It’s ER Season for Children

Wall Street Journal
May 5, 2015
It’s ER Season for Children

Dr. Jahn Avarello, Chief, Pediatric Emergency Medicine, Cohen Children’s Medical Center

With warmer temperatures come more injuries, from bumps to broken bones, for children adjusting to growth spurts
With spring comes broken arms, legs, sprained ankles, and lots of bruises for children. Why is this such a busy time for emergency rooms and pediatrician's offices? WSJ’s Sumathi Reddy joins Lunch Break. Photo: AP
 
Spring is the season for broken bones, bruises, bumps and sprains.

With more children finally free to step outside after a winter cooped up indoors, more land in emergency rooms and urgent-care centers with injuries. Some are adjusting to new height and strength after growth spurts. Others become victims of reckless horseplay or unavoidable accidents.
Doctors say any risks are outweighed by the need for children to get plenty of exercise. Simple rules of thumb can help minimize potential injuries. They should remember proper footwear and protect their heads with helmets on scooters and bikes, for instance. They should also stay well-hydrated before and after playing.

Injuries start picking up in April, says Karin Sadow, regional medical director for PM Pediatrics’s 16 urgent-care offices in the New York metropolitan area. “School sports are in full swing and the bikes come out of the shed,” she says.

By June last year the injuries PM doctors treated were nearly double what they were in the winter. Though not all injuries take place outside, doctors largely attribute the increase to children being outside and more active. Most incidents occur with children between the ages of 8 and 13.

Just in the past few weeks the practices have seen a 10-year-old girl who fell off her scooter and sprained her wrist; a lacrosse player with a finger fracture; a runner with a stress fracture; a 21-month-old with a tibia fracture after going down a slide with her aunt; a 5-year-old who fell off the monkey bars and suffered a grade-two supracondylar, or elbow fracture; a baseball player with a mild concussion; and a child bruised on a tire swing mishap, among others.

Ashleigh Mullins landed at a clinic last week. On Wednesday the 10-year-old was at the playground after school in Syosset, N.Y., playing with a Skip-It, a plastic hook that’s affixed to an ankle and spun around while skipping.

“She stepped on it and rolled her ankle, landing sideways,” says her mother, Laurie Mullins, who has two other children and lives in nearby Farmingdale.

“I have three kids, and over the years we’ve had fractured wrists and stuff like that, but nothing really serious,” Ms. Mullins says. “Finally the weather did get warmer and now everybody’s going outside and you do increase your chances of injury…or you’re doing something you haven’t done in a couple of months and you’re a little shaky.”

Ryan Goodwin, director at the Center for Pediatric Orthopaedic Surgery at Cleveland Clinic in Ohio, says adolescents are generally more prone to injuries during growth spurts because, unlike adults, children’s bones have growth plates, or specialized areas of cartilage that allow for long bone growth.
“Cartilage is less structurally sound than bone,” Dr. Goodwin says.

Furthermore, during a growth spurt, adolescents have changes in their hormonal balance that makes the growth plates slightly weaker, he says. And the long bone growth happens more quickly than the muscle growth, so as the muscle is catching up there is a relative decrease in flexibility. This can result in higher susceptibility to injury.

Children heal much more quickly than adults when it comes to broken bones and the like. A wrist fracture in a 9- or 10-year-old, for example, usually takes four to six weeks and rarely requires surgery, Dr. Goodwin says. An adult with a similar injury would likely require surgery and 12 weeks of recovery.

That’s because children have better local circulation, which promotes healing, and because they’re growing and making new bone already.

Another factor with sports injuries stems from more children specializing in single sports, experts say. Overtraining one muscle group more than others raises the risk of injury.

This year’s especially long and cold winter in many parts of the U.S. contributed to some student-athletes not being able to train ahead of time, leading to more injuries this spring, says Larry Cooper, head athletic trainer at Penn-Trafford High School in Harrison City, Pa.

“We saw more injuries with track athletes this year than ever before,” Mr. Cooper says. Out of 140 athletes who run track, 22 have had injuries like shin and arch pains. “They’re engaging their bodies in ways they weren’t prepared for,” he says.

Emergency room doctors say playground and sports injuries are the most common that they see among children, but injuries are usually not too serious.

Scooter injuries are common, since children tend to be less likely to wear helmets when riding scooters as opposed to bikes. Falls can result in broken arms or wrists or even mild concussions or abdominal injuries from landing on handlebars.

Scooters “can go pretty fast,” says Joan Shook, a pediatric emergency physician at Texas Children’s Hospital in Houston. “When not well-balanced, children can fall and hit their heads.”

She recommends wearing a helmet and protective gear like elbow and knee guards to avoid injury.

Trampoline injuries are also extremely common, says Jahn Avarello, chief of the pediatric emergency department at Cohen Children’s Medical Center in New Hyde Park, N.Y. He says on average they see one every other day. “They can be arm injuries or simple sprains,” he says. “Or sometimes falling out of a trampoline can cause a head injury.”

Dr. Avarello says the most common injury he sees is a broken forearm from falling on an outstretched arm when running or riding a bike.

One of the most common injuries Kathleen Berchelmann, a pediatrician at the pediatric emergency room at St. Louis Children’s Hospital, encounters is foot injuries due to children wearing inadequate shoes. She recommends avoiding Crocs or flip flops and making sure children wear bump toe sandals.

“We see lots of bad toe injuries from riding bikes with inadequate footwear,” she says. “Bump toe sandals are adequate. You can run well and ride bikes in them, and you don’t need socks.”

Head injuries from falling off bikes and play structures are also common and potentially very dangerous.

Experts say in some cases children assume they still have a skill they had at the end of the previous summer—like riding a bike or swimming—and learn the hard way that they’ve regressed over the winter. Dr. Berchelmann recalls a case several years ago where a 4-year-old who could swim the previous summer jumped in the water and had to be rescued.

Despite these dangers, experts encourage children to challenge themselves outside. Reaching that next monkey bar is an important part of a child’s maturation.

And the benefits of being outside and getting physical activity far outweigh any risks. The risk of a lack of physical activity, they say, is far greater: obesity.

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