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Dance Medicine is a Growing Specialty at Children’s

Dr. Reed Estes is the Chief of UAB Sports Medicine at Children’s of Alabama and an Assistant Professor at UAB. He treats young athletes, and has developed a growing specialty in dance medicine. He has worked with performers in the Boston Ballet and many other professional and amateur dance companies.

Dance, like any other physical activity, produces its share of injuries, particularly in children Dr. Reed Estes and patientand teenagers. There are sprains, strains, broken bones, bumps and bruises. The more serious injuries often require specialized care and rehabilitation aimed at getting dancers back on their feet and toes. It’s important to understand when and why this specialized care is needed.

Dance injuries account for a steadily increasing volume of my sports medicine practice at Children’s of Alabama. We provide and coordinate care across the many specialties at Children’s, and we work closely with Agile Physical Therapy, which greatly enhances our ability to serve dancers. We conduct clinics at dance studios, and see patients from throughout the southeastern U.S.

Dance injuries are fairly common. On average, 23 children are treated every day in U.S. emergency rooms for some type of dance-related injury, according to a recent study published in the Journal of Physical Activity and Health. That same study also found that the number of serious, dance-related injuries increased 37 percent from 1991 to 2007, climbing from 6,175 to 8,477 annually.

Some dancers come to us just to be checked when approaching a new, more difficult level of performance, such as beginning pre-pointe participation with ballet. Others have been injured, and come to us for specialized care. We understand the mentality of dancers and the things they need to prepare for. It’s considerably different than the way we treat our football players or soccer players.

For example, when a football player tears his anterior cruciate ligament, or ACL, we focus rehabilitation on strengthening his core movements to get him back on the field, specifically to the demands required of a contact athlete. In dance, there are different requirements. A dancer must not only be limber and able to accomplish difficult tasks in an aesthetically pleasing manner, but also maintain full stamina. Rehabilitation for a dancer focuses on that.

Not all injuries require a dance medicine specialist. I tell patients and families to watch for pain that is ongoing, persistent and may be causing disability. Pain that is present with one particular activity, every time it occurs, may indicate a need for medical intervention. Likewise, pain that progresses with a decreasing level of activity often poses a warning sign.

Of course, the best medicine is prevention, and there are things that parents can do with a child who is a dancer. Watch for fatigue, monitor dietary habits, ensure that sleep is sufficient and know when a child or teenager is under stress with projects at school. Understand how that affects them when they are in the dance studio, when they are under duress and fatigued. Young dancers tend to eat poorly and not

get enough sleep before performances when life becomes stressful. There’s only so much time in the day to practice and do homework.

Many times, teenage dancers will remain silent when they are injured. There is often a fear that their instructor may be upset with them, their classmates may lose faith in them, or they may lose their roles in performances. Oftentimes, it requires the parent watching closely and saying, “I noticed my daughter was icing down her ankle or rubbing down her knee.” Parents should be mindful of those things.

Also, we encourage parents to watch for the level of pain after dance. We usually advise that a low level of pain is acceptable some of the time. That’s a 4 or 5 out of 10, on occasion, and is often a symptom of soreness, as opposed to something that is more persistent.

Remember, most sports are seasonal, but dance is a year-round pursuit with little downtime. Thus, my mentality has to change when treating a dancer.

Cutting Sugar

Most parents at some point have uttered the phrase, “My child has such a sweet tooth!” And yet few parents do anything about it.  We hear time and again that children have too much sugar in their diets. Cutting sugar isn’t a simple task. But it’s an important one.

“One third of children in the U.S. are affected by overweight and obesity,” said Beverly Haynes, RN, nurse clinician in the Weight Management Clinic at Children’s of Alabama. “We know that this leads to a multitude of even more serious diseases such as hypertension, diabetes, heart disease, liver disease, joint problems and many more.”

One way to cut down on sugar is to reduce or eliminate the obvious offenders. Parents can easily restrict candy and products like maple syrup, honey and jellies. Eliminating sugar-sweetened drinks like sodas and fruit juices alone can make a huge impact! Consider these facts:

  • Each 12-ounce serving of a carbonated, sweetened soft drink contains the equivalent of 10 teaspoons of sugar and 150 calories. Sweetened drinks are the largest source of added sugar in the daily diets of U.S. children.
  • Consuming one 12-ounce sweetened soft drink per day increases a child’s risk of obesity.

But it’s important to know that many foods contain “hidden sugars.”  Products not normally considered “sweet” can have a lot of sugar in them.  Examples are peanut butter, salad dressings, and ketchup.

In addition, the carbohydrates in highly refined foods with simple sugars, such as white flour and white rice, are easily broken down and cause blood sugar levels to rise quickly.  Complex carbs, found in whole grains, on the other hand, are broken down more slowly, allowing blood sugar to rise more gradually.

According to Beverly, the best source of sugar is fruits and vegetables.  Instead of soda or juice drinks, serve low-fat milk, water or 100 percent fruit juice. A word of caution: although there’s no added sugar in 100 percent fruit juice, the calories from those natural sugars can add up. So limit juice intake to 4-6 ounces for children under 7 years old, and no more than 8-12 ounces for older kids and teens.

To find out if a food has added sugar, look at the ingredient list for sugar, corn syrup or sweetener, dextrose, fructose, honey or molasses. Avoid products that have sugar or other sweeteners high on the ingredient list.

Children’s weight management experts will never tell a patient they can’t enjoy an occasional slice of birthday cake. Occasional treats are okay. The key is that parents are aware of the amount of sugar in their children’s diet, and that they stay informed by reading the labels on foods and setting limits. Above all, it’s important for parents to be a good role model. Kids will see mom and dad’s wholesome habits and adopt them, leading to a healthier lifestyle throughout childhood and into adulthood.

Carbon Monoxide Dangers

While carbon monoxide may come to mind more frequently during winter months, it’s actually a year-round hazard. Knowing how your family can be exposed to carbon monoxide can keep them safe from this colorless, odorless, tasteless, poisonous gas.  carbonmonoxide

Carbon monoxide is produced when you burn fuel in cars or trucks, small engines, stoves, lanterns, grills, fireplaces, gas ranges or furnaces.  It is one of the leading causes of poisoning deaths in the United States. Carbon monoxide poisoning accounts for approximately 40,000 to 50,000 emergency room visits and 5,000 to 6,000 deaths annually in the United States. Yet all instances of carbon poisonings are preventable.

“Carbon monoxide detectors should be installed in addition to smoke detectors. If your smoke detector goes off and there is a fire, you could be exposed to carbon monoxide. However, you can be exposed to carbon monoxide even if there isn’t a fire. That’s why it’s so important to have both a smoke and carbon monoxide detector in the home,” said Ann Slattery, DrPH, RN, RPh, CSPI, DABAT, managing director, Regional Poison Control Center at Children’s of Alabama.

If your carbon monoxide detector goes off:

  • leave the home and immediately seek fresh air
  • call 911 for the fire department to inspect the home
  • call the Poison Control Center at 1-800-222-1222 if there are signs and symptoms of carbon monoxide exposure

The most common symptoms of carbon monoxide exposure are headache, fatigue, dizziness, weakness, nausea, vomiting, chest pain and confusion.

“One of the hallmarks of carbon monoxide exposure is multiple people sick at the same time. Unlike a virus that takes its time working through the household, carbon monoxide will affect everyone in the home at the same time.” Slattery said.

As warm weather approaches, you may already be thinking about your favorite outdoor activities. Keep in mind that you could be exposed to carbon monoxide through:

  • Generators — Don’t use a generator inside the home, garage or basement or near windows. Spring often brings severe weather to Alabama, so be cautious when using a generator during a power outage.
  • Grilling — Never burn charcoal indoors or use a portable camp stove in a garage.
  • Camping — Never use a kerosene lantern inside a tent.
  • Boating — Carbon monoxide from engine exhaust builds up inside and outside the boat in areas near exhaust vents. Swim and play away from areas where engines vent their exhaust. Dock, beach, or anchor at least 20 feet away from the nearest boat that is running a generator or engine. Exhaust from a nearby vessel can send CO into the cabin and cockpit of a boat.
  • Gasoline-powered tools — Never use gasoline-powered tools such as pressure washers and leaf blowers indoors or in a garage, carport or basement. These tools can produce significant amounts of carbon dioxide that can quickly build up to dangerous levels.

The Regional Poison Control Center at Children’s of Alabama was established in 1958. The center handles more than 50,000 poison calls annually, plus more than 60,000 follow-up calls. For more information, visit https://www.childrensal.org/rpcc.