Steven Ross: Giving the right tools
May 6, 2013
Each spring, many parents receive a notice from school that it is once again time for their teenage children to have a sports physical. Increasingly, our nation's youths have discovered the benefits of participating in sports to have adequate physical activity for weight control and to develop an appreciation of leadership skills and teamwork. These sports physicals will satisfy the school's legal and liability requirements, and in many cases the sports exams are a wonderful fundraiser for school band uniforms and the like.
But are the schools really the right folks to direct the best medical evaluations of our children? Are our underfunded schools the right institution for providing medical care to our children?
It was the American Academy of Emergency Medicine that reported the escalating emergency room visits for cheerleading injuries nationwide. The rate of head and spinal trauma and life-threatening injuries among high school cheerleaders "has startled researchers," the report stated. It was the Centers for Disease Control and Prevention that brought attention to the epidemic of high school sports-related traumatic brain injuries and concussions, and provided instructions for coaches through "Heads Up: Concussion in High School Sports."
The American Academy of Pediatrics was quick to point out that sports-related concussions were "a common injury that likely is under-reported by pediatric and adolescent athletes. Football has the highest incidence of concussion, but girls have higher concussion rates than boys do in similar sports." Just last month, the American Academy of Neurology revised its "guidelines for handling concussions to emphasize treating athletes case by case rather than according to a predetermined scale."
On the American Academy of Pediatrics' website are remarks defining the actual medical standard of care for our children ("Every child and youth deserves a medical home"). A family medicine or pediatric practice today works in partnership with our communities' families to provide comprehensive medical care.
The value of the sports pre-participation evaluation has been questioned in recent years. A recent review of all available medical literature on this subject concluded that the evaluation did little to prevent injury or death in screened athletes and is ineffective for identifying athletes at risk for sudden cardiac death.
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On the official AAP website is the article "Beyond the Athlete's Physical," which states, "The mass school physical can certainly provide a quick identification of immediate danger to a child in relation to the child's participation in sports. But it is not a substitute for a general physical performed by the family pediatrician. Mass physicals are not as detailed or in-depth as a pediatrician's exam. Of course, there's nothing wrong at all with the child having both a pediatric exam with the family doctor and the school-sponsored sports exam."
In "Pediatrics," the University of California — San Francisco published similar concerns for our youths: "Few adolescents received a preventive visit; among those who received this visit, provision of recommended anticipatory guidance was very low. Strategies are required to improve delivery of recommended preventive services to adolescents. Only 38 percent of adolescents received a preventive visit in the past year, despite broad professional consensus recommending an annual preventive visit for adolescents. Clinical preventive service guidelines for adolescents have been issued by several professional medical and governmental organizations, including the American Academy of Pediatrics (AAP), the American Medical Association, the American Academy of Family Practitioners, and the Maternal and Child Health Bureau. These guidelines recommend an annual well-child visit in which clinicians conduct a physical examination and screen and counsel for health-related behaviors."
The children of Yampa Valley deserve a bright future. Shouldn't we parents give them the tools to obtain it?
Steven Ross, MD, FAAP
Sleeping Bear Pediatrics, Steamboat Springs