Your frequent questions answered by the experts at Nationwide Children's Hospital

Our daughter, an eighth grader, has been playing soccer for a while now. I'm nervous about her continuing with the sport because I see how many girls in high school blow out their knees. Why does this happen so much and is there anything we can do to help protect her health? If something does happen, what's the best way to handle it?

Knee injuries are becoming increasingly common in sports. However, there are some ways to help prevent them.
The most current research shows that girls injure their knees (usually ACL ligament tears) approximately four to eight times more often than boys of the same age. There are many theories for why this happens. The most widely accepted is that girls have slightly different mechanics of jumping and landing and have different muscle forces across the knee joint than boys do.
It is virtually impossible to totally prevent this type of knee injury, but there are many things that can help decrease a child's risk:
During workouts, always make sure they warm up and cool down. Have them engage in core and balance training to improve their functional body control. Encourage them to do regular stretching to improve their range of motion and help decrease the tension on growth plates. When jumping, make sure your child bends the knees while landing and keeps the toes in sight. This takes pressure off the ACL and helps prevent injury. Injury prevention programs for athletes and coaching education, like the ones offered at Nationwide Children's Sports Medicine, are also ways to help. If an injury does occur, use ice on the injured knee and seek medical attention as soon as possible. Early diagnosis and intervention is critical for an overall successful recovery.

Kerry Waple is the Senior Athletic Trainer with Nationwide Children's Sports Medicine. She is a certified and licensed athletic trainer and a certified strength and conditioning specialist.


I hear a lot about the importance of hydration with youth sports, but then I've heard there's a growing problem with overhydration. What is it, what are the warning signs, and how do you prevent it from occurring?
When an athlete drinks too much plain water compared to how much salt they have in their system, they dilute the concentration of salt in their blood, resulting in a condition called "hyponatremia," also known as "overhydration." Athletes are prone to this condition when they exercise for long periods of time in the heat, due to prolonged and excessive sweating without appropriate salt replacement.

This usually occurs during events that last longer than 60 to 90 minutes, like all-day outdoor tournaments or two-a-day football practices. There have also been cases of hyponatremia in very young children who drink too much pool water during a swimming lesson.

A child with hyponatremia may first show symptoms of lethargy or confusion, but these symptoms can progress to unresponsiveness or seizures. In very rare cases, hyponatremia can lead to death.

Prevention of hyponatremia consists of introducing salts into the diets of those who have been exercising for long periods of time. Energy drinks that contain electrolytes have salts in them, and should be consumed instead of water during activities lasting longer than 60 to 90 minutes, especially in the heat. Children can also eat salty snacks during the day for their long events, such as pretzels or crackers.

Dr. Anastasia Fischer is a member of Sports Medicine and the Section of Ambulatory Pediatrics at Nationwide Children's Hospital.

My child wants to run track and has to get a physical. I've heard a lot about screening for sudden cardiac death (SCD) and can't help but be a little worried about it. What is it and how do you get screened for it?
Sudden cardiac death is generally described as an unexpected death resulting from sudden cardiac arrest.

The causes of SCD in children are very diverse and may include heart defects present at birth. Cardiomyopathies, which can be genetic or develop after infections, are another potential cause of sudden cardiac death.

Although there are no national mandated standards for screening student-athletes in the U.S., in 2007 the committee from the American Heart Association published updated recommendations aimed at getting a more detailed history and physical examination.

A screening checklist also been developed by some schools and pediatricians for extra precaution. The checklist asks all relevant questions related to family history or past symptoms that may call for further investigation.

The Heart Center at Nationwide Children's offers outpatient cardiology services within Columbus, and at numerous locations throughout central and southern Ohio. Patient evaluations for infants, children and adolescents, as well as cardiology clearance for school sports participation are some of the available services.
If you have additional questions about your child's participation in sports, contact your family pediatrician.

Dr. Kerry Rosen is the Director of Outpatient Cardiology Services for The Heart Center at Nationwide Children's Hospital.

Tip of the Month: Good Sports: 5 ways to reduce the risk of injury

Wear protective gear: Protective gear is anything you wear that helps keep you from getting hurt. The gear you wear depends on the sport you play.
Warm up: It's not a good idea to just bolt onto the field. Take a light jog to get loosened up and ready to play.
Know the rules of the game: When players understand what's legal and what's not, fewer injuries happen.
Watch out for others: Some rules don't have anything to do with scoring points or penalties. Some rules are just about protecting other people and being courteous.
Don't play when you're injured: Playing when you're hurt, or before an injury is fully healed, can lead to an even worse injury that might sideline you for a long time. Make sure you seek proper rest and treatment before returning to a game.

Watch Pediatric HealthSource at 5 p.m. Thursdays on 10TV News HD. To learn more about Nationwide Children's Hospital, visit www.NationwideChildrens.org