Noisy Toys, Tylenol Warning, Basketball Research – PediaCast 193

Looking for information about noisy toys, Tylenol, or basketball research?  You can learn about all of these topics on today's PediaCast with Dr. Mike! He will be talking about all of that as well as unhealthy food at Children's hospitals, calories signs in stores influencing teens, and FDA warnings regarding infant acetaminophen.


  • Noisy Toys and Hearing Risk
  • Unhealthy Food at Children’s Hospitals
  • In-Store Calorie Signs Influence Teens
  • FDA Releases New Warning on Infant Acetaminophen
  • Incidence of Basketball Injuries
  • Effect of Lace-Up Ankle Braces on Basketball Injury Rates
  • Effect of Increased Sleep on Basketball Performance



Announcer 1: This is PediaCast.


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!

Mike Patrick: Hello, everyone, and welcome once again to PediaCast, a pediatric podcast for moms and dads. As always, we're coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio. It is Episode 193 for December 28th, 2011. We're calling this one 'Noisy Toys,' [Laughter] 'Tylenol Warning,' OK, I've got to pause here. The reason I laugh at 'noisy toys' is because some toys are dangerously loud. I mean, they can actually cause hearing problems.



So, OK, why is that funny? My brother-in-law way back when gave our kids this train set that you put up around the Christmas tree. It's not like a miniature train set. It's one of the bigger ones. It's remote-controlled, you put the track around the base of the tree, and the train goes around and around. You push a button and the thing clangs and blows its whistle and rings a bell, and it's very loud, not to mention the motor.

Every year, when we put the tree up and start the train around it, we have to give him a phone call. We have the thing running in the background, so we say, 'Hey, we just want to thank you for this great gift!' that's clanging away in the background. Of course, the kids demand that it be put under the tree each year.

So that's why I laugh at 'noisy toys'. But they can be dangerous, and we're going to talk about why and how coming up in a little bit.



Also, the FDA has issued a warning about Tylenol, infant Tylenol in particular, and just a dosing warning, so we're going to discuss that.

We're also going to do a Research Roundup today. It's been a little while since we've done one of those. We're going to look at three research articles that pertain to basketball. So if you have kids playing basketball, which lots of you do this time of year, we're going to talk about some research on injury and basketball performance. That's all coming up in just a little while.

Of course, I hope everyone had a merry Christmas. It is the week now between Christmas and New Year, so I hope you all have a happy new year coming up.

I also want to welcome any new listeners that we have. It seems that this time of year we usually do have an influx of new folks, so I'd like to welcome all of you who are listening now for the first time. If you got an iPod or an iPhone or an Android device for Christmas and you are looking for podcasts and you found us, we appreciate you adding us to your list. If you gave one of those as a gift, whoever you gave it to, make sure you let them know about PediaCast so we can welcome them into our community of listeners as well.



Speaking of Christmas, one of the things, as you're kind of out and about, that you get asked a lot is, 'Hey, what did you get for Christmas?' In fact, I had a kid, I was working in the urgent care not too long ago, actually, it was the day after Christmas so that would've been two days ago, he said, 'Hey, what did you get for Christmas, Doc?' So I had to think what was my favorite gift, and, of course, I think they were all favorite gifts. I don't want to offend anyone. Seriously, it was a great Christmas. But one that really sort of stands out for me, and other dads out there will appreciate this, is something from Looft Industries called the Looftlighter.

I think back in the summer, I talked a little bit about our Big Green Egg that we have. It's a charcoal grill made of ceramic. I mean, the thing gets really hot. You could get it going up to a thousand degrees if you wanted, but if you sear a steak at 700 or 800 degrees, oh, just delicious.



The problem with the Big Green Egg, though, is it takes a long time to get up to that temperature. You light the charcoal and you basically have to wait half an hour or so to get up to a really high cooking temperature if you want to sear your steak. What the Looftlighter does is it gets your charcoal and it gets you up to cooking temperature really fast.

This is not a paid advertisement. I was just, it's a really cool item that I got for Christmas, and if you have a charcoal grill, it's fantastic. We have tried it out. Looftlighter. I'll put a link to that in the show notes for you. I'll also link to the Big Green Egg.

And I found a YouTube video on lighting a Big Green Egg with the Looftlighter, so if you want to see the thing in action, and know it's not my video, that would've been fun to do, though, but we'll have links to all that over at



A couple other things. Speaking of Christmas gifts, I want to mention, during our interviews this past year, we have talked to various doctors about all kinds of medical topics and we've been ending the interview with, 'Hey, what's your favorite game?' and we talk a little bit about playing games with families and doing fun stuff indoors that doesn't always involve screen time.

Dr. Maya Spaeth, she's a plastic surgeon here at Nationwide Children's, she had recommended Settlers of Catan. We got that for Christmas as a family gift and we've played it several times. Let me tell you, this game rocks. It's really, really fun. So just a shout-out to Dr. Spaeth for mentioning that on the show. That was her board game pick.

It really is a great game. It's one of those games where you have to pay attention not just when it's your turn, so you don't lose interest, and you have to build the civilization on an island. I'm sure many of you out there have tried it out. But if you're looking for a good family game, I would recommend Settlers of Catan.



I also got Five Crowns, which is a Rummy-style card game that's great for the whole family. The rules are pretty easy to understand and yet you do have to have a little bit of insight and strategy into it as well. Young players, I think, will get a lot out of it, but then as you try to get more into a strategy, older players will get even an added benefit from it.

So Five Crowns and Settlers of Catan. I'll have links to all that stuff in the show notes, so if you hop over to, you can find it.

All right. What are we talking about today? We have a News Parents Can Use and a Research Roundup show for you. Again, we're going to talk about noisy toys and hearing risks. It really is a real problem.

Also, unhealthy food at children's hospitals. That's not cool.

In-store calorie signs, like in the store you have a big sign telling you how many calories in a product. It actually does a good job at influencing the decisions that teenagers make when it comes to drinking sugar drinks. We're going to discuss that.



And then, of course, the FDA did have a recent release of a new warning on infant acetaminophen or Tylenol, and we're going to talk about that.

Basketball Research Roundup, the incidence of high school basketball injuries, how common are they, the effect of lace-up ankle braces on basketball injury rates, and the effect of increased sleep on basketball performance. Some recent research articles that came out on those topics, so we will discuss those as well coming up.

I want to remind you, if there is something you would like us to talk about here on PediaCast, we are all about audience participation, it's easy to get a hold of me. Just go to, click on the Contact link. You can also email or call the voice line, 347-404-KIDS. That's 347-404-5437.



I also want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, be sure to 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 over at

And with all that in mind, we will be back with News Parents Can Use, right after this short break.




Mike Patrick: Our News Parents Can Use is brought to you in conjunction with news partner Medical News Today, the largest independent health and medical news website. You can visit them online at

Buzz Lightyear Cosmic Blasters, Let's Rock Elmo, and the I Am T-Pain Musical Microphone might have been popular gifts this holiday season, but parents should ensure their children don't risk permanent hearing loss by misusing them. That's the advice from researchers at UC Irvine's Department of Otolaryngology.

Investigators measured the noise levels of two dozen popular toys and purchased the 10 loudest for precise gauging in the sound booth. All of the tested toys exceeded 90 decibels and several ones over 100 decibels, which is the equivalent to chainsaws, subway trains, and power mowers. I kid you not. Yeah, those are great toys, kids. Let's thank Santa Claus for those.



"Generally, toys are safe if used properly," said Dr. Hamid Djalilian, Associate Professor of Otolaryngology and Director of Neurotology at UC Irvine. He said, "We tested the sound levels at the speaker and again at 12 inches, which is about the length of a toddler's arm. Problems can arise if noisy toys are held too close to the ears because loud and high-pitch sounds cause damage, and hearing loss from noise damage is permanent and not currently curable."

According to the American Academy of Otolaryngology, unprotected exposure to sounds above 85 decibels for prolonged periods of time can lead to hearing impairment. Dr. Djalilian says two factors contribute to this, loudness and duration, with louder sounds taking less time to cause hearing loss. He suggests parents pay attention to the speaker's location for noisy toys and points out that speakers on the underside of a toy are safer than those on top.



Dr. Djalilian also recommends parents hold the toy as a youngster would and listen. If it hurts your ears, then it's probably too loud for a child.

Here's the complete list of the top 10 loudest toys as tested by researchers at UC Irvine.

Number 10, coming in at 92 decibels, is the Green Lantern Colossal Cannon. Ninety-three decibels, the Toy Story Buzz Lightyear Cosmic Blaster. Ninety-four decibels, the VTech Magical Learning Wand. Ninety-five decibels, Sesame Street's Let's Rock Elmo. Also at 95 decibels is both the TAPZ Electronic Reflex Game and the Whac-A-Mole Game.

At 98 decibels is the Marvel Super Shield Captain America. The Tonka Mighty Motorized Firetruck is 100 decibels, the I Am T-Pain Microphone is 101 decibels, and the loudest toy that they tested at 108 decibels is the Road Rippers Lightning Rods.

So if you have any of those toys, you may want to put a pillow over them, OK? [Laughter]



Also, if you have any toy that's really loud, pay attention and make sure your kids aren't putting them near their ear, they're not playing with them for too long, and that you just want to keep them away and quiet as much as possible. [Laughter]

It's kind of funny because, on the one hand, we kind of laugh about how loud toys are and how annoying it can be to parents, but it really can cause hearing loss, so we have to keep that in mind. Even when we're trying to be funny here, it is serious stuff.

All right. One would assume, in light of the obesity epidemic amongst the nation's youngsters, that children's hospitals would lead by example in being a role model for healthy eating. However, a new study published in "Academic Pediatrics", which is a journal, shows that in California, only 7% of entrees served in children's hospitals classify as being healthy.



According to a study by researchers from UCLA and the Rand Corporation, an assessment of 14 food venues at the nation, at the state's, sorry, this is California again, at the state's 12 major children's hospitals revealed that hospitals were falling short in their offerings and practices of healthy eating.

Lead researcher Dr. Lenard Lesser says, "As health professionals, we understand the connection between healthy eating and good health, and our hospitals should be a role model in this regard. Unfortunately, the food in many hospitals is no better, and in some cases worse, than you might find in a fastfood restaurant."

To rate the food being offered in children's hospital cafeterias, researchers developed a modified version of the Nutrition Environment Measure Scale for Restaurants or NEMSR as an evaluation tool, and that accounts for various factors including pricing, availability of vegetables, nutrition labeling, combo promotions, and healthy beverages.



From a range of 0 being the least healthy to 37 being the most healthy, the average overall score for the 14 children's hospital food venues was 19.1. Only 7% of a total of 359 entrees served at the hospitals classified as healthy under the criteria. And although almost all hospitals offered healthy alternatives like fruit, less than one-third of the healthy options contain nutrition information at the point of sale or signs that promote eating.

The study's key findings mentioned that although all 14 food venues offered low-fat or skim milk and diet soda, 81% offered high-calorie, high-sugar items such as biscuits and ice cream near the cash register. Only 25% of the children's hospitals sold whole wheat bread and half of the hospitals provided no indication of carrying healthy entrees. Forty-four percent of the hospitals did not offer low-calorie salad dressings.

The researchers presented their findings to hospital administrators, many of whom were surprised at the facts. Many of them subsequently invoked changes at their institutions including lowering the price of salads, eliminating fried foods, and raising the price or eliminating sugary beverages from the cafeterias. Oh, sure, you raise the prices of the sugar beverages. That way, you can still offer unhealthy things and make more money.



Dr. Lesser says, "The steps that some hospitals are taking to improve nutrition and reduce junk food are encouraging. We plan to make this nutritional quality measurement tool available to hospitals around the country to help them assess and improve their food offerings."

According to the researchers, hospitals can improve the food they offer by providing more fruits, vegetables, whole grains, and smaller portions. They can also reduce the amount of low-nutrient choices and offer low-cost options to promote healthy eating by attracting attention through signage and not offering unhealthy impulses at the checkout.

Dr. Lesser adds, "If we can't improve the food environment in our hospitals, how do we expect to improve the health of food in our community? By serving as role models for healthy eating, we can make a small step toward helping children prevent the onset of dietary-related chronic illnesses."



So California's a little bit late to the bandwagon, so to speak, which is a bit unusual. I mean, usually, California, you just kind of think of them as being on the cutting edge. But in this case, it's not.

Here at Nationwide Children's Hospital, we've implemented positive changes in recent years. We have actually eliminated deep fat fryers from room service food preparation and offering healthier baked versions of items like french fries and chicken nuggets. We've also reworked the ingredients of popular food items, reduced calories, and added healthy nutrients.

We offer a healthier selection on the cafeteria menu, which contains less than 600 calories, less than 30% of the calories from fat and less than 600 milligrams of sodium. We also post nutrition information in the cafeteria food court's gift shops and on the hospital's intranet.



We've reduced the size of many snacks and drinks sold in the hospital's gift shops, expanding the healthier snack options that are available and posting educational signage and handouts on how to save calories and make healthy choices.

So how was that for tooting our own horn?

The biggest change that we've made, and this was about a year ago here at Nationwide Children's, we've completely eliminated the sale of all sugar-sweetened beverages across the entire campus. Now why would we do that? Well, it's because, this is really quite shocking, each 12-ounce can of a carbonated sugar-sweetened softdrink contains the equivalent of 10 teaspoons of sugar and enough calories to require soda drinkers to walk 45 minutes to burn off all of the calories that you consume in a 12-ounce can of sugar-sweetened softdrink.

Also, if you drink one 12-ounce can of carbonated sugar-sweetened softdrink each day for a year, you would consume 33.25 pounds of sugar and an extra 54,750 calories, and that's enough calories to gain 15.6 pounds if you weren't offsetting those calories with increased activity.



That's pretty crazy, really, when you think about it. We want to point fingers at the obesity epidemic in America, and I think you've found one of your major culprits right there with sugar-sweetened beverages. That's why we've taken them off of the list of things that you can get in the cafeteria and through room service here at our hospital.

Speaking of sugar-sweetened beverages, according to an investigation published this month in "The American Journal of Public Health", teenagers in Baltimore who saw signs in convenience stores regarding calorie information bought fewer energy drink sodas and other sugary beverages.

The researchers used various methods to communicate caloric information to the teenagers including brightly-colored signs, noting that 20-ounce bottles of soda and fruit drink contain 250 calories, posters highlighting the 50-minute jogging time required to burn off the calories in a 20-ounce bottle of soda or fruit drink, and another sign informing customers that a single sugar-sweetened beverage represents 10% of their daily recommended calories.



Researchers found the signs reduced the probability of adolescents buying sugary beverages by 40% when compared to providing no caloric information at all. Non-sugar-sweetened drinks accounted for 6.7% of all purchases at the start of the investigation, a number that increased to 14% by study's end. So they were definitely choosing non-sugar-sweetened drinks over sugar-sweetened drinks once they saw the signage.

The authors say their research shows teenagers will use caloric information, especially when it's presented in a colorful, easy-to-understand format, to make healthy choices when buying drinks at the local corner store. They add that most consumers underestimate the number of calories in a can of soda and don't realize how quickly the calories add up or how much physical activity is required to offset them.



You know, sometimes we don't give teenagers enough credit for being able to make good decisions, and sometimes they don't make good decisions, but here is a case where it wasn't the parent whispering in their ear. The kids saw the signs and made a choice for themselves and made the right choice. So I think that's definitely saying something for our teenagers and also the influence of signage.

It's always advisable to read the medication label thoroughly before taking any drug, and doubly so when administering a dose to a young child. With that in mind, the FDA has issued a warning in regards to liquid acetaminophen marketed for children. The possibility for confusion and wrong doses has been increased due to the release of a different concentration of the infant formulation of acetaminophen products that will be arriving in pharmacies this winter, and in many cases are already arriving now.



Used for pain relief and to treat fever in infants, the liquid acetaminophen, the infant version of it, was available in an 80-milligram-per-0.8-milliliter concentration. The new product looks identical but requires a larger dose because of a change in concentration to 160 milligrams per five milliliters. The FDA advises parents and caregivers to read packaging thoroughly and ensure they use the correct dose.

Acetaminophen, also known as paracetamol, is widely used especially during the cold and flu season, and it would be easy for someone who previously used the infant version of the product to assume that the dose is identical. But this would lead to an infant getting the wrong dose.

If the new concentration is used with the old dosing recommendations, your baby would get a low and ineffective dose. On the other hand, if the old concentration is used with the new dosing recommendations, your baby would get a higher and potentially dangerous dose of the drug, especially if you kept giving the wrong amount during the course of an illness.



Most manufacturers are changing their product to a lower 160-milligrams-per-five-milliliter concentration, but old product is still on the shelves, setting up parents for possible confusion.

Acetaminophen is marketed under several brand names including Tylenol, Little Fevers, Triaminic, Pedia Care and many store brands including Rite Aid, CVS, and Walgreens. The new lower-concentration versions of acetaminophen may come with an oral syringe instead of a dropper as in the older packaging.

The FDA recommends parents read the drug fact label on the package carefully to identify the concentration of the liquid acetaminophen, to identify the correct dosage and the correct directions for use. Carol Holquist, Director of the FDA's Division of Medical Error Prevention and Analysis said in a statement, "Be very careful when giving your child acetaminophen."



Let's explore a little bit of the history of this. I think it will make it a bit more understandable.

Traditionally, there were two forms of liquid Tylenol that were available, infant Tylenol and children's Tylenol. Those were the original acetaminophen products here in the United States. Now, of course, other manufacturers have jumped on the acetaminophen bandwagon, so acetaminophen is available as different brand names such as, again, Little Fevers, Triaminic, Pedia Care, and lots of different store brand names. So acetaminophen, which is the active ingredient in children's Tylenol and infant Tylenol, is what we're talking about here.

Now there's no difference in the infant version of acetaminophen and the children's version of acetaminophen. There's no difference in the active drug. Acetaminophen is acetaminophen, and the amount of milligrams that we want to give of whether it would be the infant formulation or the child formulation is the same.

The difference, though, came in the concentration with the infant form having a much higher concentration than the children's version. The infant version traditionally of acetaminophen products has been 80 milligrams in 0.8 milliliters.



Those of you who have recently had babies, and even if it's been a little further out, you probably remember that infant Tylenol would come with a dropper that had a 0.4 and a 0.8 on it, and if you went up to the 0.8 on the dropper, you're giving your baby 80 milligrams of medicine.

The children's version, on the other hand, came in 160 milligrams per teaspoon, which is five milliliters. Now, that means the infant version was more concentrated, so you had to give less volume. It's the same drug, it's the same amount of milligrams; it's just because the concentrations are different, the amount that you give is different.

I think the fact, though, that the infant version was way more concentrated, I mean, if you extrapolate out the infant version of it in a teaspoon, the children's version as 160 milligrams, the infant version in a teaspoon has 500 milligrams, which is the same that's in an extra-strength adult Tylenol.



I think most parents find this sort of surprising because there's the sense that an infant product must be gentler and safer than the children's version of the product, right? I mean, if we tell a mom with a baby, 'Hey, you can use the children's version. Here's the dose that you would need to use it,' we usually hear back, 'Are you sure? Is it safe? Is my baby really ready to move up to the children's version instead of the infant version?'

So this sort of two-tier system has, I think, really irritated pediatricians for the longest time, and it's always been a potential source of confusion. Just as an example, if you take a 24-pound 12-month-old, so this is right around the 50th percentile in weight for a one-year-old baby, then the dose for a 24-pound 12-month-old is going to be about 160 milligrams, which only works out to a teaspoon. So to give that 160 milligrams, you give them a teaspoon.



With infant Tylenol, 160 milligrams is 1.6 milliliters or up to the 0.8 line on that dropper twice. This is sounding familiar, right? But if a parent accidentally gave a teaspoon of the infant product instead of a teaspoon of the children's product, they'd be giving their baby 500 milligrams of acetaminophen, and if you do that a few times in the course of a couple days of fever, it could lead to liver failure. It can be quite dangerous to give an overdose of Tylenol.

And that's why the infant Tylenol bottles were so small. Really, it was to protect babies from their parents. If a mom or dad is going through an entire bottle of Tylenol every few doses, hopefully they figure out they're doing something wrong.

Then the next question becomes, well, why did we even have this two-tier system in the first place? That's largely an invention from the marketing people. 'Let's make a unique product. We'll package it up all pretty and make it so parents only have to give a very small volume. We just need this cute little dropper full. That's all that you need.'



Never mind that babies are fine drinking entire bottles full of formula. The volume's not an issue. But when it comes to medicine, parents feel better about giving only a tiny amount. Of course, what they don't realize is they're giving the same amount of the drug, just in a smaller carrier volume, because the concentration was so much higher.

So this new lower concentration of infant acetaminophen that's coming out is really just repackaged children's acetaminophen or children's Tylenol, because now the infant version and the children's version will both be concentrated at 160 milligrams per five mls or a teaspoon. The only difference will be that the infant version comes with a syringe to measure and give it and the children's version will come with a cup to measure and give the medicine.

I think pediatricians everywhere are applauding, because it will be much easier to tell parents how much to give. So this is a good change, and it's one that's been a long time coming. We just need the ibuprofen manufacturers to follow suit and switch to a standard concentration for their infant and children's products as well, because the infant versions of ibuprofen, which is Motrin, Advil, other brand names as well, the infant version has double the concentration of the children's version. So it would be nice to get those standardized across the board as well. But, I know, one battle at a time.



For parents, your battle this winter is to make sure you know which concentration of infant acetaminophen you have in your medicine cabinet and to make sure that you are giving the correct dose.

All right, that concludes our News Parents Can Use. We're going to take a quick break and we're going to be back with a special Research Roundup on basketball. That's coming up!




Mike Patrick: All right, we are back, and we are going to do our Research Roundup. It's been a little while since we've done one of these. We've got three fairly recent articles for you on basketball, so I think parents and grandparents out there who have kids and grandkids playing basketball, this will be of special interest to you.

The first one is a little bit longer ago, but I wanted to include a study that looked at just what is the incidence of basketball injuries. We don't really consider basketball to be a contact sport, and it probably should be when you hear the incidence of injuries.

Now this article, admittedly, is a little bit old. This goes back to May of 1999. Boy, for those of us who grew up listening to Prince and his song, he's going to party "Like It's 1999", and now we're talking about 1999 as if, 'Well, this article is a really old one,' it's pretty crazy.



This comes out of the University of Texas Health Science Center in San Antonio and was published in the "American Journal of Sports Medicine", again, back in May of 1999. We'll put a link to all three of these articles, by the way, to the PubMed online abstract, so if you want to check out the article for yourself, just go to, click on the Show Notes, and we'll have links to all of these articles so that you can check them out for yourself.

The question before the researchers on this one was, among varsity high school boys and girls basketball players, how common are injuries? And I will tell you what, as you're listening to this right now, come up with your own hypothesis. What is your hypothesis? What percentage do you think for boys and girls, get a number in your head, and then we'll go through this article and just see how close you are.



I don't want to give it away. When I did this, I did the same kind of thing, and I kind of came up with probably somewhere between a third and a half, that if you look at all kids who play basketball competitively, both boys and girls, in high school, what percentage do I think would have an injury. Well, I guess first you have to define what's an injury, and we're going to get to that. But I guess, if I had to pick a number in my own head, I came up with somewhere between 33% and 50% I thought was a reasonable number.

OK, let's see what they actually came up with. They took 100 high schools all in Texas, and they did this during the 1996 to 1997 basketball season. In order to be included as a high school in this, you had to have a full-time certified athletic trainer overseeing the program. So we have someone who has some knowledge of sports injuries and how to prevent them there watching these kids and overseeing what the coaches are doing, so hopefully that will help decrease the number of injuries, right? Yeah, right.



We also had to have a school student body of greater than 740 students, so these are large high schools, and the students had to be between the ages of 14 and 18. So if you had any geniuses playing basketball, they're 12 years old and they're in high school, we're not going to count them because their bodies are different, and if you have any guys who are 22 and still in high school for whatever reason, their bodies are different also. We're just looking at 14- to 18-year-olds and their injury rates, at large high schools, with full-time certified athletic trainers overseeing the program.

And then we had a weekly injury report submitted by the athletic trainer. It was a standardized form and results could be sent in on the paper, kind of faxed in, or they could be phoned in, and this was done at the beginning with pre-season practice and it ended with the final game of the season. So from the time the team got together to start conditioning until the very end of the last game, these athletic trainers would send in weekly injury reports.



Now what is an injury? What's a reportable injury that we're going to count as a tick there that, 'Yep, we've got one. Here's another one. Here's another one.' Well, the injury must occur during an organized practice or game and it must result in missed practices or games after the injury occurs. So you have to be injured during a practice or a game that was organized by the school and the team, and then you had to miss a subsequent practice or game because of that injury. Even if it was just one, that counted.

Or if it resulted in a physician counsel. So if you injured yourself and then it was bad enough that you went to the doctor, even if you played in the next game, they did go ahead and count that as a reportable injury. Or if the injury involved the head or the face, then, even if you played the next day, it did count as an injury.

Severe injuries were then defined as requiring hospitalization or surgery.

The injury rate would be defined as, pretty simply, the number of players who sustained at least one injury that met our criteria, divided by the number of players participating in any organized practice or game at that school.



OK, how many kids did we look at?

Well, boys, 75 from the 100 schools actually completed the study, and of those, 92% of the 75 schools submitted all of their weekly reports from pre-season to the end of season. So if they missed a couple here and there, they went ahead and let them still be involved in the numbers, but if they missed too many of them, which 25% of the schools did, they just kicked them out completely and said, 'OK, you're not completing the study because our numbers aren't going to be valid.' For the girls, 80 out of the 100 schools completed the study, with 88% of those 80 schools submitting all 100% of their weekly reports from pre-season to the end of the season.

So the overall participation was 973 boys with an average of 13 participating players per team and 890 girls with an average of 11 participating players per team. So we've got pretty good numbers there, upwards, close to 1,000 for both the boys and the girls.



So what did they find?

The injury rates for boys was 543 out of that 973, so the injury rate for boys was 56%. For girls, it was 436 out of the 890, so theirs was 49%. So for boys, 56%, a little bit more than I had predicted, and girls, 49%, which is at the high end of what I had predicted. How close did you guys come at predicting?

The risk of injury was higher for games compared to organized practices for both boys and girls. That makes sense. People are a little bit more competitive, might be a little more daring and try some potentially dangerous moves during a game compared to practice.



Ankle sprains were the most common for both boys and girls and knee sprains were the second most common for both boys and girls. Of note, girls were 3.79 times more likely to have an anterior cruciate ligament knee injury and boys were more likely to have head, facial and upper extremity injuries.

OK, what about severe injuries? Severe injuries, so these are ones that required hospitalization or surgery, of the boys, 26 out of 973, so it's 2.7%, and girls, 34 out of 890, so that's 3.8%. So right around 3% to 4% on the severe injury incidence.

The authors' conclusions? Basketball injuries are common, about 50%. Severe injuries, though, are less common, about 3% or so.



Again, do these results surprise you? I think, as an emergency department and urgent care doctor, we see lots of basketball injuries. Does this mean that kids shouldn't play basketball, it's just too dangerous to play, half of them are getting injured? No. Basketball is a great exercise, it's a team sport, and the severe injuries aren't too common.

But still, a non-severe injury incidence rate of 50% is high, so we want to do what we can to lower this number. And since ankle injuries were the most common injury for both boys and girls, the next question becomes, how can we minimize ankle injuries for high school basketball players?

That leads us to our next research study that we looked at. This one comes from the University of Wisconsin Sports Medicine Center in Madison and was published in September 2011, so we've got more of an up-to-date article here for you. It was published in the "American Journal of Sports Medicine". Again, we'll have a link to the abstract at PubMed for you over at

The question before these researchers, among high school basketball players, do lace-up ankle braces reduce the incidence and severity of acute first-time and recurrent ankle injuries? So lace-up ankle braces, is this going to help prevent ankle injuries in high school basketball players?



They looked at 1,460 high school student athletes, both boys and girls, and they came from 46 different high schools.

Players were divided into two groups. One group would get no lace-up ankle braces, so just the regular tennis shoes that they're playing with. This is your control group. And then the second group would use lace-up ankle braces, so this is our experimental group. So the experimental group, we're going to have them use lace-up ankle braces. Those are going to be used for both ankles, and anytime that the kids are involved with team-sponsored conditioning practices or games, they must use the ankle braces.



Athletic trainers were going to record ankle injuries and then note how many days were lost of playing due to the injury.

Their injury definition for this particular study was any event occurring during a basketball exposure, so during conditioning, practicing, or games, that forced the athlete to stop participating in the current basketball game or practice or exposure and also prevented the athlete from participating in at least one subsequent exposure. Again, this is an injury definition like the previous study that we looked at. It had to occur during the game, practice or conditioning, and you had to miss at least one more practice, game or conditioning session after that.

So what were the results?

Well, altogether there were 112,439 basketball exposures. So if you look at individual conditioning sessions, practice sessions, or games, we have 112,439 of those. Seventy-six percent of them were conditioning or practice exposures and 24% of them were actual games.



The overall ankle injury rate, so when you look at everybody, the overall rate for this one, for ankle injuries, was at much less than 50%, actually. It was only 16.6%. So 246 of the kids out of the 1,460 had an ankle injury. So 16.6%.

Ligament sprains accounted for 50% of those ankle injuries. They don't really mention what other injuries were noted, whether they were fractures or just bruising or what, but sprains accounted for 50% of all the ankle injuries.

What about the difference between the two groups? Well, if we do the math to make it per 1,000 exposures, so how many injuries per 1,000 practices or conditioning sessions or games, for the braced group, it was 0.47. So 0.47 injuries per 1,000 basketball exposures. For the non-braced groups, this is now the control group, it was 1.41 injuries per 1,000 exposures.



So 0.47 if you used the brace, 1.41 if you didn't use the brace. That difference was statistically significant, meaning it is unlikely that this difference occurred by chance alone.

For those with previous history of ankle injury, the injury occurred 60% less often in the braced group compared to the non-braced group, and for those with no previous history of ankle injury, injury occurred 68% less often in the braced group compared to the non-braced group.

There were no differences in the rate of injuries for either group when you compared boys versus girls, or if you compared grade levels, or if you compared competition level, like junior varsity versus varsity, or if you compared body mass index. Are kids who weigh more have a higher body mass index? Are they more likely to injure their ankles? No, there was no difference when you sorted things out based on those kind of differences.



So it really does seem that the ankle brace was what made the difference there, that there weren't any confounding factors such as boys versus girls, grade levels, competition levels, or body mass index playing a role here.

The authors conclude that the use of lace-up ankle braces reduce the incidence of acute ankle injuries by over three times in high school basketball athletes regardless of sex, age, level of competition or body mass index, and that injury reduction was similar for braced players both with and without a previous ankle injury. So lace-up ankle braces certainly sound like a good idea for boys and girls playing basketball.



A couple other questions come to mind, though.

Do those ankle braces have an effect on performance? So we wear the lace-up ankle braces. That's great. We have less ankle injuries. But does that interfere with how well you play basketball?

And then the next question is then, if you're going to use them, should that be universally required so that everyone's on a level playing field? I mean, you don't want one school to say, 'We're going to be safe. All of our players are going to use lace-up ankle braces,' and they're playing schools that don't use it. I mean, you don't want to have competitive disadvantage necessarily.

Again, I'm not saying right or wrong here that they should be used, but if you're going to make them required, it seems like your competition should have to wear them, too, like in football. I mean, you can't imagine one football team saying you've got to wear pads and helmets and the other team saying no, you don't. Pretty crazy.

But if the first study was right in terms of the incidence and it's really 50%, is this something that we should be doing?



All right. Speaking of basketball performance, our last study looks at the effect of sleep on basketball performance.

This one was done at the college level. The institution that did this study was the Stanford Sleep Disorders Clinic and Research Laboratory. This was published in the journal "Sleep" in July 2011, so another recent article. Again, we'll have the PubMed link for you at

The question before the researchers is, among college athletes, what is the effect of increased sleep on athletic performance?

So this was done at Stanford University. It involved the men's varsity basketball team. There were 26 members of the team and 11 were able to meet the participation requirements, which seems kind of low for looking at numbers. We'd like to have a bigger sample size than this. But when you hear what's involved in this study, you can understand why only 11 of 26 actually were able to meet all of the participation requirements.



So here's what they did. For a two-to-four week period, during basketball season, this is kind of what we call our baseline period, players just maintained their usual sleep/wake patterns. Six to nine hours of nightly sleep was allowed, but they were told not to use alcohol or caffeine during that baseline two-to-four week period.

During the next five to seven weeks, this is also now during basketball season, players extended their nocturnal sleep as much as possible with 10 hours per night being the minimum allowed, and again no alcohol or caffeine was allowed during the study.

And then players kept a daily sleep log and they also wore an activity sensor to corroborate their sleep/wake activity. So they kept a log, but they also kept them on an activity sensor to make sure that they were being honest about how much sleep that they were getting.

And then, their mood was assessed using the profile of Mood States questionnaire, and this has sub-scales for vigor, fatigue, tension, depression, anger, confusion, and total mood disturbance. This was, again, all done during both the baseline time and then during the study time when they had the increased sleep.



Daytime sleepiness was assessed during the baseline period and at the end of the study using the Epworth Sleepiness Scale.

Athletic performance was evaluated in the following way: After each practice, each player would have a timed sprint, shooting accuracy with 10 free throws and 15 three-point throws. They would also rate their subjective mental state on a scale of 1 to 10 and their subjective physical state of a scale of 1 to 10, just how you're feeling physically, how you're feeling mentally, on a scale of 1 to 10 give me the number.

And then twice daily, their reaction time was measured by self-performing the Psychomotor Vigilance Task test on a personal digital assistant or PDA, and then once a week the reaction was directly measured by the investigators.



So there's no wonder that less than half the team actually completed this study and did all the things they were asked to do, because there was a lot.

So what did we get in terms of results?

Well, again, it's a small sample size, but really, the results were phenomenal. There are many parameters and numbers to look at here, and if I just spew them all out, things are going to get confusing in a hurry. So here's a summary of the statistically significant findings without going into all the numbers, because you'll be swimming in numbers if I do that.

In terms of statistically significant findings, sleep extension, so that period of time when they got at least 10 hours of sleep a night, resulted in increased vigor, decreased fatigue, decreased tension, decreased depression, decreased anger, decreased confusion, and decreased daytime sleepiness.



It increased sprint times, it increased free throw accuracy, it increased three-pointer accuracy, and it improved their subjective physical state and improved their subjective mental state. Also, it decreased reaction times.

Again, it did all of these things in a statistically significant way. If you want to see the numbers for yourself, again, we'll have a link at to the actual article.

The authors conclude that these improvements in measurements of basketball performance associated with increased nightly sleep suggest the optimal sleep is likely beneficial in reaching peak athletic performance.

Some pros of this study, they really did a good job of using a wide variety of tools to measure both physical and mental components, so kudos there. Again, cons, small study, limited to one team, they only looked at men, and even though their improvements were statistically significant, the next question to my mind becomes, would they really have made a difference in a game? Did the increased sleep result in a difference in game outcome?



And that's a difficult thing to do a research on. You don't know, would they have won or would they have lost? Could there have been some losses than they won? I mean, it's hypothetical, but just as an interest, just because they did better, did that affect game outcome?

The next question, did it decrease injuries, we've been talking about injuries so I kind of had that in my mind, but that's something that they didn't talk about in the study that would've been nice to see. Was there any difference in injuries when you had increased sleep? Those kind of things weren't addressed.

The reason I ask is because some of the improvements, even though they were statistically significant, when I did look at them, they were still slight. This is the reason I asked would it really have made a difference with game outcomes. Again, I don't want you to swim in the numbers, but just a couple of examples here.



Even though it was statistically significant, free throws on average improved from 7.9 to 8.8 out of 10 throws. Again, do you have enough of an improvement there? Yeah, it is statistically significant, but is it enough of an improvement to change the outcome of a game, which is, if you're playing competitive basketball, ultimately you want to win the game and not have injuries.

Three-pointers on average improved from 10.2 out of 15 throws to 11.6 out of 15 throws. Again, statistically significant, but does that really make a difference in game outcome?

So the extra sleep earned them an extra 0.9 free throws for every 10 shots and an extra 1.4 three-pointers for every 15 shots. Also, these minimal improvements were seen in a quiet gym, not during the adrenaline rush of a game, so given our two previous studies, it would be interesting to know, again, about injury rates and increased sleep, whether that would've made a difference.



So the study kind of leaves me wanting to know more. From an athlete's point of view, it sounds like more sleep is a great idea, although 10-plus hours of sleep in college may not always be realistic when you have grilling athletic schedules and you have all your academics you want to keep on top of and you still want to make some healthy and legal memories with your college friends. I mean, really, folks, we do have to be realistic in our recommendations, and is this one, getting 10 hours of sleep a night, is that one we're going to say college students should do? Does it really make that big of a difference?

Anyway, just all things to keep in mind. You look at a study and it's easy to get glamor in your eyes and say, 'Oh, yes, this is great. College athletic basketball players who are men should get 10 hours of sleep or more,' but then when you really start digging into the numbers, does it make that much of a difference?

All right, that wraps up our last Research Roundup of 2011. We'll be back to wrap up the entire show right after this.




Mike Patrick: All right. It is the last show of 2011 and I just want to kind of wrap up the year here.

We've had some big changes this year. This year, we really saw a rebirth of PediaCast. This is something that we've been doing since 2006, but there was a period of several months when we did not actively produce the show. This year, we revived it and I think it's bigger and better than ever, and hopefully you agree. So it's been an eventful year in terms of just getting the show back up and running and as a resource for parents.



We made the big move here to Nationwide Children's. We were doing this in a home studio in Florida, now we're actually on the campus of Nationwide Children's Hospital, one of the five largest children's hospitals in the country. We're happy to be doing that.

We have incorporated interviews into the show regularly. We did have interviews in the past, but they were done by Skype. We didn't have a guest in the studio and we didn't do nearly the number of interviews prior that we're doing now. But we still tried to keep covering News Parents Can Use and answering your questions and looking at pediatric research and how it can affect your life as a parent.

But still, we want to be better. We want your feedback. Of course, we can't promise to incorporate everybody's idea. I mean, some people want long shows, some people want short shows, some people want more interviews, some less interviews. We can't please everybody, so we're trying to come to a middle-of-the-road place where we can benefit the most number of people. We do want to hear from you in terms of what do you think we're doing well, what we could do better, and any suggestions or ideas for the show that you have moving into 2012.



Because, really, this show is for you. It's not as a marketing machine for this hospital, it's not for me just to be a talking voice out there.

Really, we want you, the listener, to get something out of this show, to really have a great source of information that you can trust and a place where you can come and ask questions, not necessarily for medical advice for your specific child but you just have some general educational questions that you want to know about pediatrics. 'Hey, why do you do this?' 'Why do you do it that way?' 'How does this work?' Those are the questions that we want to be here and be able to answer for you.

Also I want to thank all of you for really being a part of this show, those of you who get to the outro segment or those who are our diehard listeners who listen to the entire show all the way through. I just really want to say thank you for making PediaCast a part of your day and a part of your routine. We really appreciate that.



I know you have lots of choices on where to get your medical and pediatric information, and I just really, from the bottom of my heart, want to say thank you for choosing PediaCast and trusting us as a pediatric source for you.

I also want to remind you to share the show with others who may not have heard about it. We don't have a big marketing budget here at PediaCast to get the word out, so we really rely on you.

iTunes reviews are helpful. If you have never done an iTunes review, it really does not take a long time at all. Literally you can write a review in a couple of minutes. So if you go to iTunes and just review the show, we really appreciate that. I know, since I've been kind of pushing that the last couple of episodes and we have had some new reviews and I appreciate it, but we could always use more of those.



Because a lot of people, when you're looking to see, I don't know, when I'm in the App store of my iPhone, that's the first thing I do, or at Amazon, you're looking at a product, well, what kind of reviews does it get? That's what I want to know. I want to read people's reviews, see if I want to check it out. So I think the iTunes reviews really are helpful when other people are looking for a source of information and to subscribe to our show.

Also, if you run a blog, you're on Facebook, which I think most of you probably are, or you have a Twitter account, we really appreciate any mentions in your blogs, on Facebook and in your tweets.

We also have a new fancy-dancy website where we are encouraging community participation. If you have a comment about this particular episode, go to and go to the Show Notes page, find Episode 193, and make your comment there so other people can join in, hear what you have to say. Maybe you have some helpful ideas or hints or tips for basketball, for example, how do you keep your kids safe, do you talk to them about injuries, do you talk to the coaches about injuries, do your kids use lace-up ankle braces, what's your experience been with them. All those kind of things, just head on over to the show notes blog and make a comment, and we'll get people talking



Of course, we do have the PediaCast flyer available under the Resources tab at the website. If you could take one of those into your doctor, we would really appreciate it just so that they know about the program. Even if you're far away from Nationwide Children's, we want this resource to be there for everyone in the entire world, not just those in Central Ohio.

Finally, I want to remind you, if there is a topic that you would like us to talk about or you have a suggestion or an idea for the show,, the Contact link, I can't say that enough times, or you can also email or call the voice line, 347-404-KIDS. No, you're not going to get someone answering that phone; it's a voicemail box. But I listen to all the messages. Just leave your message there and maybe we'll get you on the show that way.

All right. Well, again, it's been a great 2011. Really looking forward to 2012. I just appreciate this audience so much.



And until next time, this is Dr. Mike saying Happy New Year, and also stay safe, stay healthy, and stay involved with your kids. So long, everybody!


Announcer 2: This program is a production of Nationwide Children's. Thanks for listening! We'll see you next time on PediaCast.

One thought on “Noisy Toys, Tylenol Warning, Basketball Research – PediaCast 193

  1. I enjoyed your segment on noisy toys. One strategy we use in our house for really noisy toys is to cover the speaker with packing or duct tape. This helps to dampen the noise to a more tolerable level. I even have the different colored duct tapes so that the tape doesn’t detract from the look of the toy. 🙂 Keep up the great work! I love the show!

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