Musculoskeletal and Sports Medicine Curriculum Guidelines for Pediatric Residents.

ABSTRACT: Musculoskeletal (MSK) and sports-related conditions are relatively common in the pediatric population. Pediatric residencies should provide residents with the knowledge and skills to assess and manage both acute and chronic MSK and sports injuries and complaints. Residents should develop the competencies and attitudes to safeguard and promote a healthy and active lifestyle for youth. Programs can use a variety of educational tools, both in the clinic and on the field, to provide a well-rounded MSK curriculum throughout the residency years. This article provides a review of general pediatric sports medicine curriculum guidelines and suggested implementation strategies.

Participation and Injury in Martial Arts.

Martial arts encompass a variety of formal movements and traditions that can be practiced for self-defense, competition, physical fitness, motor development, and emotional growth. There are both noncombat forms that have less risk of injury and sparring/combat elements that have increased potential for injury. This article will review several common types of martial arts and the potential health benefits of participation. Common injuries of each discipline will be discussed with a focus on potential injury risk reduction efforts, such as protective padding and more focused rule enforcement. Special attention will be placed on head injuries/concussions, how forced or rapid weight loss may be a detriment to overall health, and the particular risk found in mixed martial arts competitions.

Youth Participation and Injury Risk in Martial Arts.

The martial arts can provide children and adolescents with vigorous levels of physical exercise that can improve overall physical fitness. The various types of martial arts encompass noncontact basic forms and techniques that may have a lower relative risk of injury. Contact-based sparring with competitive training and bouts have a higher risk of injury. This clinical report describes important techniques and movement patterns in several types of martial arts and reviews frequently reported injuries encountered in each discipline, with focused discussions of higher risk activities. Some of these higher risk activities include blows to the head and choking or submission movements that may cause concussions or significant head injuries. The roles of rule changes, documented benefits of protective equipment, and changes in training recommendations in attempts to reduce injury are critically assessed. This information is intended to help pediatric health care providers counsel patients and families in encouraging safe participation in martial arts.

Reducing injury risk from body checking in boys' youth ice hockey.

Ice hockey is an increasingly popular sport that allows intentional collision in the form of body checking for males but not for females. There is a two- to threefold increased risk of all injury, severe injury, and concussion related to body checking at all levels of boys' youth ice hockey. The American Academy of Pediatrics reinforces the importance of stringent enforcement of rules to protect player safety as well as educational interventions to decrease unsafe tactics. To promote ice hockey as a lifelong recreational pursuit for boys, the American Academy of Pediatrics recommends the expansion of nonchecking programs and the restriction of body checking to elite levels of boys' youth ice hockey, starting no earlier than 15 years of age.

Athletic participation by children and adolescents who have systemic hypertension.

Children and adolescents who have hypertension may be at risk for complications when exercise causes their blood pressure to rise even higher. The purpose of this statement is to update recommendations concerning the athletic participation of individuals with hypertension, including special populations such as those with spinal cord injuries or obesity, by using the guidelines from "The 36th Bethesda Conference: Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities"; "The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents"; and "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure."

Pediatric residency education: is sports medicine getting its fair share?

INTRODUCTION: Sports are the leading injury-related cause for pediatric primary care visits. Pediatric residency education guidelines suggest incorporating sports medicine (SM) education into curricula; however, research is lacking regarding effective teaching methods. OBJECTIVE: To assess reported US pediatric residency SM curricula, teaching methods, and resident evaluation of SM education. DESIGN/METHODS: Chief residents (CRs) and third-year residents (PL3s) from 100 randomly selected US Accreditation Council for Graduate Medical Education-accredited residency programs, stratified by size and geographic location, received surveys regarding programs' SM curriculum and teaching methods and individuals' methods for learning SM. RESULTS: Response rates were 63% and 39% for CRs and PL3s, respectively. According to CRs, 34% of programs had no one in charge of their SM curriculum. Lecture (77%) was the primary method used for teaching SM. Hands-on teaching (37%) was used less frequently. CRs stated that 29% of programs did not include musculoskeletal examination teaching in their curriculums; 24% did not include formal teaching of concussion management, and 29% did not include reasons for medical disqualification. PL3s rated teaching of joint examinations and the preparticipation physical as the most poorly taught components of the physical examination. PL3s rated hands-on teaching and patient experience as the best methods for improving SM education. CRs reported that only 36% of programs have discussed incorporating more SM into their curriculum. CONCLUSIONS: SM education is deficient in US pediatric residency programs. Standardized curricula should be developed with a focus on hands-on training as a means for teaching SM to pediatric residents.

Training issues in elite young athletes.

Over the past decade, there has been a surge in the number of sports opportunities available to young athletes. Although physicians, parents, and coaches should promote healthy activity and participation, intense training at a young age can predispose exuberant young athletes to certain difficulties. Elite young athletes are at risk for overuse and growth plate injuries in certain sports. Intense training combined with inadequate nutrition may cause growth delay in elite young athletes, but this delay does not appear to affect permanent adult height. Weight training, when done properly, is safe and effective for prepubescent and pubescent athletes. Awareness of neurobehavioral development can help guide the process for appropriate sports participation. Young athletes should be closely monitored for signs of excessive physical and emotional stress so that sports participation can be fun and rewarding.

Poisoning prevention education during emergency department visits for childhood poisoning.

OBJECTIVE: Childhood poisoning represents a major public health problem that can be prevented through educational efforts. Commonly, young children experiencing a first poisoning episode will have a second occurrence. The aim of this study is to assess whether caretakers of children evaluated in an emergency department for acute poisoning exposure recall receiving poisoning prevention education as part of the medical encounter. METHODS: Consecutive poisoning exposures reported to a regional Poison Control Center concerning children under the age of 6 years were identified. Inclusion criteria were an emergency department referral and subsequent discharge. Within 10 days of emergency department visit, a single trained interviewer administered by telephone a scripted questionnaire concerning the provision of poisoning prevention education. Poison control center logs were reviewed for demographic and treatment data. RESULTS: Of 102 eligible subjects, 77 families were contacted and 75 participated. The median age of poison exposure was 2 years; 45% were male. Seventy-three percent (95% CI: 61% to 83%) of caregivers reported receiving no poisoning prevention education. Among the minority receiving some information, only 25% received verbal instruction. Caregivers of children treated in urban academic centers were more likely to recall prevention education than those treated at suburban and rural hospitals (RR = 5.4; 1.8 to 16.2). Caregivers of children treated at specialized children's hospitals were more likely recall prevention education than general hospitals (RR = 5.3; 1.6 to 17.7). CONCLUSION: Emergency department personnel are missing a potentially important opportunity to provide poisoning prevention education to families of children at high risk for repeat occurrence.

Prevention of pediatric sports injuries.

With over 30 million children participating in sports each year across the United States, a number of significant injuries are to be expected. Although mild injuries such as strains, sprains, and contusions predominate, catastrophic injuries do occur. Young athletes are at an increased risk for growth plate and apophyseal injuries, overuse injuries, and heat illness. Many of these sports injuries can be prevented. Prevention strategies include protective equipment, rule changes, preseason and season prevention interventions, safety measures, better coaching, education, and a societal awareness of injury and prevention. This article discusses current injury prevention for children participating in baseball, football, soccer, and ice hockey.