Q. and A. with Dr. Kiskila- This Month’s Topic: Back to School and Sports Physicals

Question: Dr. Kiskila what are back to school and sports physicals?

Answer: Back to school sport physicals are a physical medical exam with a doctor to evaluate that the student is healthy enough to participate in school-related physical activities. They are often referred to as back to school exams, because they are typically done at the beginning of the school year and are valid for the entire school year, but they can be done anytime.  Ideally, sports physicals should be done 6 weeks before preseason practice begins.

Question: Who needs them?

Answer: Any student who participates in sports should have a physical once a year.

Question: What do you check and assess during these physicals?

Answer: Doctors check the student’s vital signs like blood pressure and heart rate to make sure they are healthy enough to participate in sports. We assess the heart and lungs for any murmurs or wheezing for asthma. Doctors also assess the student’s muscular and skeletal range of motion, and perform a neurological exam to check reflexes, pupil dilation, and vision. We palpate the abdomen to assess abdominal organs such as the spleen. Additionally, we look at the patient's ears, nose and throat. For males, we may need to check for a hernia by pressing on the groin area. We also review the student athlete’s personal and family medical history and answer any questions. We want the students to be healthy, active and successful as they participate in their sports.

Question: Are there particular questions that parents should ask the physician during the exam?

Answer: Back to school and sports physicals are a terrific opportunity to not only ask activity-related questions, but to also inquire about the child's overall health.

Question: What occurs after the exam?

Answer: If the doctor determines that that child is healthy and safe to participate, he will fill out a clearance form for the family to give to the school.  If the child needs further testing before they can be cleared to play, next steps will be scheduled for the second evaluation.  The objective is to get the young athlete healthy and fit to participate as soon as possible.

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.
 

 

Children and Fractures by Colleen Kraft, M.D.



Although the term fracture may sound serious, it is just another name for a broken bone. Fractures are a very common injury among children under age six. Falls cause most of the fractures in this age group.

A broken bone in a child is different from one in an adult, because young bones are more flexible and have a thicker covering, which makes them better able to absorb shock. Children’s fractures rarely require surgical repair. They usually just need to be kept free of movement, most often through the use of a molded cast.

Most broken bones in children are either “greenstick” fractures, in which the bone bends like green wood and breaks only on one side, or “torus” fractures, in which the bone is buckled and twisted but not completely broken. A “bend” fracture refers to a bone that is bent but not broken. “Complete” fractures, in which the bone breaks all the way through, also occur in young children.

There are three types of fractures that may require surgery. A “displaced” fracture, where the ends are separated or out of alignment, an elbow fracture, or a fracture through the child’s growth plate (an area at the end of the bone that regulates further growth) may require surgery and longer term follow up by an orthopedic surgeon.

Fractures also are classified as “non-displaced,” when the broken ends are still in proper position, or “displaced,” when the ends are separated or out of alignment. In an “open” or “compound” fracture, the bone sticks through the skin. If the skin is intact, the fracture is “closed.”

Signs and Symptoms:

It’s not always easy to tell when a bone is broken, especially if your child is too young to describe what he’s feeling. Ordinarily with a fracture, you will see swelling and your child will clearly be in pain and unable—or unwilling—to move the injured limb. However, just because your child can move the bone doesn’t necessarily rule out a fracture.

Home Treatment—Until your child can be examined:

  1. You can use an ice pack with a child older than two; cold can cause skin injury to the delicate skin of younger children.

  2. Do not give the child anything by mouth to drink or relieve pain without first consulting your doctor.

  3. If part of the injury is open and bleeding, or if bone is protruding through the skin, place firm pressure on the wound; then cover it with clean (preferably sterile) gauze. Do not try to put the bone back underneath the skin. Call 911 and let paramedics supervise transportation and help make your child comfortable.

  4. Until your child can be seen in the pediatrician’s office, emergency room, or urgent care center, use an improvised sling or rolled-up newspaper or magazine as a splint to protect the injury from unnecessary movement.


 

Professional Treatment:

After examining the break, the doctor will order X rays to determine the extent of the damage. If the doctor suspects that the bone’s growth plate is affected, or if the bones are out of line, an orthopedic consultation will be necessary.

Because children’s bones heal rapidly and well, a plaster or fiberglass cast, or sometimes just an immobilizing splint, is all that is needed for most minor fractures. For a displaced fracture, an orthopedic surgeon may have to realign the bones. This may be done as a “closed reduction,” in which the surgeon uses local or general anesthesia, manipulates the bones until they’re straight, and then applies a cast. An “open reduction” is a surgical procedure done in an operating room, but this is rarely necessary for children.

Usually casting brings a decrease in pain. If your child has an increase in pain, numbness, or pale or blue fingers or toes, call your doctor immediately. These are signs of swelling. To relieve the pressure, the doctor may split the cast, open a window in it, or replace it with a larger one. You should also let your doctor know if the cast breaks or become wet and soggy, as the cast needs to be intact to help the bone heal.

Bones that have been broken will sometimes form a hard knot at the site of the break during the healing process. As the bone remodels, it will resume its normal shape within in a few months.

 

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

 

 

Is Your Preschooler Ready for Kindergarten? By Colleen Kraft, M.D.

Your child's social, emotional, academic and behavior skills are equally critical to school success, and too many U.S. children start kindergarten without them.

What does "school readiness" mean?

The idea that some children are "ready for school" by 4 or 5 and others are not is controversial. Just as children begin to walk or talk at different ages, they also develop the psychological and social skills needed for school at varying ages.

When you're deciding when your child should start kindergarten:

  • Look carefully at your child's development. Is your child able to communicate? How are his listening and social skills? Would he be able to get along with other children and adults? Is he toilet trained? What about physical skills like running, playing, or using a crayon or pencil?  

  • TA word about kindergarten screenings or readiness testing:


Some schools may conduct their own tests to evaluate your child's abilities. So-called "readiness tests" tend to look mostly at academic skills, but may evaluate other aspects of development, too. The tests are far from perfect; some children who do poorly on them do just fine in school.

So, if the test or screening identifies some areas where your child seems to lag behind, use the information to help you and the school plan for the special attention he may need in the year of kindergarten ahead.

You are your child's best advocate. By sharing information with your child's teacher and other school staff, you can help them be ready for your child. At the same time, you are establishing a partnership for your child's education that can and should continue throughout her childhood.

School readiness milestones

Important development milestones that help school go smoothly for children include:

Sensory development―the ability to use touch, sight, and hearing to explore and figure out the world around them.

Social, emotional, and behavioral development―such as being able to:

  • focus and pay attention

  • control impulses and emotions

  • take turns

  • cooperate and follow directions

  • make friends

  • empathize with others

  • control and communicate emotions

  • limit aggressive behaviors


Early language, literacy, and math skills― such as being able to talk, listen, and understand concepts like sound-letter associations, numbers, shapes, and how objects are related to each other.

How to promote school readiness:

Let Your Children See You Reading

If your children see you reading regularly, there is a good chance that they will follow your lead and sit down with a book themselves. Set aside some time to talk with them about what each of you is reading. If you have been regularly reading aloud to your children, by school age they'll probably want to read aloud to you, too!

Talk About Your Day

Find time to talk with your children about your respective days—in­cluding what they did at school. Even on a night when you are particularly busy, you should still be able to find a time and place to talk. This gives your children a chance to re-teach you what they learned that day.

Encourage Art & Writing

It is great for children to write and/or draw without any ed­ucational purpose in mind other than to express themselves. For example, you can encourage your children to write original stories, cards, letters, and invitations to friends and relatives. Keep paper, pencils, crayons, markers, and tape in a convenient lo­cation so your children can sit down and use them easily. Research has shown that writing improves a child's reading skills—and vice versa.

Plan One-on-One Time with your child

Plan some activities that you can do with your child—such as an art project. Keep phone call interruptions and media use to a minimum during this special time. Make it a time you are spending with each other. Some children say they wish they could call their parents on the phone, because a phone call or mobile device always gets first priority.

"Educational" Apps: Use with caution

Even though tablets, computer games, and apps are advertised as "educational," the truth is most of them have not been tested to show that children actually learn from them. They teach very basic skills, so don't assume an "interactive" game will be a good learning experience. Children learn better through creative playtime—where their brain takes the lead, not the app or computer game.

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

 

 

Difficulty with Sleep? By Your Marque Team

The Importance of Sleep

Sleep is very important for the functioning of our bodies as it helps restore the immune, nervous, skeletal and muscle systems. Without restful sleep, these bodily functions will not work optimally. Sleep deprivation can cause a multitude of health issues. It is well known and studied that there are associations with increased risk of diabetes, heart disease, immune disorders and cognitive impairment in people that do not sleep well. Studies have shown that sleeping better promotes longevity.

Sleep Help, Sleep Hygiene and Stimulants

There are many things you can do to improve your sleep. One of the best things you can do is to avoid stimulants. Stimulants affecting sleep can be broken down into many categories. There are drinks that can be stimulating such as those containing caffeine and alcohol. There are foods that can be stimulating including chocolate, certain fruits and foods containing MSG (monosodium glutamate). Even foods rich in aged cheese contain a substance called tyramine that affects sleep. There are drugs and medications that can be stimulating. These can include certain prescription medications such as steroids, mood and anxiety medications (SSRI and similar medications), and ADHD medications (containing amphetamine like substance). Certain supplements such as Ginseng can be stimulating. Even chemicals in toothpaste such as Triclosan may affect sleep. There are also other environmental stimulants that one should be careful of such as bright artificial light. This is now very common with use of smartphones.

Sleep Tips

  • Avoid food and drink stimulants as listed above, especially several hours before bed or even entirely.

  • Avoid TV and smart phone use while in bed preparing for sleep.

  • Make sure your bedroom is dark and noise free when trying to sleep.

  • Avoid exercise before going to sleep.

  • Discuss use of stimulating medications with your doctor if having difficulty with sleep.


 

Supplements and Medication

There are options to help with poor sleep if the things above do not help. Most over-the-counter sleep aids use anti-histamines as they have a side effect of drowsiness. These can unfortunately cause daytime grogginess or drowsiness and can have other unwanted side effects. Prescription medications are an option but most are considered controlled substances and can be discussed with your doctor. Melatonin and herbal sleep aids are an option also and are available without prescription.

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

 

 

 

 

 

 

 

Summer Camp by Colleen Kraft, M.D.

The American Academy of Pediatrics (AAP) has created this checklist to help you navigate the camp experience. Use this list to make your child’s summer camp memories safe, healthy, and fun!

Camp Choices—The Basics:

Choosing a summer camp for your child can seem like an overwhelming experience of choices and costs. Consider these points when scouting camps:

  • Start looking for camps early. Some camps start booking as early as January―and fill up quickly!

  • Consider your child’s personality and interests. Camps comes in all shapes and sizes. The arts, sports, nature, some combination? There are many possibilities.

  • Day camp vs overnight camp. Think about your child’s comfort with being away from home and talk together about what seems like a good fit. While there is no hard and fast rule about what age is best for overnight camp, most children are ready between ages 7 and 8 years old.


After you’ve decided on the basics, the next step is to get more detailed information:

  • Get referrals. Ask other parents who sent their children to the camp about their experiences. Remember, though, that there’s no better way to find a perfect fit than checking camps out in person with your child.

  • Ask about the staff. Do the same counselors return each year or is there high turnover? Is the staff made up of young adults or teens, as well as adults? What are their roles? What is the child to staff ratio? If applicable, it is also important to ask about whether the staff has any prior experience working with children with special needs and/or whether they are willing to accommodate your child.

  • Ask how healthcare is delivered at camp. Many camps have camp nurses, but no physicians. Some camps don't even have camp nurses due to their size, and only first-aid trained staff members. Ask how the camp deals with minor illnesses and injuries? How are staff trained to handle these situations? Does the camp have arrangements with local hospitals and emergency medical services? Know who is caring for your children, and what training those staff members have. 

  • Is the camp accredited by the American Camp Association (ACA)? Accreditation is different than licensing. This does not guarantee a risk-free environment, but it's some of the best evidence you have of a camp's commitment to a safe and nurturing environment for children.

  • What are the swimming requirements? Camps with a water component will likely require your child to take a swim test. If your child does not pass the test, this can lead your child feeling left out and/or forced to be in a lower age group.

  • Ask about sunblock. Most camps have kids outside all day. Camps should have a protocol for how often they have children reapply sunscreen.

  • What does the camp require prior to attendance? Make sure all campers are required to be vaccinated according to the recommended childhood immunization schedule. Many camps also require a sports physical, because campers are athletes too!


Camp Prep: What to Do Before You Go

Now that you’ve booked your child’s camp experience, the next step is preparation:

  • Swim lessons. By age 5 or 6, most children in swim lessons can master the front crawl. If your child hasn't already started in a learn-to-swim program, now is the time! Water survival competency skills are very important for campers. Consider some refresher lessons to prepare your child for the camp swim test.

  • Make your doctor’s appointments. The AAP recommends asking to have a sports physical when scheduling your child's next routine well-child visit. Make sure your child has a camp, sports or annual physical before heading to camp. Many camps require this before entry.

  • Talk to the camp directors about any special health care needs. If your child has a condition such as asthma, food allergies or other special needs, have special emergency action plans. Keep the camp informed in the same way you keep your child’s school informed. For example, does the camp allow peanut or tree nut food products?  Does your child know how to use personal emergency medications such as inhalers or epinephrine auto-injectors independently?

  • Know the rules about electronics at camp. If your child is “off-grid” or electronics are not allowed, plan for how best to keep in touch. If tablets, for example, are allowed but must be kept in backpacks or cabins, make sure your child understands and follows those rules. Ask the camp how best to communicate with your child in an emergency.

  • Do not make any medication changes before camp. Parents are often tempted to take “drug holidays” during or before camp. Camp is not a good place to find out that medication changes are not going well.

  • Talk openly about homesickness. Stay positive about the camp experience but help your child understand that it may take getting used to. Know homesickness can happen at any time―regardless of how many times your child has been to camp before.


The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.