Meningitis, Early Puberty, and Trampoline Injuries – PediaCast 033
- Early Puberty
- Gifted Kids
- Infant Feeding
- Trampoline Injuries
- infant meningitis and later school performance
- early puberty and older boyfriends: a bad combination
- gifted kids listen to more heavy metal music
- trampoline injuries
Announcer: This is Pediacast.
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Announcer: Hello, Moms, Dads, Grand Moms, Grand Pas, Aunts, Uncles and anyone else who looks after kids. Welcome to this week's episode of Pediacast, the pediatric podcast for parents. And now, direct from Birdhouse studios, here's your host, Dr. Mike Patrick, Jr.
Dr. Mike Patrick: Hello everyone, and welcome to Pediacast, the pediatric podcast for parents. This is Dr. Mike coming to you from Birdhouse studio and I'd like to welcome everyone to the program. This week on the show, we're going to have a little discussion on infant feeding. I've pulled some questions together from listeners.
We had a question on young infant feeding. Another one on sort of a 46-month range and then another regarding finger foods so we're kind of pulling the questions together this week and we're going to have a nice discussion on infant feeding. Now, if you don't have an infant at home, we have something for you as well in the program. In our News Parents Can Use segment, we're going to talk about school age kids, and their school performance for kids who had infant meningitis when they were babies. And we're also going to discuss early puberty in girls and those girls with early puberty who have older boyfriends — it turns out it's a bad combination. So we're going to talk about that. Also, gifted kids listen to more heavy metal music — these are all things coming up in the News Parents Can Use segment. And then we'll wind down the show after our infant feeding frenzy and talk about trampoline injuries with spring here, well I tell you, it's been like 75 degrees today in Central Ohio.
It was a beautiful day and it's time of the year when people start to get those trampolines out. So we're going to talk a little bit about trampoline injuries and there's been a research study on that so that will be in our research roundup. Don't forget, if there's a topic that you would like us to discuss on Pediacast, it's easy to get a hold of us. Just go to www.pediacast.org and click on the contact link. You can also email me at email@example.com and if you prefer to attach an audio file, you can do that to your email, or you can call the Skype line at 347-404-KIDS.
Alright I'd like to remind everyone that the information presented in Pediacast is for educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face-to-face interview and hands on physical examination.
This week's News Parents Can Use is brought to you through our partnership with Medical News Today. Medical News Today is the largest independent health and medical news website with at least 60 new articles everyday including weekends. That's more than any other health news site. Visit medical news today at medicalnewstoday.com.
"Meningitis in infancy erodes academic success" — this is from the British Medical Journal.
One in four teenagers who had meningitis during infancy will not pass any GCSE exams, reveals research published ahead of print in Archives of Disease in Childhood (which is part of the British Medical Journal).
The findings are based on the GCSE exam results of 750 16-year-olds across England and Wales, 461 of whom had had bacterial meningitis during their first year of life.
The children were all taking part in a long term national study of infantile meningitis in England and Wales. So what's the GCSE? Well, the General Certificate of Secondary Education exam is taken by 16- year-olds in England and Wales. Results are graded A to E, and the national yardstick is to pass five subjects at grade C or above.
Almost 8% (which is 36 kids) of those who had bacterial meningitis before their first birthday were in special schools, which is around four times the national average. All those in the comparison group attended mainstream schools.
One in four who had had the infection did not manage any GCSE passes at the C or above level with just over 6% having that same failure rate in the comparison group. So, 6% in kids who did not have infant meningitis, 6% of the kids did not pass any of the exams but 25% of the kids who did have bacterial meningitis did not pass. So it's much much higher fail rate in the kids who had meningitis as infants. And we're talking about 16-year-olds. Almost half of the teens at state schools who had had meningitis in early childhood failed to achieve the national educational standard of five grade C or above GSCE passing grades.
Again, this rate was twice as high as that of children at the same type of school but who had not had meningitis.
More than a fifth failed to pass even one GCSE at grade C compared with 8% of their comparison group and the national average in England of less than 4%.
Even pupils who showed no signs of meningitis associated disability, when assessed at the age of 5, were half as likely to achieve the national standard as children in the comparison group at the same type of school.
All children who have had meningitis in infancy should be closely monitored and provided with continuing educational support throughout their school days, recommend the authors of this study.
And we'll put a link in the show notes for you so you can actually read the text of this article. So it's kind of an interesting one. I think it's important. It doesn't mean that if your child has meningitis as an infant that they're doomed in school, but you know, parents, if you have a baby who has bacterial meningitis during the first year of life — I should point out that it was bacterial meningitis that these kids had, not a viral or aseptic meningitis — but the kids with bacterial meningitis, you know, you probably should do a little bit of a better job of making sure — of course, you're going to do this for your kid anyway — but you want to make sure that they're doing well in school and that they have all the resources available and they're not slipping or getting behind without you knowing about it. So, just, parents, if your babies had bacterial meningitis when they're less than a year old, pay special attention.
Okay, "Girls with early puberty and older boyfriends are at a greater risk for drugs, sex, and alcohol" — this comes out of the University of North Carolina at Chapel Hill.
Teenage girls who mature physically sooner than their peers and who also have a romantic partner at least two years older have a higher risk for substance abuse, sex and a combination of sex and drug use, according to a University of North Carolina at Chapel Hill study.
"Adolescent girls and boys all are at risk for experimenting with sex, alcohol and drugs,… said Carolyn Tucker Halpern, associate professor of maternal and child health in the UNC School of Public Health.
"Those who mature early are known to be at higher risk for these problems. But within that group, girls who have an older boyfriend appear to be at an extra risk for multiple high-risk behaviors such as intravenous drug use, marijuana use and sexual intercourse….
The study was based on a nationally representative sample of about 4,000 adolescents who participated in the National Longitudinal Study of Adolescent Health. The students were under age 15 for the first part of the study, carried out during the 1994-1995 school year, and have been tracked since then through follow-up surveys. The results are published in the March 2007 issue of the journal
One in five teen girls in the study who started maturing physically earlier than their peers reported having a romantic partner who was older, compared to only one in 25 males who matured. There were not enough boys with older girlfriends in the study to allow researchers to draw any conclusions about whether older partners increased the boys' danger for engaging in risky behaviors. However, having a romantic partner of any age increased the likelihood of risk behavior for both boys and girls.
More than 40 percent of the teens in the study reported having no romantic partners, and more than 36 percent of girls and 47 percent of boys had romantic partners of the same age or younger.
Halpern said this research should be a caution for parents.
"Parents of all teenagers have a responsibility for talking to their children and guiding them through romantic relationships and the risks of drug use,… she said. "But this study shows that parents of girls who reach puberty ahead of the peers and who have an older boyfriend should take a special interest….
The study was supported by a grant from the National Institute of Drug Abuse of the National Institutes of Health.
And again, we'll have a link to that article in the show notes as well.
And finally in News Parents Can Use, "Gifted students beat the blues with heavy metal" — this is from the University of Warwick.
Gifted students who feel the pressure of their ability could be using Heavy Metal music to get rid of negative emotions.
This is the conclusion of Stuart Cadwallader and Professor Jim Campbell of The National Academy for Gifted and Talented Youth at the University of Warwick.
They discussed their findings at the British Psychological Society's Annual Conference at the University of York.
(Well, we have a lot of British news today. Ah but it affects all of us.)
1, 057 students aged between 11 and 18 years old completed a survey which asked them about family, school attitudes, leisure time pursuits and media preferences. They also asked them to rank favored genres of music. They found that rock was the most popular form of music, closely followed by pop. But there were also differences between the type of music the young people liked and their attitudes – with those who liked Heavy Metal having lower self-esteem and ideas about themselves.
To find out why this was, the researchers then quizzed 19 gifted students via an online group interview to find out their views on Heavy Metal. These pupils said they did not consider themselves to be "Metalheads" but identified with specific aspects of this youth culture. They spoke specifically about using Heavy Metal for catharsis, literally using the loud and often aggressive music to jump out frustrations and anger.
Although the more ardent fans stated that "there's Metal out there for every occasion," many also stated they listen to the music when they are in a bad mood. Mr. Cadwallader said, "Perhaps the pressures associated with being gifted and talented can be temporarily forgotten with the aid of music. As one student suggests, perhaps gifted people may experience more pressure than their peers and they use the music to purge this negativity….
And again, there'll be a link to that news story as well in the show notes.
Alright, again, thanks to our news partner, Medical News Today, the largest independent health and medical news website at medicalnewstoday.com. And we'll be back with our first listener question right after this break.
Okay so we have the first of three infant-feeding questions for you. This one comes from Brian in North Carolina. Brian says, "I am a new subscriber to the Pediacast and enjoy listening to them and find them very informative for my child. I do have a topic I think might be good to discuss — starting your child on cereal. Our doctor recommended to start at 4 months. My questions is how to introduce cereal and what type to get and how to mix it and what to mix it with. Thanks, Brian."
Okay, cereal — you know that is the traditional first solid food and it's a good choice because it has sort of a bland taste so, you know, most kids aren't going to really find the taste of cereal to be — you know, it's not too exciting but it's not the kind of taste that a lot of them are going to resist.
And then the other thing is, it has a pretty low rate of allergic reaction except for wheat products. We have talked before that wheat proteins — babies can have allergies to those. So usually, we start with like rice cereal, that's a pretty bland one. Oatmeal cereals, another one. Barley cereals, good.
So you want to avoid sort of the mixed cereals in the very beginning. Definitely avoid wheat. But rice cereal and then progressing to oatmeal and then barley is sort of a good plan. And you want to start this at about 4 months of age. It's a good idea to, again, to weigh on the wheat and the mixed cereals and do those last because it could cause allergic reactions in very young babies. You can use pre-mixed baby cereals in a jar, or what I recommend is just using a dry cereal to which you can add breast milk, formula or water and the pre-mixed foods may be easier to use but the dry ones are richer in iron and even — more importantly, because they're still at this age getting a lot of iron from the breast milk or the formula.
But by using the dry one and then adding breast milk, formula or water to it, it allows you to control the thickness of the cereal. So you want it to be about the thickness of like a mustard and you know if it's a little too think, you can add some more of the dry cereal. If it's a little too thick, you can have a little bit more breast milk, formula or water.
Now, whichever type of cereal you choose, you want to make sure that it is for babies. So you want to make sure that it is for babies. So you want to make sure that this is a baby dry cereal. Now, there comes a sort of rice cereal flakes. Now, this is not all — [laughs] I’m not making this up — there was one time, I was going over this [laughs] with new parents — I shouldn’t laugh, I’m sorry. It’s been a long enough ago now that I’m sure that well, maybe [laughs] — hopefully they are not listening, but if you are, you know, it is good-natured stuff, you know. I kind of doubt they are. [Laughs]
So anyway, people who would ask what I'm going to tell you probably don't have iPod savvy, but okay. Anyway, I was seeing a patient and talking about rice cereal, and the dad looked at me and said, "You mean we put the Rice Krispies in the bottle?" [Laughs] Okay, "No, not Rice Krispies." Okay we're not talking Rice Krispies cereal, we're talking rice flakes that are made for babies and that's what I would use.
Alright, you want to start by making about a table spoon or so and then, of course you're not going to feed them the whole tablespoon with a tablespoon, but just in terms of total volume, about a tablespoon is a good start for a 4-month-old infant who's just eating cereal for the very first time.
Your baby may not know what to do with it, when you first give it to them.
I mean, she may look confused. He might wrinkle his nose or roll the food around in the mouth or ejecting it all together. That's a normal reaction because this is definitely different than what your baby has been used to up to this point. One way to make eating solids for the first time easier is to give your baby a little breast milk or formula first and then switch to a very small sort of half-spoonfuls of food at a time until you get, you know, one or two teaspoons, maybe the whole three teaspoons, which equals a tablespoon, as you have watched the show "Are you smarter than a 5th grader?" or "Can you be smarter than a 5th grader," whatever that show is, one of them the other night was "How many teaspoons are in t a table spoon?" The answer is three.
So anyway, if your baby, they'll probably one or two teaspoons the first time. If you make a whole tablespoon and they take all that, hey wonderful! But if you do the milk first, and then give them a little bit of the cereal and then finish with a little bit more breast milk or formula, that'll prevent them from getting frustrated because they're really hungry and they just want that milk or formula but you don't want to give them all their milk or formula first because then they're going to be too full and not be interested in the cereal.
So just give them a little milk and then the cereal and then finish up their milk is probably going to give you the best success.
Now, again, don't be surprised if most of the first few solid food feedings wind up on your baby's face, in their hands, on their bib. You know, this is just for fun and practice in the beginning. It's not necessarily all for nutrition. And then you just increase the amount of food that you are using with the cereals gradually.
Again just a teaspoon or two start and then working at the whole tablespoon each time. If you do that a couple of times a day in the beginning, that's definitely going to be adequate and it'll give your baby some time to learn how to swallow a solid.
So again, when do you do this? Well, any time between 4 and 6 months. Between 4 and 6 months they still need to have the majority of their nutrition coming from breast milk or formula and the solid foods are just for fun and practice and get them used to doing it.
So, if they don't seem to be taking that much, it's not a big deal. They don't really need it until about their 6 months old. So then when do you do the fruits and the vegetables? Well, once you do the rice cereal, then they progress to oatmeal, then barley, and then you can try to mix cereals at that point. When they're doing well with the cereals for maybe three or four weeks, something like that, then you can move on to the fruits and vegetables. So, once they're somewhere between 4 and 5 months of age, you're going to be able to start fruits and veggies. Now, which do you do first? You know, the grandparents out there in the crowd will tell you that you start with the orange vegetables and then the green vegetables then you go to the fruits but you know, really the order is not that important. You just want to make sure that as you introduce things, you do something new not more often than every two or three days. That way, if your baby has a reaction to a food, it'll be easy to pinpoint which food that caused that reaction.
So you want to go through the fruits and vegetables, you know, kind of slow, one thing at a time and give it two or three days in between new things so you'll know which one they're having a reaction to.
Now let me also just say that in terms of the orders, some would say well you do the vegetables first so that they'll like them. Well let me tell you. It doesn't matter whether you do the vegetables first or second. Most babies are going to like the fruits better. The sweet taste is generally preferred for babies than the sort of the more bittery, bland taste of vegetables. And once they have the fruits, they're going to like the fruits better. You could argue that, well, let's do the vegetables first, get them used to that and then give them the fruit, because if you do the fruits first, then they're going to definitely resist the vegetables.
But on the other hand, you're trying all these new things, it's not their usual course that they're used to on a daily basis and if you do the vegetable first, you could be kind of setting them up for failure.
I mean if they are trying to do something new here, don't you want to give them something that they like and are going to have a chance of being successful with because they like the taste of it. I don't know. I think you can make an argument either way. Bottom line is, it doesn't really matter. You know, variety is the spice of life. Do fruit first. Do vegetables first. It doesn't matter.
The important thing is you go slow and you just introduce things, you know, something new every two or three days.
Alright, we're going to move on to stage 2 foods, which is started around 6 months of age. And we have another listener question with regard to stage 2 foods and we'll get to that right after this quick break.
Okay, listener question number 2, which is about stage 2 foods comes from Shana in Georgia.
Shana says, "Dr. Mike, our doctor recommended feeding our 6-month-old stage 2 foods, because he said they were more cost-effective. He said we shouldn't feed him the mixed fruits and vegetables yet.
Why is this? And then when can we feed him the mixed fruits? We love your show. It seems after each doctor's visit, we come up with a few questions we didn't think to ask the doctor because we were trying to get the baby dressed and into the car seat without forgetting any of the things you have to drag with the baby every time you leave the house."
Alright, so let's talk a little bit about stage 2 foods. You know, stage 2 foods basically are the same consistency as the stage 1 foods. So they get thicker really, and chunks in them, with the stage 3 foods.
What makes a stage 2 food a stage 2 food? Well it generally is larger jars. So, now you're baby is at that point where they are eating a little bit more bigger meals and so the jars are going to be a little bit bigger and they typically are mixtures of things.
So what's the problem with mixtures. Well, really, there is no problem inherent to mixtures. The issue is just that you don't want to be in the situation where you have a mixed food and both components are your baby has never had before. And then if they have a reaction, you know they're covered in hives and really broken out and maybe even wheezing, you know, they had a really serious reaction to the food, you kind of want to know what they had the reaction to so that you can avoid it. And if they just had a mixed food, you're not going to know which one it was that caused the problem. Now again, and this is really rare. I mean, how often do I see babies who have a severe reaction to their food at this age. I mean, really, maybe one or two a year. I really is very rare to have that kind of allergic reaction. You know, more likely, you're going to have sort of a milk allergy that's causing bad eczema and a runny nose.
We see that a lot more often, but in terms of hives and bad allergic reaction from a food, especially stage 1 and stage 2 foods, it's not too often. But you know like the boy scouts say, be prepared. It's probably prudent to not do the mixed things if the two components are both new things. Now if they have done one individually, I would say you're fine going with the mixed one because if they have a reaction, you know, it's probably the other component and if they've had both of those things individually, you're fine going with the mix.
I mean, you know, they're going mix in the stomach anyway, right? so mixed is fine. You just want to make sure it's not two new things that they've never had before at the same time.
Okay so let's just do a recap here real quick.
So basically between birth and 4 months of age, babies really just need breast milk or formula and that's it. They really don't even need water because breast milk and formula is mostly water.
They are getting most of the water through the breast milk or the formula and you probably don't want to fill them up with empty calories with just water, unless of course there are weight issues and they are still wanting to mouth something, but then really, you probably do a pacifier or a pinky and not necessarily a bottle of water, but you know you talk to your doctor about that.
Now from 4 months to 6 months, remember this is like food training. It's just for fun and practice. It's okay if most of it comes back out at you in the beginning. You just, you know, a couple of times a day is fine because this is, again, this is just teaching them to take care of eating solid foods and not gagging and choking on them.
And then around 6 months of age, that's when the solid food becomes more of a nutritional need that kids have. And if they are doing cereal and stage 1 baby foods pretty well at that point, then they are probably ready for the stage.
Also in terms of frequency, you know, I tell parents start out with a couple of times a day, and then by 6 months, you sort of want to be working up to the point where they are taking little solids at breakfast, lunch, dinner and then snack before bed time.
So you know, four meals a day is probably pretty good. Some of them may also need sort of a mid-afternoon snack in there. But you want to talk to your pediatrician about it. It's going to depend too on how their growth is, or are they a little overweight or are they a little underweight, you can make little adjustments in the frequency and the amounts based on their growth charts to some degree.
Okay so we've talked about stage 1 and stage 2 baby foods. What about around 9 months of age now when we're going to go into the stage 3 foods and table foods, finger foods that kind of thing. There's definitely more variability when kids are ready to do the thicker, more solid stuff. And we do have a listener question actually, an audio question, and we'll take a listen to that right after this break.
"Hey, Dr. Mike. This is Steven in Indianapolis. I wanted to give you a call to ask a question about a note that came home with my 6-month-old son from day care the other day suggesting that we start him on finger foods such as banana slices, cheerios, and other small finger foods and it seems that since he's only a 6 months old, doesn't have any teeth and has just started on pureed baby food, that it might a little bit early to be giving him finger foods. So I just want to get your thought on when you think babies should start on finger foods and how best to avoid the kind of natural choking hazards that come along with some of those things. Keep up the good work. I love listening and I look forward to your response.
Alright, well thanks for the question, Steve. We appreciate it. So as I understand there, you have a 6-month-old son and day care wants to give finger foods, or they are suggesting that you start do finger foods and Steve, you are concerned that your child is not ready. Well, Steve, I agree with you. I think that 6 months is too young for finger foods. So again, as we discussed in the last segment, 4 months of age is when you start the cereal in the stage 1 baby foods around 6 months of age, you start the stage 2 foods you know with the larger jars and the combination products. And then it's going to be more like 9 months — maybe 8 months for some babies — but 8, 9 months to 12 months, when they are ready to do the stage 3 foods which are much thicker and the finger foods.
And you want to slowly introduce them to these things, you know, watching for gagging and choking because there's a range of when kids are ready to this. If they are gagging on it or they are choking on it and you are worried about that, just stop, you know go back to the stage 2 foods, a couple of weeks later try again.
We see some babies who are definitely ready at around 8 months of age to do this. Most of them, though, probably 9 to 10 months of age. And then there are going to be a few who just are not ready for those thicker textures until they are closer to about 12 months of age or so.
Now, what are some good finger foods to do. Well, first of all, let me say, you definitely want to avoid anything that is going to have a small piece or chunk that could accidentally go down into the airway and cause them to stop breathing and choke. And if you don't know how to do like the baby Heimlich type maneuver or actually you don't really do the Heimlich in babies, but you do chest thrusts and back blows.
And if you have done an infant and child CPR class basic first aid through the American Red Cross, I highly recommend for parents to call their local chapter of the American Red Cross and learn how to do that because you don't want to your baby choking and you don't know what to do. So, I think that is an important thing that parents should consider.
Okay, so what kind of things can you do. Well, crunchy toast, well-cooked pasta, small pieces of chicken. As they get to be a little bit older and closer to around 12 months of age you could try some scrambled eggs or ready to eat cereals, small pieces of banana. Of course they have the biter biscuits and, you know, things that are made for babies. Boy, those things make a mess though, [laughs] I tell you. Like those, the biter biscuits. You know what I'm talking about. They really make a mess!
But anyway, there are some things that are a little less messy that babies can do. You want to offer a variety of flavors, shapes, colors and textures but again, always watch your child for choking and in case they bite off a piece that's just a little bit too big to swallow.
Now because children often swallow without chewing, you don't want to offer babies and toddlers these kind of foods. So these are things now that you definitely want to avoid. You want to avoid chunks of peanut butter, nuts, seeds, popcorn, raw vegetables, hard, gooey or sticky candy, chewing gum — I mean these are all things that infants and even going up to 15, 18 months, 2 years old, even 3 years old. You know these are some things that you probably want to avoid because they are the ones that are the biggest culprits for causing choking. Now other firm, round foods like grapes, cooked carrots, hotdogs, meat sticks, sort of baby food hotdogs, or chunks of cheese or meat — these should all be cut into very small pieces and of course, before cutting a hotdog, you may want to take the peel off and then cut it, instead of in circles, sort of cut it into more lengthwise bits. Or cut it into circles and sort of do a criss-cross, make little triangles.
Okay, [laughs] it is great. You’ll love it. We’re talking about how to cut up a hotdog. [Laughs] Alright.
Babies and small children do not know what foods they need to it. Your job as a parent is to offer a good variety of healthy foods. Watch your child for cues that she's had enough to eat. And do not overfeed. Begin to build good eating habits. Usually eating five to six times a day, three meals, two or three snacks like we talked about before. It's a good way to meet older babies' and toddlers' energy needs.
Children who grates or eat constantly may never really feel hungry and they can have problems from eating too much or too little. If you are concerned that your baby is already overweight, talk with your pediatrician before making any changes to the diet.
During these months of rapid growth, your baby needs a balanced diet that includes fat, carbohydrates, and protein. It's not wise to switch a baby under 2 years of age to skim milk or to other low fat substitutes for breast milk or formula.
A better solution might be to slightly reduce the amount food your child eats at each meal if you are worried about their weight, and this way your child will continue to get the balance diet he or she needs.
So up until the age — once they are a year old until they are 2, you want to stick with vitamin D whole milk, unless your doctor tells you otherwise.
Your pediatrician will help you determine if your child is overfed, not eating enough or eating too many of the wrong kinds of foods. Because prepared baby foods have no added salt, you do not have to worry about salt at this age. However, be aware of the eating habits of others in your family and as your baby eats more and more table foods, he or she will imitate the way you eat including using salt and nibbling on snacks.
For your child's sake as well as your own, cut your salt use, and watch how much fat you consume. Provide a good role model by eating a variety of healthy foods yourself.
Okay that concludes our infant feeding discussion. That was kind of brief. You know, we are answering those specific questions. We didn't talk about juice. We didn't talk about meats and what things to avoid. But you know, this one, I didn't want to saturate you with too much information. If you have a specific question about infant feeding, toddler feeding, child feeding, teenage feeding — eating, I should say, not feeding — just let me know.
Okay we're going to take a quick break and we'll be back with the research roundup. We're going to talk about trampoline injuries and we'll do it right after this break.
Okay this week in our research roundup, we're going to talk about trampoline injuries. Now this comes from — [laughs] it's another British one — this is from the British Journal of Sports Medicine.
Trampoline use for both recreational and competitive sports has continued to increase over the last decade. This increase has been associated with an increased risk of injury. One study revealed more than 6,500 pediatric cervical spine injuries related to trampoline use in the United States in 1999 and continued safety concerns led the American Academy of Pediatrics to reaffirm their recommendation
that trampolines not be used in the home in routine physical education classes or on the playground.
Now this descriptive study examined the mechanism, locations and types of injury for all patients treated for trampoline-associated injuries at St. Olav's University Hospital in Norway from March 2001 until October 2004. This hospital is the only hospital in the area and it serves an estimated 600,000 people.
All patients in this study were identified from a National Injury Surveillance System at the Norwegian National Institute of Public Health. Patients seen in the emergency department for a trampoline injury (or their family members or physician) were asked to complete — I don't know why their doctor, [laughs], I'm just telling you what the study says — so the person who is injured or the family member or their personal physician (maybe they accompanied them to the ER, I don't know), but anyway they were asked to complete a standard questionnaire, and physicians then categorized the severity of injury utilizing a standard scoring system.
Subsequently, patients were asked to complete another questionnaire for details of mechanism of injury and other circumstances surrounding the event. Initial questionnaires were completed for all patients, but only 48% of the patients returned the follow-up questionnaire.
Between 2001 and 2004, 556 patients were treated for trampoline-related injuries, representing about 3% of all injuries treated in the emergency department. The total number of injuries was similar for each of the 4 study years, although greater than the numbers seen in the previous 4 years. Males slightly outnumbered females, 56% to 44%. Young patients (less than 15 years of age) represented greater than 85% of the injuries with 40% of injuries occurring in children aged 6-10 years, 32% in children aged 11-15 years and 13% in children aged 1-5 years.
(Now who puts their 1-year-old in a trampoline?)
Alright. Cause of the injury was available for 551 of the patients. Most of the injuries (53%) resulted from an awkward landing on the trampoline, while only 22% actually fell off of the trampoline. In 74% of the cases, more than 2 people were on the trampoline at the same time, and 13% of the injuries resulted from collision with another person. Lower extremities were most commonly injured (at 44%), followed by upper extremity (34%). Head was 9%; neck was 8%.
The most common types of injury were fractures, or broken bones, which is 36% and ligamentous injuries, so ligament strain, 36%. Fractures were common in children under 10 years of age (125 of 295 children versus 76 of 261 older children and adults). So in the younger kids under 10, 42% were in that age group who had fractures and only 29% were in the older child or adult range. So it's the kids under 10 that are much more likely — not quite twice as likely, but almost — to have fractures of a bone as their injury with the trampoline.
Twenty-three patients experienced a supracondylar fracture of the humerus (that's an elbow fracture), and 3 of which had associated ulnar nerve injury — that's a bad thing. Severe injury occurred in 11% of the injured children with the majority of these occurring when individuals fell off of the trampoline. So then falling off was less common; however, of the severe injuries the ones who fell off were more likely to be severely injured. Neck injuries accounted for 8% of the total injuries and were generally mild although 3 patients experienced a severe neck injury with a neck bone fracture or instability of the cervical spine (those are very, very bad things). Based on the results, the authors do not support a ban on trampoline use for children.
So the American Academy of Pediatrics recommends a ban for trampoline use in homes and routine physical education classes, and here, this Norway study, the authors do not support a ban on trampoline use. So trampolines must be very, very, very popular in Norway. And you know, they did mention that 3% of all injuries treated in the emergency room was from trampolines. Now while we do see quite a few trampoline injuries in the United States, and again I'm guessing at this, but I'll bet it's not 3%. That's a pretty high number for trampoline injuries. So trampolines must be more common in Norway and more popular and they don't want to ban them.
Now there was a commentary on this study by David Bernhardt, who is a Fellow of the American Academy of Pediatrics. He's a pediatric orthopedic surgeon with the Division of Sports Medicine at the University of Wisconsin Children's Hospital and University of Wisconsin Sports Medicine in Madison, Wisconsin.
And here's what Dr. David Bernhardt had to say about this study.
This Norwegian study demonstrates the significant risk posed by the trampoline and adds to information from previous from the US. The authors properly highlight the fact that, without knowing key demographics such as the amount of time patients were exposed to trampolines, it is very difficult to compare the risk of trampoline activity to that of other sports or activities. The frequency of injuries seen in the younger age groups along with the severe neck injuries and elbow fractures is worrisome. Based on similar information, some authorities have argued for banishment (like the American Academy of Pediatrics) of the trampoline as a household toy, physical education modality, or piece of playground equipment. Others, the study's authors state, recommend explicit warnings and use of a safety net to lessen the chance of a fall off the trampoline, while noting that there are no data regarding the efficacy of trampoline safety nets.
Pediatricians and other primary care providers must be aware of the risks of trampoline activity in order to properly advise families, as well as recommend possible approaches to a safer environment if parents choose to have their children participate in such activities. Potential methods for improving safety include direct parental supervision (I think that's a big one), allowing only 1 jumper at a time on the trampoline, keeping children under 6 years of age off the equipment altogether, and using a safety net.
So if you are in the American Academy of Pediatrics camp, it's just simple: no trampolines. If you are with the Norwegian authors, yeah, trampolines are okay but you may want to do some things that's going to lessen the chance of fall like the safety net.
And if you're in Dr. Berhnardt's camp which I think makes some sense — you know, he added some things to that such as, you know — it's got to include direct parental supervision. I mean that's really important because you know kids are going to do some crazy things on the trampoline but if the parent knew what they were doing, they would've stopped it. So you have to watch your kids and then only allowing 1 jumper at a time is very important. Children under 6 should stay off it all together. Even though there have been no studies that show using the safety net, improves outcomes with trampoline injuries, it's still probably not a bad idea. Do use one, according to Dr. Bernhardt. And I would agree with that.
As always you know parents should make up their own mind. You know, we do not have a trampoline at our house, probably never will. I have definitely seen, personally, lots and lots of fractures. Before I worked in a pediatric practice like I do now, I worked in the pediatric emergency department for a year after my residency, and in that one year, ah, we just saw lots of trampoline injuries.
So it's definitely out there, we definitely see it, but you got to use some common sense and of course there is risk in everything that we do. And as we always talk about on Pediacast, parents have to decide, is the benefit worth the risk?
Alright, we're going to take a quick break and we'll be back to wrap up this episode of Pediacast right after this.
Alright welcome back to the program. Before we leave, I want to remind you about the Pediascribe blog, which is being handled currently by my lovely wife Karen. If you'd like to read the blog, you can go to pediacast.org and click on the Pediascribe blog link or you can go to pediascribe.com. Now, Pediascribe blog is really, I think, a nice complement to the program. Pediacast is more medical and parenting information from a doctor/dad's point of view, whereas the Pediascribe blog comes from the mom's point of view and is really more about daily life as a mom. So if you'd like to take a look that, I'm sure Karen would appreciate it and of course, you are always welcome to comment on the blog, and it also has an RSS feed so if you have a feed reader and would like to subscribe to the blog, that's easy to do too and you can do so at the blog's home page.
Last week's topics: don't listen to the critics; little kids, little problems; "nick-isms…; haiku; and apparently on dating again.
So if you want to hear about my wife's boyfriend, the cowboy next door, you can — [laughs] it's funny I can laugh because it's my son, he's crazy.
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