and feeding sessions. Comparing pre-feeding and post-feeding weights can offer more insights before considering surgery.

Parents should receive ample support and follow-up care to monitor their baby's feeding, weight gain, and overall health. If breastfeeding doesn’t improve after surgery, other causes must be explored.

What to Expect if You Opt for Tongue-Tie Surgery

Tongue-tie surgery can be performed by pediatric dentists, otolaryngologists, trained pediatricians, and other qualified providers. Look for a provider who can bill insurance to avoid health inequities.

Frenotomy is usually a quick, in-office procedure performed without general anesthesia. Both sterile instruments and lasers are effective, with no evidence favoring one method over the other. The procedure takes just minutes, and after a short observation period, babies can go home. Over-the-counter pain relievers can help manage post-surgical discomfort. Long-term complications are rare, though parents should watch for persistent bleeding or pain.

Post-Surgical Stretches: Not Proven Effective

Post-surgical stretches and exercises for infants recovering from tongue-tie surgery have not been proven effective and may even hinder nursing temporarily. The American Academy of Pediatrics (AAP) does not recommend these exercises.

A Call for More Research

The AAP supports further research to develop consistent diagnostic criteria for tongue tie in newborns and infants and clear guidelines for when surgery is necessary. Long-term outcome studies will help parents make more informed decisions about the procedure.

Safeguarding Children During Extreme Heat: Essential Tips for Parents

Outdoor play and exercise are typically great for boosting a child's physical and mental well-being. However, when the heat index reaches 90°F or higher, as defined by the National Weather Service, it poses significant health risks.

High temperatures and extreme heat can quickly lead to dehydration, heat exhaustion, heat cramps, and heat stroke—a serious medical emergency. Additionally, extreme heat can increase irritability and contribute to "eco-anxiety," causing emotional distress due to climate change. Here are some practical tips to help keep your children safe during extreme heat.

Staying Cool in Hot Weather

When temperatures soar, it's best to visit a swimming pool or beach for a brief period or stay indoors with activities like crafts, reading, or board games.

If you expect several days of high heat, plan creative indoor activities to prevent "cabin fever." Encourage easy yoga stretches, indoor hide-and-seek, or fun, low-intensity physical challenges to keep kids active.

If You Don’t Have Air Conditioning

Seek out air-conditioned places such as libraries or shopping malls to escape the heat. If your area experiences frequent power outages or your air conditioning is unreliable, identify a safe place to go during extreme heat. Many communities offer cooling centers in gyms or large buildings for heat relief.

At home, close window blinds and curtains, and stay on lower floors, which tend to be cooler.

Using Fans

Fans can help if air conditioning is unavailable, but keep them at a safe distance from children to avoid hazards. Direct fans can dry out mouths and nostrils and circulate allergens. Avoid using fans in extreme heat (high 90s and up) as they don’t cool the air and can cause the body to gain heat instead of losing it.

Tips to Beat the Heat

If you need to be outside, take these steps to protect your child from heat-related illness and hazards:

• Stay Hydrated: Encourage frequent water drinking and keep it readily available. Bring water bottles when going out. Infants receiving breast milk or formula can be given additional breast milk or formula but avoid giving water to infants under 6 months old.

• Dress Lightly: Light-colored clothing helps kids stay cool by reflecting heat, while darker clothing provides better sun protection. Opt for loose-fitting clothes that offer ventilation and sun protection. Single-layer absorbent clothing maximizes sweat evaporation and cooling. Remember to apply sunscreen.

• Plan for Rest: Heat can make everyone feel tired and irritable. Take regular breaks indoors to cool off, rest, and drink water.

• Cool Off with Water: Give children a cool bath or mist them with water to cool down. Swimming is a great way to stay active and cool, but always supervise children to prevent drowning.

• Never Leave Children in a Car: The interior of a car can become dangerously hot quickly, even with windows open. Never leave children unattended in a car.

Watch for Signs of Heat Illness

Call your pediatrician immediately if your child shows any of these symptoms:

• Feeling faint

• Extreme tiredness (unusually sleepy, drowsy, or hard to wake up)

• Headache

• Fever

• Intense thirst

• Not urinating for many hours

• Nausea

• Vomiting

• Breathing faster or deeper than normal

• Skin numbness or tingling

• Muscle aches

• Muscle spasms

Final Reminder

Don’t hesitate to call your child's pediatrician for advice on protecting your child during extreme heat. Ensuring children's safety during high temperatures is crucial for their health and well-being.

Which Sport Should Kids Start With?

Parents often ask me about the best first sport for their children, and I always recommend swimming for several reasons.

Swimming is a fun, relaxing activity that promotes brain health and builds strong bodies. It's especially beneficial for growing children as it enhances coordination and flexibility. With access to indoor pools, swim clubs, and water parks in many communities, families can enjoy swimming throughout the year.

The Importance of Early Swim Lessons

One of the most compelling reasons I advocate for early swim lessons over sports like t-ball, basketball, and soccer is safety. Beyond being enjoyable and promoting fitness, swimming is a crucial life skill that can prevent drowning.

Drowning is the leading cause of death among children aged 1 to 4. Research indicates that early swim lessons are a vital preventive measure against drowning. Swimming is the only sport that has the potential to save lives.

The Allure and Danger of Water for Children

Children are naturally drawn to water, which makes it both fascinating and dangerous. Drowning can occur in seconds and often happens silently. My family experienced this firsthand when my toddler son fell into our backyard pool. Despite being closely watched, he quickly went under, but we were able to pull him out in time. This incident highlighted the importance of water safety and supervision.

When to Start Swim Lessons

Children develop at different rates, so there isn't a fixed age for starting swim lessons. Factors like emotional maturity, physical development, and any special limitations play a role. Consult your pediatrician for advice on the best time to begin swim lessons for your child.

Generally, formal swim lessons are recommended for children aged 4 and older, as they can develop the necessary water safety skills and confidence. By ages 5 or 6, most children can master basic swim strokes.

Swimming for Special-Needs Children

Parents of children with special needs might worry about their ability to learn swimming. However, children with conditions like autism are at a higher risk of drowning, making water safety even more critical. Swimming can offer numerous benefits, including improved coordination, balance, muscle tone, and stress relief. Many swim schools offer specialized sessions for children with special needs.

Building Swim Skills in Parents

A significant percentage of adults in the U.S. cannot swim, often due to cultural, racial, and economic barriers. Learning to swim as a family can enhance water safety and create bonding opportunities. Organizations like U.S. Masters Swimming provide resources for adult beginners and can help find local classes.

Finding Affordable Swim Lessons

While private swim lessons can be expensive, there are many budget-friendly options. Public pools, local high schools, colleges, universities, YMCAs, and swim centers often offer group classes at reasonable rates and discounts for siblings.

Essential Water Safety Skills

The goal is not to train future Olympic swimmers but to ensure children develop the five basic water safety skills outlined by the American Red Cross:

1. Enter water above their head

2. Surface and float or tread water

3. Turn and find an exit

4. Swim 25 yards to the exit

5. Climb out without a ladder

Benefits of Swimming Beyond Safety

Swimming skills can boost your child's confidence in social settings, help them build stamina and strength for other sports, and provide a calming and relaxing activity to develop resilience against stress. Swimming is a lifetime sport that many adults continue to enjoy.

I encourage parents to start swim lessons early and to consult their pediatrician with any water safety concerns.

Guidelines for Freezing and Refrigerating Breast Milk

Proper storage of breast milk depends on when you plan to use it. Here are some tips to ensure safe storage of your breast milk.

Safe Storage and Preparation of Breast Milk

• Before Expressing or Pumping: Wash your hands and thoroughly clean all storage containers. Label each container with the date the milk was expressed (and your child's name if it will be given to a child care provider). Consult your child care provider about their specific requirements for storing and labeling breast milk.

• Storage Recommendations: Store breast milk in small batches, ideally 2 to 4 ounces, to minimize waste. Any leftover milk after feeding should be used within 2 hours or, if quickly refrigerated, used for the next feeding. You can always thaw additional milk if necessary.

• Refrigeration: Chill or refrigerate milk immediately after expression. Freshly expressed milk can stay at room temperature (up to 77°F or 25°C) for up to 4 hours, or up to 6-8 hours if expressed very cleanly. However, it's best to chill it as soon as possible. Store breast milk at the back of the refrigerator (39°F or 4°C) to avoid temperature fluctuations and use it within 4 days.

• Warming Milk: To warm milk from the refrigerator, place the bottle in a bowl of warm water or run it under warm water. Do not microwave breast milk as it can cause uneven heating and scalding.

• Freezing Milk: If you won't use the milk within 48-72 hours, freeze it. Leave some space in the container for the milk to expand as it freezes. Store the milk at the back of the freezer, not in the door.

  • If using a refrigerator freezer with a separate door (0°F or −18°C), milk can be frozen for up to 9 months.

  • In a chest or deep freezer (−4°F or −20°C), milk can be frozen for up to 12 months.

• Thawing Milk: Thaw frozen milk in the refrigerator overnight, under warm running water, or in a container of warm water. Do not microwave breast milk. Once thawed, it can be refrigerated and is best used within 24 hours, but may be used within 48-72 hours.

Simplified Rule for Breast Milk Storage

To simplify, remember the "rule of 4s": breast milk can be stored for 4 hours at room temperature and 4 days in the refrigerator.

Note on Hospital Guidelines

These storage guidelines are suitable for premature and hospitalized babies, but hospitals may have their own rules. Consult your baby's pediatrician or hospital for specific guidelines.

AAP Breastfeeding Recommendations

The American Academy of Pediatrics (AAP) advises exclusive breastfeeding as the primary source of nutrition for about the first 6 months. After introducing solid foods, continue breastfeeding for as long as desired, up to 2 years or beyond.