Sudden Cardiac Death in Student Athletes – PediaCast 280

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Dr Naomi Kertesz joins Dr Mike in the PediaCast Studio to talk about sudden cardiac death in student athletes. Topics include pre-participation screening and EKG, AED devices, hypertrophic cardiomyopathy, coronary artery abnormalities, and long QT syndrome. We’ll also take a quick look at high chair injuries!

Topics

• Sudden Cardiac Death in Athletes
• Hypertrophic Cardiomyopathy
• Coronary Artery Abnormalities
• Long QT Syndrome
• AED Devices
• Pre-participation Cardiac Screening
• Pre-participation EKG
• High Chair Injuries

Guest

• Dr Naomi Kertesz
  Pediatric Cardiology
  Nationwide Children’s Hospital

Links

• CONTACT DR MIKE – Ask Questions, Suggest Show Topics
• CONNECT NOW with a pediatric cardiologist from Nationwide Children’s – Referrals and Appointments

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Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now direct from the campus of Nationwide Children’s here is your host Dr. Mike.

Dr. Mike Patrick: Hello everyone and welcome once again to PediaCast. It’s a pediatric podcast for moms and dads this is Dr. Mike coming to you from the campus Of Nationwide Children’s Hospital. We’re in Columbus, Ohio it is February 26, 2014 episode 280 and we’re calling this one Sudden Cardiac Death in Students Athletes. I want to welcome everyone to the program.

0:02:48.3

I do have an interesting topic lined up for you this week it’s a scenario that crosses the mind of every mom and dad who has a student athlete at home. Fortunately it’s a rare scenario but we all heard the stories in fact most of us can think of one or two examples in our own community where a student athlete collapses while playing their sport and dies.

0:03:10.3

It’s unexpected, it’s tragic, and it’s a cause of concern for many moms and dads. What causes sudden cardiac death in student athletes? And is your child at risk? Are there warning signs that could have alerted you to an impending problem? And what sort of screening should athletes undergo prior to participation? All good questions and we have an equally good studio guest this week to help us answer them. Dr. Naomi Cortez is a pediatric cardiologist here at Nationwide Children’s Hospital, we’ll get to her in a moment but first I do want to remind you about our terrific hospital blog. If you haven’t checked it out yet it is most definitely time to do so 700childrens.org is where you’re going to find it.

0:04:01.1

It’s the 700 Children’s blog, now you may be wondering how in the word did they come up with the name 700 Children’s. That’s been the address of the hospital for as long as anybody can remember, 700 Children’s Drive and it just kind of stock, something that’s easy to remember and does have a history with the hospital. So 700childrens.org and some recent and upcoming topics include Treating Your Child’s Dry Skin This Winter, Knee Injuries, Respiratory Syncytial Virus, Allergy Shots, Resources for Kids With Special Needs, Electronic Cigarettes, Foods Allergies, and Car Seats and also a post from yours truly on Raw Milk which another thing we talked about recently on this program. Lots of families have gone organic in the milk department including our family, but now some moms and dads want to push the envelope and go raw, raw milk is that a good idea?

0:04:56.4

You probably know what my answer’s going to be on that but you may not fully understand the reason without taking a look at the post, so you may want to check that out again it’s at 700childrens.org. We do have sudden cardiac death in athletes coming your way and in the course of that discussion we’ll also be talking about hypertrophic cardiomyopathy, coronary artery abnormalities, long QT syndrome, AED devices, and pre-participation cardiac screening, and EKG’s. Then stick around at the end of the program for a final word on high chair injuries, and high chair safety. So that’ll be coming your way at the end of the program. Don’t forget if there’s a topic that you’d like us to talk about, or you have question for the program, or you want to point me in the direction of a new story it’s really easy to get in touch, just head over to pediacast.org and click on the contact link and we’ll see what we can do to get your comment or your question on the show. Also I want to remind you the information presented in PediaCast is for general educational purposes only.

0:06:00.2

We do not diagnose medical conditions of formulate treatment plans for specific individuals. If you do have a concern about your child’s health make sure you call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find at pediacast.org. Let’s take a quick break, we’ll get Dr. Naomi Cortez settled into the studio and we’re going to have a nice talk about sudden cardiac death in student athletes, that’s coming your way right after this.

[Music]

0:07:05.2

Dr. Mike Patrick: We are back and I am joined at the studio by Dr. Naomi Cortez, she’s a pediatric cardiologist at Nationwide Children’s Hospital and an associate professor of pediatrics at the Ohio State University College of Medicine. Her clinical expertise includes the diagnosis and management of cardiac arrhythmia including radio frequency and cryoablation of super ventricular and ventricular arrhythmias. Dr. Cortez is an expert in three dimensional heart mapping for ablation procedures in the implantation of phase makers and internal cardiac defibrillators and her research interest include the long term follow up of patients with these devices. I realize I used a lot of big words there, some of which we’ll explore a bit later in the program but we also have a good many pediatric practitioners in the crowd who do understand what I’m saying and are duly impressed. It’s with a warm welcome that I introduce Dr. Cortez, welcome to PediaCast.

0:07:59.8

Dr. Cortez: Thank you.

Dr. Mike Patrick: We really appreciate you stopping by. Let’s just start out with a basic definition, what is meant by the term sudden cardiac death?

Dr. Cortez: The definition of sudden cardiac death is the non-traumatic, non-violent, unexpected result from a sudden cardiac arrest within six hours of a previously witnessed state of normal health.

Dr. Mike Patrick: So they look fine and a few hours later they’re dead?

Dr. Cortez: Correct.

Dr. Mike Patrick: And in particulars I kind of mentioned during the introduction to the program, we really kind of focused on athletes that this happens to because this is a fear, you hear about this once a year so in a particular community where kids on the playing field, or the court and suddenly dies and there’s a sense of fear, could this happen to my child? This is a pretty rare thing right?

0:09:00.1

Dr. Cortez: It absolutely is a very rare thing and I think the reason that people fear it is because it’s so unexpected. The risk is fell to be about one in 200,000 student athletes so it’s very rare. I think that the reason it causes such a fear is because when we hear that a football player got injured on a football field we all realize that that’s a risk. When we hear of a car accident where it’s unexpected we realize that’s a risk. Most of us do not expect our young, healthy, cardiovascularly fit people or children to die suddenly and I think that’s what really frightens people.

Dr. Mike Patrick: It may seem like it happens more often than it really does because you hear about every single case they happens. It makes the headlines, it’s in the news, people talk about it.

Dr. Cortez: The other problem really is that the media will tell you that somebody died suddenly with exercise and immediately everybody assumes it’s the heart.

0:10:06.1

They do not come back a month later and correct it and say, “Oh no, it actually was a brain aneurysm, oh no it actually was heat stroke.” So what’s reported in the media actually is of higher incidence and it does not represent sudden cardiac death because sometimes these athletes die of non-cardiac etiologies and nobody corrects that.

Dr. Mike Patrick: And there’s really no follow up to let folks know what really happened. For those who it really is sudden cardiac death in an athlete, what are some of the causes of that? What causes the heart just to stop working?

Dr. Cortez: The most common cause of sudden cardiac death in the US and I say that specifically because it is actually different among different countries but in the US the most common cause of sudden cardiac death is hypertrophic cardiomyopathy which is a thick heart and it is due to an arrhythmia that can occur in those patients.

0:11:07.0

That is in about a third of the sudden cardiac deaths in young athletes do occur in hypertrophic cardiomyopathy. The second most common is coronary artery abnormalities where you’re born and a coronary artery might come off the wrong place, or course the wrong way to the heart and that occurs in almost 20%. So those are really the top two causes of sudden cardiac death. When you start going down to other things they all occur in less than 5% but they’re primary rhythm abnormalities, there’re other types of heart muscle disease and those can be some of the other causes.

Dr. Mike Patrick: How does one get this? Are these genetic issues? Is this something that the heart muscle becomes thicker because of your genes? Is it something you inherit? Or is it an inquired problem?

0:11:59.3

Dr. Cortez: Hypertrophic cardiomyopathy what we talked about is a genetic condition, it is most typically familial, it is possible that you’re the first person in a family to have it but it is a genetic disease. Coronary artery abnormalities are not genetic and so those can happen sporadically in families.

Dr. Mike Patrick: And this is really just a difference in where the coronary artery comes off of the heart.

Dr. Cortez: Where comes off the aorta, yes.

Dr. Mike Patrick: And then there’s one other in particular that I wanted to talk about called Long QT syndrome, what is that?

Dr. Cortez: Long QT syndrome is what’s called a channelopathy. This is specifically a patient who has a normal heart and so I like to tell my patients that I’m a glorified electrician. I’m not a plumber, I don’t deal with walls, I don’t deal with valves, I’m an electrician and so long QT syndrome is actually an abnormality within the electrical system and how the heart electrically resets itself and how long the heart is vulnerable to rhythm problems.

0:13:09.1

And so it is, you can look at a child, they look normal, you can do an Echo on the child, their Echo is completely normal but what they have an abnormality is in the electrical system and how it resets itself.

Dr. Mike Patrick: Some of the causes of these could be abnormal electrical system of the heart that was undiagnosed, you don’t really know about it and it suddenly causes a problem. The muscle of the heart being too thick, or the coronary arteries being in a place where they may not get good blood flow during high levels of activity. In particular the hypertrophic cardiomyopathy, the thick muscle. Since it runs in the family, is that something where if you know that you have that problem you probably have other people in your family know so that they could possibly be screened to see if they have it before there’s an actual issue?

0:14:02.2

Dr. Cortez: In any patient who is diagnosed with hypertrophic cardiomyopathy, one of the first things we do is screen all the first degree relatives because it is a known genetic disease. We are starting to identify and have identified some of the genetic mutations that cause the disease so that we can see what we know that you have the genetic mutation, then instead of waiting for signs to develop and when I say waiting for signs to develop hypertrophic cardiomyopathy is a difficult disease because you may have a normal Echo at one point in your life. You don’t have manifestations of the disease from birth, let’s say your father has hypertrophic cardiomyopathy, you could have an Echo at one year, five years, at 10 years and they’ll all be normal and you don’t manifest signs of the disease till you’re 15. It’s not only important to be screened once, it’s actually if you’re known to be in a family of hypertrophic cardiomyopathy that you are screened on a periodic basis to see if you will develop the disease.

0:15:07.5

Dr. Mike Patrick: I think that’s a really important point because a lot of times it does seem that a family can have a sigh of relief, OK we have the Echo done, his heart’s normal but really that’s something that needs to be followed up on. Are there any symptoms or warning signs that occur in folks who have these problems before a sudden cardiac event? Is there something that parent should be watching for to give them a clue that hey this could be coming down the line?

Dr. Cortez: I think something that is clearly a risk factor is if you have unexplained fainting. Specially any fainting during or associated with exercise. What I teach our residence in pediatrics, if you faint during or immediately around exercise that say do not passcode, do not collect 200, you get to see pediatric cardiology because this is clearly a risk factor.

0:16:04.6

Now not to frighten families, the majority of patients I see with fainting with exercise are completely healthy, however this is a known risk factor for potential malignant disease. The American Heart Association also recommends to ask for a history of if you have chest pain with exercise, is another risk factor. Obviously chest pain in children usually is not the heart, however if you’re having chest pain during exercise that can be a risk factor for one of these diseases.

Dr. Mike Patrick: What are some of the other things that could cause kids to pass out when they’re exercising?

Dr. Cortez: The reality is that kids when they exercise and I think that’s another thing to talk about is what defines exercise because a lot of these screening programs and so fort talk about screening athletes.

0:17:02.9

How do you define athlete? And so how do you define who you screen? Because if you define athletes and most of us who talk about the screening population will say you need to screen those who are in competitive teams. The reality is kids who are playing at home in their driveway maybe achieving just as much level of exercise as any kid on a field. There’s actually a very well-known basketball player who played his entire career and actually had a sudden death event when he was playing at home on his driveway. Let’s just be clear, when we talk about exercise we’re not only talking about the exercise that occurs with team sports with a coach but that’s really where the focus of screening has come.

0:18:00.4

Dr. Mike Patrick: Most kids who do pass out around the time that they’re exercising, it’s not going to be a malignant problem that’s going to end up causing sudden cardiac death although you can’t make that assumption and you have to go to the process to make sure that that’s not what’s going on. But just what are some of the other things that could cause kids to faint during exercise around that time?

Dr. Cortez: The reality is that things that cause you to faint during exercise are the same things that cause you to faint not when you exercise. If you decide that you don’t want to eat breakfast or lunch and you decide that you feel like running around and playing a soccer game when it’s a 100 degrees in the shade you may faint due to dehydration. Many of the times that the reason to children faint are issues with their blood pressure, they have nothing to do with a malignant rhythm disturbance affecting their blood pressure with have everything to do with their blood pressure was low because they didn’t drink, they’re otherwise ill, there’re other children who actually have trouble with their blood pressure during exercise not in a malignant way but in a way that could cause them to faint.

0:19:05.6

Dr. Mike Patrick: But again you don’t want to make that assumption, you want to make sure the heart is fine and nothing is going on there when that happens with exercise.

Dr. Cortez: We call it sort of a diagnosis of exclusion, in other words the onus is on us to make sure the heart is fine and only once we are sure the heart is fine, are we willing to accept that yes the reason you fainted was not because of a malignant problem.

Dr. Mike Patrick: How can folks that witness this kind of events, so if you’re a coach, or parents, or a spectator, how can we as a community be prepared to intervene when this sort of thing happens? Is it possible for someone to save a child’s life who has a sudden cardiac event like this?

Dr. Cortez: Absolutely, we’ve unfortunately seen children and I’ve been involved with families of children who have both been saved and not saved because of communities and their preparedness.

0:20:02.2

Number one is CPR, people should know CPR. Now I’m not going to say that everybody’s now are going to run and get CPR certified. However what every school, what every parent should know where it is an AED. An AED is an automatic external defibrillator, you open it, it tells you exactly what to do and if you are a malignant arrhythmia it can stop it, it will save a child’s life. The biggest problem with AED is, 1. Nobody knows where they are, 2. They don’t know how to use them. I had a patient who collapsed in a swimming pool, was taken out of the pool, somebody ask for the AED, they had an AED but nobody knew how to use it and so the child had to wait for EMS to arrive, that significantly impacted her recovery and care. I’ve also had situations where schools ask me how do we buy an AED? We don’t have funding for an AED and I’ve asked them are you sure you don’t have one?

0:21:04.2

Because I’m pretty sure that you do and they say, “Oh you know what? You’re right it was locked in some cabinet.” So you would never expect a football coach to let his players on the field without the appropriate pads and mouth guards and all that. So why do we allow our children on those field without an AED on the field? I don’t mean an AED in the school locked up somewhere that nobody knows where the key is. If the football goes out on the field, so as the AED , there’re many times when all you need is an AED.

Dr. Mike Patrick: As a parent that’s something that you can be an advocate for. It’s OK to be in the coach’s business, where is the AED? Can you get it out and show us how it’s used? That sort of thing.

Dr. Cortez: Honestly anybody can use an AED, they are designed to be used by anyone, the AED’s will talk to you say please place pads, there’re pictures where to place the pads.

0:22:02.9

The machine will analyse the rhythm, the machine will tell you to deliver a shock. This is actually been studied not only in adults but in children and shown that this devices accurately evaluate the rhythm and if tells you to shock the child you should and you will very likely save their lives.

Dr. Mike Patrick: For those of you that wants to know more about AED’s, PediaCast episode 251 if you head to pediacast.org and search the archives, we had an entire segment where we talk all about AED’s and exactly how they work, that you should familiarize yourself with them and take the one wherever you are. That particular machine really take a look at it and see how to use and become familiar and comfortable with it. Let’s talk about primary care doctors, when kids have their pre-participation physical exams what sort of screening should doctors be doing to try to help identify kids who are at risk for sudden cardiac death?

0:23:07.6

Dr. Cortez: The American Heart Association actually has developed and has specific recommendations for that and they’ve been updated as recently as 2012. Basically it consists of a medical history specifically in a personal history. One: do you have any exertional chest pain or discomfort? Two: any unexplained syncope or near syncope? Three: excessive exertional and unexplained shortness of breath or fatigue associated with exercise. Four: prior recognition of a heart murmur, and five: elevated systemic blood pressure that’s the personal history. Then under family history is there a pre-mature death, sudden and unexpected or otherwise before the age of 50 years due to heart disease in one or more relative. Is there a disability from heart disease in a close relative less then 50 years of age?

0:24:00.3

And is there specific knowledge of certain conditions in family members, hypertrophic or dilated cardiomyopathy, long QT syndrome, or other ion channelopathy such as long QT syndrome, Marfan syndrome or any other rhythm disturbances. And then a physical exam looking for 1. A heart murmur, 2. Make sure the pulses in the femoral region or the legs to make sure those are adequate, 3. Do they have any features consistent with something called Marfan syndrome, and 4. To take a blood pressure in the arm in a sitting position. The very specific guidelines of what you can do as a primary care practitioner to pick up or identify those patients so that there isn’t a sudden cardiac death.

Dr. Mike Patrick: If you’re going through that list of things, is that something if any of those are positive then the child should see a pediatric cardiologist? Or does that mean they should have an EKG done?

0:24:59.1

Dr. Cortez: No, they should actually see a pediatric cardiologist. There’s been a lot of discussion about EKG’s and first of all one of the issues of the EKG is not who does the ECG but who reads the ECG because there’re many ECG abnormalities that are common in athletes. There’re many ECG abnormalities that may be common in adults with certain of these conditions but not common in children. And so at the end of the day it’s not performing the ECG that helps you, it’s who reads the ECG. For example at Nationwide Children’s all ECG’s that are order not by cardiology are read by pediatric electro physiology which is what I specifically do and we are cardiologist who are specifically have advance training in the interpretation of electro cardiograms. I for example have been reading for the last years that I care to admit 15 to 17 years, somewhere between 47,000 ECG’s a year.

0:26:01.9

So when I go through ECG’s I can tell that’s not normal, or that is normal. I get many patients who have been referred for a “abnormal ECG” to not read by pediatric electropysiologist or cardiologist and usually is interpreted in a way that’s either appropriate for adults or they basically just signed the computer interpretation. Let’s be clear that the ECG isn’t going to help you, you really need the knowledge of a pediatric cardiologist to that point to figure out not only what testing is needed but if any testing’s needed because at the end of the day sudden cardiac death is a problem. However childhood obesity is a bigger problem and if we take kids inappropriately from exercise we are putting them at risk for early hypertension, diabetes, and other issues that also shorten their lifespan. So we want to make sure that if we’re taking our child out of sports it’s for the right reasons.

0:27:08.7

Dr. Mike Patrick: I think if you just look at it on the surface parents will see where there are some countries where pre-participation EKG’s required of every single athlete regardless of symptoms or family history or anything and here in the United States we don’t do that and so a lot of parents would think well we’re kind of behind the ball. But really the EKG’s limited.

Dr. Cortez: The EKG is very limited so specifically the country that does that is Italy. Let’s just take a step back, Italy’s incidents of sudden cardiac death is no different than the US’s incidents of sudden cardiac death. Even though they require a pre-participation ECG, they have not reduced the incidents of sudden cardiac death below that of the US. Secondly the ECG is not going to detect certain things, in fact it won’t detect many things.

0:28:00.0

The third problem is the country Veneto, Italy is a very homogeneous population, the United State is not so what will happen is we do not have ECG standards that are specific enough to take into account different races and so what is normal in one might not be normal in another and so you may inappropriately restrict children of a certain race because we don’t have those ECG standards.

Dr. Mike Patrick: As you say if a parent then thinks that there is a problem because of the preliminary EKG and other really worried and they don’t want their kid to be active and even maybe when they see the pediatric cardiologist they still have in their mind that there could be something wrong and causes anxiety, and fear, and lack of participation. Once a student athlete has been identified based on their history, their family history, or their physical exam that they need to see a cardiologist, what sort of work-up do you perform in at that point?

0:29:01.4

Dr. Cortez: It really depends on why they came to us but honestly our work-up is pretty simple, we get a history and we do a physical exam. Now I will say that anybody who sees a cardiologist gets an ECG that’s more because if we’re going to say you’re fine as a cardiologist that really is part of the conversation. It’s not because we endorse pre-participation screening, it’s because as cardiologist if we’re going to say you are normal and can do anything we have to take that one out.

Dr. Mike Patrick: It’s kind of a tool in your tool box.

Dr. Cortez: When somebody gets referred to us, if they’ve had an ECG, we look at that ECG but really we just sit down and take a history, do a physical exam, and do an ECG because we have a different level of expertise and comfort with what the symptoms are.

Dr. Mike Patrick: When would you get an echocardiogram? So you look at the actual heart with sound waves to try to visualize what the heart looks like, when is that indicated?

0:30:02.2

Dr. Cortez: The times that we get an echocardiogram really are based on a few things so 1. Any child who’s had fainting with exercise automatically gets an echocardiogram, any child whose ECG is significantly abnormal, any child whose physical exam is abnormal. We really take the same history that the American heart Association does. Now let’s say they have a normal ECG, they’ve never had symptoms and the physical exam is normal but dad has hypertrophic cardiomyopathy, well they’re getting an echocardiology. We really do the same thing that we recommend the primary care providers do, we do a personal history, a family history, and a physical exam and if one of those things is abnormal in such a way to guide us towards the echo. So let’s be clear people look at the echo is the gold standard. I told you before I’m an electrician, the patients that I see who are at risk of sudden cardiac death they have normal echoes because the echo does nothing to evaluate the electrical system of the heart.

0:31:07.7

And so people need to sort of wrap their head around it, yes an echo is a pretty test and we do all this things but there’s more to the heart that just the muscle.

Dr. Mike Patrick: When we talk about the electrical abnormalities like the long QT syndrome that could cause it, that’s where an EKG’s going to be more helpful but if you’re looking at the hypertrophic cardiomyopathy or the coronary artery abnormalities then the EKG may be helpful in at least in the hypertrophic one but that’s where the echocardiogram is going to help you out.

Dr. Cortez: Absolutely, and I do want to comment a little bit on echocardiograms because not all echocardiograms are created equal. A bicycle is not the same as a truck, they are both devices that you get in to move. There’re many programs out there in the State who advertise doing an echo to make sure your child is OK to play sports.

0:32:05.1

Let us be clear they are not evaluating your child’s coronary arteries, that is a very difficult thing to do by echo and you really need an expert in a complete evaluation. So this screening Echoes will not pick-up coronary artery abnormalities, it may not pick-up other things, it may not pick-up subtle hypertrophic cardiomyopathy. So sometimes what happens and what we’re very concerned about in the cardiology community is that families go to these screening places, they get an ECG and an Echo, nobody does the physical exam, nobody does the personal or medical history but they get the EKG and the Echo and then their kid’s fine. Well the reality you have missed, some of the most important things because if you have had fainting with exercise then I’m sorry they have not done a complete evaluation and I think that parents can be misled to thinking that their child is fine.

0:33:00.7

Dr. Mike Patrick: This is really and we’ve talked about this on this program many times in the past, you really can’t practice medicine in a vending machine fashion. You have to have a brain looking at every single aspect and taking the whole picture together, you may use the EKG and the Echo as a couple of your data points but you also need the history, and the physical, and someone who has experience in putting all that together to decide whether there’s really a risk or not and a pediatric cardiologist is the best person to do that in this particular situation. Let’s say that you do the work-up and you do find one of these problems, does that mean the person cannot play sports? Is there treatment for these things and can kids still safely participate if they have one of these conditions?

Dr. Cortez: That’s very specific to the condition they have. For example one of the conditions that we screen for is something called Wolff-Parkinson-White syndrome or WPW, that actually is curable, that is actually what I do ablation for, so that is actually a curable thing.

0:34:04.3

Many of these things depending on what they are, so hypertrophic cardiomyopathy you are not allowed to be a competitive athlete in the current long QT syndrome. The new Bethesda guidelines are coming out and the Bethesda guidelines are guidelines about participation in sports for specific cardiac conditions and looking at we have gone beyond the point of saying long QT syndrome should be classified as one disease because they’re actually different sub-types of long QT syndrome some of which are more susceptible to issues with exercise and others. So that’s actually a conversation that you’ll have to have with your pediatric cardiologist. At the end of the day our goal is to make sure our patients live long, productive, healthy lives. That’s a long discussion about who can play? Who can’t play? Which of these can you play with? And everything in life is a risk benefit.

0:35:04.9

Most of them that we’re discussing are going to have some type of exercise restriction.

Dr. Mike Patrick: And again it’s really going to depend on the particular problem, the risk tolerance level of the family, and what kind of physical activity that we’re talking about.

Dr. Cortez: Right, because in the Bethesda guidelines golf and football are not the same thing. Whether or not it’s an Olympic sport doesn’t mean that we discuss restriction in the same way and so there’s very different approaches depending on which type of exercise you do because they have different risk profiles.

Dr. Mike Patrick: Tell us a little about the Heart Center at Nationwide Children’s Hospital. Let’s say there’s a family who is concern, how do they get connected with you?

0:35:53.8

Dr. Cortez: So basically the Heart Center at Nationwide Children’s, you just have to have either somebody refer you to us either your primary care provider, an ER doctor, anybody of that nature we’re typically able to see patients if they medically need it within 24 hours. We have locations across the State all the way into the North and the South so you don’t necessarily have to come to Columbus to be seen by a pediatric cardiologist, we do have locations all across the State. Some of the test that we do we can only do on main campus but things like EKG’s and Echoes we can do at any of our locations. If you need something like a treadmill test, you may have to come to main campus but many patients do not need that. If there’s a concern we can typically see you very quickly depending on the parent’s concern, it may be of that for example if they live in Lima, Ohio we can see them in a month because that’s our next clinic, if they worried and they want to drive down to Columbus we may be able to see them in two days.

0:36:59.8

So some of it depends on you, we’ll make it as convenient to you as you need it to be if you’re frightened and you want to come down we’re happy to see you. If you’re like I’m not that worried then we’ll wait till you come out to Lima, that’s fine with us as well.

Dr. Mike Patrick: And for those of you who want a really easy way to get connected, if you head to pediacast.org and click on the show notes for this episode which is 280, there is a link there that says connect now to pediatric cardiologist and you click on that and it’ll take you to our welcome center where someone can get you more information right away in terms of how to make that referral process happen, so that’s available too. We really appreciate you stopping by and talking to us today. The pediatric cardiology they’re the Heart Center at Nationwide Children’s really one of the best in the country and we’re just really glad to have you in that resource available.

Dr. Cortez: Thank you for having me.

Dr. Mike Patrick: We’re going to take a quick break and I will be back with a final word right after this.

[Music]

0:38:28.7

Dr. Mike Patrick: High chairs and booster seats are commonly used to help make feeding young children easier although most parents assume these products are safe, millions have been recalled in recent years an injuries associated with their use continue to occur. This according to researchers here at Nationwide Children’s Hospital and reported in the journal Clinical Pediatrics. Investigators examined data involving children three years of age and younger who were treated in US emergency departments from 2003 through 2010 for high chair related injuries. On average more than 9400 children were treated each year for an injury associated the high chair or booster seat equalling to one child every hour nationally.

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In addition, the annual number of injured children increased during the study period. Nearly all injuries associated with a high chair or booster seat involved a fall. In the cases that reported what the children was doing just before the fall, two-thirds of the kids were climbing or standing in the chair, which means in many cases that parents weren’t using the chairs safety restraint system correctly, or the restraint system failed. Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s and a professor of Pediatrics at The Ohio State University College of Medicine says, “Families may not think about the dangers associated with the use of high chairs, they’re typically used in kitchens and dining areas, so when a child falls from the elevated height of the high chair, he or she is often falling head first onto a hard surface such as tile or wood flooring with considerable force which can lead to serious injuries….

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Closed head injuries which include concussions and bleeding into the brain were the commonly diagnosed high chair injuries followed by bruises and cuts. The number of closed head injuries increased by almost 90 percent during the study period. Dr. Smith says, “The number one thing parents can do to prevent injuries related to high chairs is to use the safety restraint system in the chair. The vast majority of injuries from these products are from falls. Buckling your child in every time you use the high chair can help keep them safe…. He also notes that many parents assume the tray will keep a child from jumping or falling out but stresses that the tray was not designed as a restraint, so use of the safety straps is still essential. Other tips for keeping children safe in high chairs include: Always use those safety straps. Buckling your child in the seat with the straps every time he’s in the high chair will help set a routine and keep him securely seated in the chair. Make sure the straps are in good working order and firmly attached to the chair.

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And only use high chairs with either a three points or five point harnesses that includes a crotch strap or post. Remember the tray is not enough to keep your child in the seat. Use high chairs appropriately during meal time. Teach your child that her high chair is where she sits for eating. Allowing her to play, climb or stand on the chair can cause it to tip over. Also make sure that older siblings know not to climb on the chair. Keep the area around the high chair clear. Children are naturally curious and will grab things in their reach. Make sure tablecloths, placemats, sharp silverware, plates and hot food and liquids are out of reach. Also be aware of where you put the high chair. If it is too close to the table, a counter or the wall, the child may knock the chair over by pushing his or her feet against these objects. Make sure the chair is stable. Before selecting a high chair for your child, test it out. Chairs with a wide base tends to be more stable. Using high chairs that meet current safety standards is important. And if the chair has wheels, make sure they are locked into place before use.

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Stay with your child during meal time. An unsupervised child is more likely to try to escape from his high chair and also make it more likely that he or she will choke on food. Finally check for recalls. Millions of unsafe high chairs have been recalled during recent years. Make sure the one you are using does not have any known injury hazards. And you can visit recalls.gov to see if your high chair is on the list. So high chair injuries they’re common but many cases preventable especially if you keep these safety tips in mind. And that’s my final word. I do want to thank everyone for taking time out of your day to make PediaCast a part of it. Also thanks to Dr. Naomi Cortez for stopping by the studio and talking to us about sudden cardiac death. Don’t forget PediaCast and our single topic short format programs PediaBytes are both available on iHeart Radio Talk which you’ll find on the web at iheart.com and the iHeart radio app for mobile devices.

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Reviews and comments on iHeart Radio and in iTunes would be most helpful as our links, mentions, shares, re-tweets, re-pens all those things on the various and social media sites. We are on Facebook, Twitter, Google Plus, and Pinterest and be sure to tell you family, friends, neighbors, and co-workers about the program. Most importantly tell your child’s doctor next time you’re in for a well check-up or a sic office visit, or an ADHD re-check. Just let your doctor know, say there’s an evidence based pediatric podcast from Nationwide Children’s Hospital and It’s something that your other patients how to know about. And we do have posters available under the resources tab at pediacast.org. If you like to get in touch, if you have a question or a comment for the program, it’s easy to do that, just head to pediacast.org and click on the contact link. I do read each and every one of those that come through and we’ll try to get your question or your comment on the show.

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And again there’s also that link connect now with a pediatric specialist from Nationwide Children’s and that’ll get you in touch with the folks who help make referrals happen so we can get you in to see one of our specialist if you would like to do that. That does wrap up our program today, until next time this is Dr. Mike saying stay safe, stay healthy, and stay involve with your kids. So log everybody.

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Announcer 2: This program is a production of Nationwide Children’s, thank you for listening. We’ll see you next time on PediaCast.

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ve with your kids. So log everybody.

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Announcer 2: This program is a production of Nationwide Children’s, thank you for listening. We’ll see you next time on PediaCast.

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