Total calories- difficult to estimate, may range from 2000-4000 calories per day. Do not restrict calories (unless directed by a physician) and do not skip meals.
Standard recommendations from most sports medicine authorities recommend majority of calories come from Carbohydrates.
However, there is emerging thought that higher protein/fat diets with lower carbohydrate intakes may be more favorable, especially to reduce risk of diabetes, overweight, and other health concerns while also enhancing exercise performance.
Essential for optimal exercise performance and cognitive (thinking) function.
US Recommended daily allowance: 15 mg/day
Good sources: lean red meat (three times a week), dark chicken, fish, beans, eggs, iron-fortified cereals, and green vegetables.
Vitamin C can enhance iron absorption (drink orange juice with the above foods), also cooking in a cast iron skillet.
Tea, coffee, fats, and soft drinks decrease iron absorption.
Low iron stores can reduce athletic performance but do get a full evaluation from a qualified sports medicine specialist before taking iron supplements.
Boys and pre-adolescent girls need 1000 mg of calcium/day (four dairy servings).
Adolescent girls need 1500 mg of calcium/day (six dairy servings).
Each cup of milk, carton of yogurt, and chunk of cheese counts as a serving.
Calcium+appropriate physical activity= maximal bone mass
Vitamin-D fortified milk is more crucial than other dairy products
All children need at least 400 International Units of Vitamin D every day, while many athletes may need even more for optimal health and performance.
Athletes who do not get regular sun exposure (10-15 minutes/day for 3-4 days/week), have darker skin tone, or who do not get adequate intake of Vitamin D food/drinks might be at higher risk for Vitamin D insufficiency.
Probably the safest and most important nutritional supplement.
Good science shows dehydration causing a 1 pound weight loss may reduce athletic performance.
Pre-hydrate before activity and have regular access to fluids during practice and games.
Fluids with sugar and salt more helpful if activity is over one hour in duration.
Pre-event and post-event weights can help determine fluid needs.
Drink 16 ounces for every pound lost after activity.
Immediately after activity, eating 1 gram of carbohydrate for every 1 pound of body weight can help replenish lost energy sources.
Getting 30 grams of protein can assist in recovery (good food sources include chocolate milk, peanut butter, Greek yogurt)
Chocolate milk is a great recommendation for post-workout recovery drink with a good carbohydrate to protein ratio that also provides fluids, Vitamin D, and a good tasting, low-cost, easy to find option.
Do they work?
Yes, some of them have been shown to improve exercise performance.
Do they have side effects?
In the case of andro and steroids, yes, there are well-known serious side effects.
In the case of creatine, we dont have enough long-term data to say for certain.
What little short-term data we have has been collected in adults, and may not apply to growing children.
Many cases of supplements having additional substances not listed on the label, some of which are either banned or potentially harmful.
Thus, the safest route is to avoid supplements. Save your money and safeguard your health.
In female athletes, insufficient caloric intake can contribute to the Female Athlete Triad which consists of disordered eating, reduced bone density, and irregular or absent menstrual periods.
While any female athlete could be at risk, those athletes who participate in sports that value a lean physique are at higher risk.
Excessive exercise demands coupled with insufficient caloric intake can lead to irregular or absent menstrual periods.
Estrogen, a hormone necessary for building bone density, is released during normal menstrual cycles.
No menstrual period means no estrogen release, leading to a reduction in bone density that makes the athlete more prone to stress fractures.
Confronting an athlete about these issues is quite difficult; however, there are some suspicious signs:
To prevent these issues, make certain female athletes consume sufficient calories (often 2000-3000 cal/day), calcium (1000-1500 mg/day) and iron (15 mg/day).
In addition, excessive pressure from coaches, parents, or other athletes regarding body shape or image can lead to disordered eating patterns.
Lack of iron is very common in young women, especially in endurance sports.
Appropriate evaluation by a sports medicine specialist can help uncover iron deficiency and prevent associate fatigue, poor performance, and reduce academic achievement.
However, there are now eloquent voices in the sports nutrition communities who are teaching a more low carbohydrate, higher protein and fat diet. I will ask you to review this podcast featuring the prominent exercise and sports medicine science expert Dr. Timothy Noakes.
Proponents of the low carbohydrate diet focus on the concept of carbohydrate intolerance where excessive carbohydrate intake (especially of processed foods) contribute to higher rates of snacking with subsequent increased risk of diabetes and overweight obesity.
Who is or might be at risk for carbohydrate intolerance?
What foods must be reduced/avoided?
One would increase meats/poultry/fish and nut sources along with vegetables and dairy products. Concerned about the increase in cholesterol? Those who support the low carb/high fat and protein diet will argue that lowering blood sugar amounts is more beneficial to heart health and outweighs the risk of higher cholesterol amounts.
If interested in a low carb diet, what are recommendations to put it into place?
I post this to encourage thoughtful consideration about the on-going debate of appropriate carbohydrate intake and how each individual can best adjust their intake to optimize long-term health and athletic performance.
There is no magic age at which a child can begin weight training.
Readiness for weight training depends on the willingness of the child to lift weights, follow directions, and maintain the program for several months to see results. Remember, this is for the child, not for an adult or coach.
Weight training should supplement regular sport activity. It is not acceptable to have weight training injuries keep an athlete away from his/her sport.
I recommend qualified supervision by a performance or physical trainer who routinely works with children and adolescents. The focus should be on appropriate-sized equipment, meticulous weight lifting technique, starting with low weights/high repetitions, and working multiple body parts. In appropriate program, a child will often lift weights 2 or 3 days a week with at least 48 hours of rest between sessions.
The physical results, such as muscle enlargement and weight gain, depend on the gender and developmental stage of the child.
Androgens are a particular hormone, produced more in boys than girls, which produce muscle and strength gains. Since androgens increase late in puberty right after the growth spurt (age 11-12 in girls, age 13-14 in boys) lifting before this time will not result in massive muscle bulking or extreme strength gains.
Does this mean one should not lift before this point? No, but just place the emphasis on good technique and reduce the expectations for big-time muscle gain. Remember, due to lower androgen production than boys, girls will have less increase in muscle mass.
Studies have shown that a properly designed and supervised resistance training program can be safe for children and young adults.
Contrary to popular belief, weight training at a young age does not stunt growth as long as proper techniques are utilized.
There are reports of overuse injuries with back strains the most common but at no greater frequency than what is seen on the athletic field. Again, placing the emphasis on a properly designed and supervised resistance training program will help reduce injuries and maximize enjoyment.
Both published studies and personal experience have shown impressive strength, speed, and endurance gains with an appropriate weight training program.
There is no good scientific data to show that this directly translates to better on-field performance, but it does contribute to overall athletic ability. The athlete needs to be aware that he/she must stay with the program or risk losing the gains.
Two high school-based studies indicate a resistance training program could decrease the number and severity of injuries, and also reduce the rehabilitation time once an injury has occurred. These benefits may be due to stronger supporting joint structures, muscle absorbing more energy before tiring out, and greater muscle balance around a specific joint.
1) When an athlete is not wearing appropriate protective equipment.
Bike helmets do no good when they are strapped to the handlebars, just like shin guards can not work if they are left in the gym bag.
Make sure the equipment is in good condition, fits well (especially with growing children), and is always properly used.
2) Within a month of a new season or activity
Good studies on Marine recruits show that foot stress fractures are most commonly seen three weeks into boot camp.
My experience with young athletes is quite similar as about three weeks into a new sport, I will start to see overuse injuries.
The body is unable to handle the stress of a new activity, and breakdown occurs.
How can this be minimized?
Have the athlete prepare for the new activity with some light conditioning.
Going straight from Sega football to double days on the field can be a recipe for disaster.
Also, start slow and increase intensity or length of workouts slowly to allow the body to adjust- and do not forget those rest days.
3 )When an athlete steps up to a higher level
This often includes playing with older, more mature (and bigger) athletes, attending an intense sport camp, or starting high school or college training.
No matter what success the athlete has enjoyed in the past, these situations can overtax a young body.
Limit situations where 9 year-olds play with 12 year-olds.
Prepare well for camp or a new school, and gradually increase the training.
Sports medicine physicians use the mantra TOO MUCH, TOO FAST, TOO SOON as a recipe for overuse injuries.
4) Playing more than one sport at a time
Many athletes can handle playing club soccer and running cross country at the same time, while some cannot.
Other athletes can handle summer football, baseball, and basketball camps without missing a beat while some cannot.
I will often see athletes who are burned from too much activity and once they take a brief rest period and then focus on one sport the majority return refreshed and are more successful.
5) Playing too much of one sport
The more is better philosophy may work for some, but is has also caused the demise of many young bodies.
Repetitive activity strengthens bones and joints, but too much repetitive activity can over stress bones and joints, leading to injury.
Thus, swimming for two club teams, or playing on three baseball teams may be detrimental in the long run.
Do not forget that private throwing lessons or personal training sessions also add to the cumulative stress placed on the body.
Factor all activities into the equation when determining limits for your young athlete.
6) Playing through pain or discomfort
No child should ever play through any significant pain.
I use a 1-10 pain grading scale (1= no pain, 10= major pain).
Any pain rating higher than 2-3/10 is significant pain.
Schedule an appointment if there also is pain that causes a limp, changes technique, or forces a child to change position or not want to continue activity.
7) When an athlete is tired
Fatigue minimizes the ability to make quick decisions and movements that can help avoid injuries.
Tired muscles and ligaments are less able to withstand forces on the field.
Make certain the athlete is getting sufficient sleep (8-10 hours a night) and enough rest between practices and games.
Despite what many young athletes think, rest is your friend.
As a parent, it is your responsibility to help your child take appropriately placed rest days.
Children ages 5-10 should participate in organized sports no more than 3 or 4 days a week, while children ages 11-15 should take at least two rest days off per week.
High school-aged athletes should take at least one day off per week.
Another good rule- take at least two months (preferably 2 separate months) away from a sport per year for overall rest and to enjoy alternate activities.
Another sensible guide: keeping the number of organized activity hours/week equal to or under the age of the child (in years) can reduce risk of injury.
Thus, if an 11 year old is playing organized sports more than 11 hours a week, there is a statistically increased risk of injury.
8) Too much running in cleats
Cleats are designed for a particular sport (soccer, baseball, football, etc) and not designed for prolonged running.
In early season practices with lots of running and conditioning, have young athletes wear running shoes to run, and use cleats for the sport-specific drills.
Will make a huge impact in reducing lower leg/heel pain and limit missed time.
What happens if an injury is not treated correctly?
Children tend to heal quickly (that is why I chose pediatrics) so most injuries are not a long-term concern.
However, in a worst-case scenario: the athlete has life-long pain or disability.
Serious growth issues can develop if a minor injury is allowed to mature into a major injury.
Injuries are a common reason why kids stop playing sports, and why athletes fail in the quest for a starting job, a varsity letter, or a scholarship.
Certain injuries label the child as damaged goods, for example once a pitcher has a shoulder or elbow injury- it is common for coaches and scouts to automatically write off that athlete.
Have no regrets- call and get a qualified opinion on any childhood injury.
There is no helmet than can provide 100% protection against concussion, and studies have failed to find certain types or brands of helmets or mouth guards that are superior in ability to prevent concussions. Helmets can protect against direct trauma to the face and scalp, but cannot be endorsed to fully prevent rotational forces that can create concussions.
Some injuries are rather dramatic such as the athlete who is knocked out or a player who suffers a broken leg.
However, most injuries are not so obvious, so here are some particular signs of concern:
While nobody expects a parent or athlete to diagnose or treat injuries, some basic first aid and a bit of common sense can be of help.
For most bone and joint injuries, use a bit of R.I.C.E.
Injuries that deserve immediate evaluation within 2-4 hours:
Whether or not you seek care in the Emergency Room, call for an appointment within a few days of the injury so we can develop an appropriate treatment plan.
Often pain and swelling limit the initial physical examination, so I will likely get a better idea if 2-3 days have passed since the injury.
Further diagnostic tests may be needed to better evaluate the injury and give a more accurate diagnosis.
The post-injury rehabilitation plan developed by a sports medicine physician might be the most important difference between a safe and efficient return to play or prolonged disability and recurrent injury.
In most cases, there are particular exercises or alternate activities that can be done to aid the healing process.
I may recommend working with physical therapists or athletic trainers (specialists in rehabilitating and strengthening athletes), while special braces/supports and medications may also be needed.
Regular follow-up visits are often scheduled to determine when an athlete can safely advance in the rehabilitation program.
There is no one standard test or question to diagnose a concussion- I often will use multiple questions and evaluation tests to follow a concussion.
Please refer to the SCAT Concussion Form found on the Patient Forms tab.
Many star athletes have limited or ended careers due to troubles from repetitive head injuries.
While there remains much to learn, sports medicine experts are growing more concerned over the long-lasting impact of head trauma especially in young athletes.
Concussions do not necessarily require being hit in the head or getting knocked out.
The full definition of a concussion is any fall, blow, or trauma that causes physical, emotion, or mental changes with or without loss of consciousness.
What are some of these changes?
Athletes must realize that it is not tough to play with a head injury.
Parents, coaches, and medical personnel cannot read the mind of an athlete.
Many symptoms are not obvious to an outsider and we must depend on the athlete to report problems whenever they occur.
Convince your child that it is indeed cool to tell coaches, parents, or an athletic trainer of any head injury symptoms.
If there is any suspicion of a concussion, immediately remove the athlete from play and do not allow return to any sport activity until evaluated and advised by a sports medicine professional familiar with concussion management.
If the athlete has neck pain or is unable to leave the playing field, do not move the athlete and dial 911 to activate the emergency response system.
A qualified medical professional must evaluate the athlete before any return to activity.
Often relative physical and cognitive rest is prescribed for the first few days with limited computers, TV, cell phones, texting, music, DVDs, reading or other stressors on the healing brain.
A normal CT scan after a head injury means no sign of bleeding, fracture, or abnormal swelling of the brain.
However, it cannot show what happens to the microscopic nerve cell level where damage occurs.
Most CT Scans are normal after a concussion, but this does not mean that the athlete did not suffer a concussion.
Sports medicine professionals base the diagnosis of concussion on signs and symptoms rather than the results of a CT Scan.
In many cases, symptoms will clear within several hours to days- however, because it is difficult to predict when resolution will occur, close and regular follow-up is key to developing an individual recovery program.
It is essential that the athlete is free of any and all symptoms before he/she fully returns to play.
Often, an athlete begins with light running and non-contact exercise and then later returns to full-speed, contact sports.
Incomplete healing of a first head injury makes the athlete more prone to a second, often more severe head injury with death as an uncommon but possible outcome.
Some athletes may be diagnosed with post-concussive syndrome with symptoms that last for weeks to months and not only affect sport participation, but also school and personal relationships.
Even when symptoms have finally cleared, any athlete who has suffered a previous head injury is statistically at greater risk for future head injuries.
Often, parents of athletes with a history of head injuries have to make tough decisions about certain sports that have higher likelihood of head injuries.
If your child has a history of previous head injuries, or in any case of complicated head injury, call the office or schedule an evaluation.
Computerized programs have been developed to evaluate athletes in certain neuropsychological areas such as memory, visual motor skills, attention, and concentration.
These tests can be done in the pre-season, and then repeated if necessary after a head injury.
The post-injury results can be compared to pre-season numbers to help manage an athlete after a concussion.
They are part of the entire evaluation after a concussion.
A computer result alone does not determine when a performer returns.
The return-to-play decision is up to clinical judgement after looking at several aspects of the post-concussion recovery.
I have recently teamed with other head injury specialists to start head injury prevention and management programs for local club, high school and college teams.
If you would like more information or would like your organization to participate, please contact the office.
When trying to decide if an athlete is too ill to participate in sports, I tend to ask the following questions:
Study and experience tells us that a fever over 100.4 degrees Fahrenheit increases metabolic demands of the body, often making exercise more difficult.
Thus, many authorities recommend either limiting or stopping exercise until the fever is gone for at least 24 hours.
I have found that the neck rule can assist athletes and parents in deciding on sport participation:
No athlete wants to be sick during the season and spread illness to other team members.
Following some basic rules can help prevent the spread of infections:
Children should play sports to have fun, learn the values of hard work and life-long exercise, while taking pride in self-improvement and teamwork.
I find many 5-8 year old children eager to tell me about all the fun they have in their various sports and activities, so I think these goals are often met in younger children.
However, when I see adolescents, I tend to see two extremes.
Some of them are burned out and disinterested in sports or any exercise- while others are part of an increasing number putting so much emphasis on sports that they are suffering from overuse injuries and fatigue.
Helping to place proper perspective on sport choice and participation is an important role for all parents, and your participation in sports and behavior at sporting events send a message to your child.
If exercise is a regular part of your life, odds are your children will be more receptive to regular exercise or sport participation.
Negative adult attitudes or poor sideline behavior set bad examples for children and take away much of the enjoyment of youth sports.
You may have to make tough decisions or set limits on sports participation- that indeed is part of your role as a parent, and do take that role seriously.
Sure, winning records, all-star teams, college scholarships, and pro contracts are cool goals- but these should not be the ultimate measure of success.
Sports should be enjoyable for all- athlete and family.
Simple skills such as throwing or kicking a ball are part of normal toddler development.
However, children this young are not ready for more complex tasks like proper throwing or kicking technique.
All play at this age should be fun and spontaneous with minimal organization.
I highly recommend that all pre-school and early school–aged children learn skills such as balancing, tumbling, rolling, and jumping.
No matter what activity is selected later in life, command of these fundamental tasks will enhance athletic ability and safety.
Formal introduction of organized sports should begin at age 5 at the earliest.
Most five year-old children have developed an attention span to listen to adult teachers, work with other children, and follow simple multi-step commands.
They also can learn a task in one situation (school) and repeat it in a new situation (home).
All these reasons explain why children start kindergarten at age five.
From age 5-8, the main emphasis should be on fun and learning of the basic sport skills.
There should be no competition (keeping score or standings) as competition is so complex it may interfere with learning skills.
Repeat as many times as necessary: there should be no competition.
Contrary to the beliefs of many parents and coaches, an early start or early success in sports is not consistently correlated with success in later years.
Thus, the key to five year-olds is to teach proper technique and focus on the basics.
At this young age, the winning percentage should not be based on any measure of wins and losses, but rather on how much fun the children have and how many want to play again the next season
Childhood is a time for challenge and exploration with a variety of sporting activity developing multiple skills and interests, usually leading to more overall sport enjoyment.
However, this does not mean that children should participate in so many different sports that the parents feel like virtual taxicab drivers.
Make ample time for schoolwork, family time, friends, and just being a kid.
Unfortunately, the concept of single-sport specialization is becoming more commonplace at increasing younger ages.
In fact, the American Academy of Pediatrics Committee on Sports Medicine and American Medical Society for Sports Medicine recently cautioned against early sport-specialization.
The concerns of physical injuries and emotional burnout often outweigh the benefits of concentrating on one particular sport.
Most high school and collegiate coaches that I know like to see the multi-sport athlete (aka 2-3 sport letter winner in high school) because they know these kids are well-rounded athletes and not just good in one particular activity.
The multi-sport athletes also have more up-side potential when they get to college and then focus on one sport leading to more improvement than the athlete who has already focused on one sport and may not get much better.
Ideally, younger children should participate in a variety of activities including team sports, individual sports, sports that focus on lower body (soccer, running) and those that focus more on the upper body.
Allowing the children the chance to sample different activities can build up different talents and interests.
I also believe that early in life, children should learn basic gymnastics skills such as balance, tumbling, rolling, and proper ways to land or roll after a fall.
These are important talents that can be used in a variety of activities to prevent injuries and improve self-control.
Young children should spend at least one hour a day engaging in play which can be a formal sport practice or game, working in the garden, walking the dog, or chasing other kids around the neighborhood.
Do not be too worried about structure as most children have enough organization in their lives so allow spontaneity and creativity.
If you try to participate on occasion with your child- this will be a benefit for both of you.
For adolescents and young adults, the American College of Sports Medicine recommends 45 minutes of vigorous physical activity at least 4 days a week.
This does not have to be 45 minutes all at once, 15 minute activities done three times a day counts just the same.
Vigorous activity is anything that raises heart rate and increases breathing rate.
I like to use the talk test to measure exertion: if you can say one or two sentences before needing a breath; you have found an appropriate activity level.
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