Ask the Experts

Written by Katie Harlow

Our Experts on Young Athlete Deaths, Discipline and Eye Care

June Experts:

Dr. Anjan Batra is the medical director of electrophysiology at the CHOC Children's Heart Institute. For more information about CHOC Children’s, visit www.choc.org.

Susan Kelsey is a licensed Marriage and Family Therapist based in Orange County. For more information about Susan, visit www.CounselingCalifornia.com.

Dr. Eliot Grossman is the current Vice President of Eye Care at LensCrafters. His career path has carried him to Aliso Viejo, where he currently resides.

Preventing Young Athlete Deaths

Q (Teens): Over the past six months, I have heard a disturbing number of stories about young healthy athletes dying of sudden heart problems. My teenage son is a star soccer player and I'm concerned for him. What can I do to assure his health?

A: The sudden death of a young athlete is a tragic occurrence that causes significant concern in both the general public and medical community. Strategies to prevent these catastrophes have become a prominent public health debate. Sudden cardiac death is a critical topic capturing national attention due to the increase of incidences on and off the field. However, more awareness is needed to help prevent tragedies and save lives.

Prevalence and Rates of Sudden Cardiac Death

The United States boasts approximately 25 million competitive athletes and 10 million high school and college athletes. We do not know exactly how many athletes die each year as there is no national registry keeping track of these numbers. The risk for sudden cardiac death for the young competitive-athlete population is estimated to be 2 per 100,000 persons per year. The risk for sudden cardiac death rises with increased peak intensity of exercise and increased level of competition.

Routine Electrocardiogram (ECG) Recordings in Young Athletes

Doctors can uncover many heart problems through screenings before a child or teen enters competition. Screenings can detect heart defects that might lead to sudden death during competition and they may also help prevent a heart problem from getting worse. To help avoid incidences of sudden cardiac death, medical experts advocate adding an electrocardiogram (ECG) test to the athlete pre-activity screening process. An ECG has the potential to detect conditions associated with exercise-induced cardiac arrhythmias and sudden death. Abnormal ECGs are common in some conditions such as hypertrophic cardiomyopathy (in which as many as 90 percent of ECGs are abnormal). Other conditions associated with sudden death during exertion may not be detected with a resting ECG. As an example of its importance within the competitive sports community, The International Olympic Committee based in Switzerland and the European Society of Cardiology advocate routine ECGs in addition to the history-taking and physical examination for routine screening of all young competitive athletes.

Orange County Is Taking Action

We are proud that Orange County is at the forefront of improved awareness and implementation of strategies for the prevention of sudden cardiac arrest in our youth. The county has the largest number of per capita NCAA and Olympic athletes in the United States and a significant amount of youth involved in sports. Within the last year, there have been three deaths of high school athletes reported by the media. In addition there were other cases not reported by the media because the athlete went on to succumb to irreversible neurological injury or completely recovered.

The Life Threatening Events Associated with Pediatric Sports (LEAPS) initiative emerged in Orange County three years ago. This included an annual symposium with local and national experts in the area geared towards school educators, nurses, parents and physicians in the community. Task forces were created for screening activities including ECGs, implementation of an Automated External Defibrillator (AED) program in the schools, and improved CPR training within schools.

As a direct result of the LEAPS initiative, a screening program was implemented in collaboration with various organizations, including the Orange County Department of Education, local hospitals, and physician and staff volunteers. Other LEAPS strategies include the implementation of an AED program and improved CPR training within schools.

What You Can Do - Look for Warning Signs

Parents should look for warning signs that could indicate their young athlete may have a heart problem. This is especially true if symptoms occur during sports or other activities. It's important to ask if your child has:

• Been dizzy or light-headed
• Passed out or nearly passed out
• Had chest pain or pressure
• Felt like his heart was racing or skipping beats

Although these signs do not necessarily mean your child has a heart problem, talk with your child's doctor. Identifying the cause of these symptoms is the first step to keeping your child healthy.
 - Dr. Anjan Batra

Discipline Decisions

Q (Toddler): When is a child too young to be disciplined? I have been successfully redirecting my toddler from things I don't want him to do, but his grandparents think he should be punished when he gets into things so he will learn. Who's right?

A: One of the biggest challenges for parents is trying to navigate all of the well-intended advice from loving friends and family regarding how we discipline our children. There are many discipline styles that parents can employ which are taken from how they were disciplined by their own parents, reading parenting books, advice taken from friends and family, taking parenting classes, etc.

What is discipline?

I find it helpful to remember that the word "discipline" is related to the word "disciple," which is defined as a student of a mentor or teacher. Parents are their child's first teacher, and I find it helpful to decide on discipline strategies from that perspective - your job is to teach and provide a role model for your child.

Matching Discipline to Your Child's Age

Just as a teacher would never consider teaching calculus to a first grader, parents should match their discipline strategies to their child's developmental age. Toddlers are naturally curious about their environment and are unaware of safety concerns or social propriety so it's very appropriate for parents to redirect a toddler to a safer or more suitable activity if they are doing something you don't want them to do. As you redirect them, you might say, "Climbing on the bookcase is not safe, but you can climb on this slide." Take time to learn about child development so you can be clearer on age appropriate strategies to use as your children grow and change.

As children get older, discipline strategies should evolve to match their developmental needs. For instance, a weekly "star chart" for doing simple chores might be appropriate to teach a seven-year-old the value of working together as a family, but it would likely be ineffective for a four-year-old who has not yet developed a sense of delayed gratification.

Is It Necessary to Punish a Child in Order For Them to Learn?

I don't think it's necessary to "punish" anyone in order for him or her to learn. I think people learn best when they feel respected, supported, and when they can trust that their teacher is wise and has their best interest in mind. It should be safe for children to try new things and make mistakes as they learn without fear of shame and guilt.

Setting Rules and Consequences Parents should set clear rules and logical consequences (which can be done as a family with older children). An example of a rule for an older child might be "Respect the property of others," and a corresponding consequence might be "If you break or lose something belonging to someone else, you must replace it using your own money." Rules and consequences should be followed with consistency or they lose their meaning and value.

So What Should You Do With That Well-Meaning Advice Given By Friends and Family? Be kind and listen and take their suggestions into consideration - appreciate that your friends and family are just trying to help you. Keep what fits for you and discard the rest. Educate yourself on child development and find a parenting style that fits for you. Learn to trust in your own wisdom as a parent. Remember that you are your child's mentor, and you will teach him what he needs to learn to be a good citizen - in your own unique style. - Susan Kelsey

When Sun Gets in Their Eyes

Q (All Ages):  As a parent, I'm well aware of how important it is to protect my child's skin from sun exposure, but are there measures that I should be taking to protect their eyes as well? If so, how can I make sure that my child is safe from the sun?

A: According to the World Health Organization, up to 80 percent of a person's lifetime exposure to UV is received before the age of 18. While we all know how important it is for children to be active, especially at a young age, it is equally important that they are fully protected from the elements each time they step outside.

Besides the fact that they simply spend more time outside, children are the most physiologically susceptible to UV damage because their eyes' lenses are much more transparent than adults' lenses. In the least, if it's bright enough for you to wear sunglasses, your child should be wearing them too.

The best way to protect your child's eyes from the sun and improve their overall visual comfort is to equip them with sunglasses or prescription sunglasses that block at least 99 percent of UVA and UVB rays whenever they head outdoors; the same way you would use sunscreen to protect their skin. Add a wide brim hat to offer even more protection on brighter days.

UV rays are strongest between the hours of 10 a.m. and 2 p.m., prime hours for play dates, trips to the beach, and recess. This applies to overcast days as much as it does to sunny days, as ultraviolet radiation passes through clouds without losing its intensity. Children should also wear sunglasses in shaded areas since UV rays can bounce off of buildings, roads, and other surfaces. If your child requires vision correction, consider prescription sunglasses, especially for children who are too young for contact lenses.

For parents in southern locales or mountainous regions, it's important to note that the sun's rays become stronger closer to the Earth's equator and greater at higher altitudes. Also, when on family vacations, keep in mind that UV rays are more harmful against reflective surfaces like water or sand.
Polarization is another important factor to consider when choosing your family's sunglasses. Polarized lenses aide in protecting young eyes from UV rays while significantly reducing glare. Outdoor activities such as fishing, boating, golfing, skiing, biking or driving are greatly enhanced by polarized lenses by helping you and your child see the world more clearly.

Of course, none of this information matters if you can't get your children to actually wear their eyewear. The key is to get them excited about their new sunglasses so that they want to wear them, rather than feeling like they have to. The more your child likes and feels comfortable in the glasses and sunglasses they wear, the more likely they are to wear them.

Regardless of your child's age, it's important for sunglasses to feel comfortable on their face. Make sure to have their shades adjusted by an optician so that they don't slip down their nose. This will enhance protection and achieve a more comfortable fit.

In addition to fit you'll want to think about function. If your child is active you should consider a pair of sport frames that are designed for a closer fit - some even come with an adjustable strap, which will help the frame stay in place.

The final step in protecting your child's eyes from potential risks and damage is to schedule an annual eye exam with an eye care professional. This helps to ensure that any changes in their eyes are monitored and possible eye disorders are detected and treated early. {jcomments on}
 - Dr. Eliot Grossman