 CHILDREN AT PLAY: This photo won 1st place in the "Children At Play" category of the Children at Play photo contest sponsored by Children's Hospital of Orange County, UCI Pediatric Exercise Research Center, and The Orange County Register. COURTESY OF KAILEY BARTH
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Exercise common sense to keep kids fit and safe
Children need activity, but adults must be aware of the potential for harm.
Editor's note: This is the first in a three-part series of essays by UCI pediatrician Dr. Dan Cooper on children and exercise. The photos are winners from this summer's Children at Play photo contest, sponsored by The Orange County Register, UC Irvine's Pediatric Exercise Research Center, and Children's Hospital of Orange County.
A year has passed since we inaugurated the Children at Play photo contest to raise awareness about the role exercise plays in health and growth in children, and the response has been great, as evidenced by the wonderful photos seen here.
Much has happened to remind us of how important exercise is to children. We were all enthralled by the spectacle of the Olympic Games. While so much of the competition was particularly exciting to Orange County (read swimming), the negative side of extreme competition also came to light: the use of performance enhancing drugs.
And, oh yes, how old were those gymnasts?
These issues bring into focus a troubling aspect of exercise in children. Vigorous physical activity is necessary for children's optimal physical, social and intellectual development, but some aspects of exercise and competition are dangerous.
As a young pediatrician, I was taught to remember Hippocrates' admonition, "First, do no harm!" So let's pause to consider how exercise – increasingly viewed as a "treatment" for obesity, diabetes, and other conditions – can, in limited circumstances, be dangerous. What can we do to ensure that children get the most benefit from their participation in sports, play, and all forms of exercise?
The reason exercise may sometimes be unhealthy is not that surprising. For our distant ancestors, the ability to flee a rapidly advancing saber-toothed tiger clearly was life-saving. Humans pushed themselves to journey over yet another hill, overcoming thirst, hunger, and fatigue, to search for new food sources.
This built-in structure of muscle, bones, blood vessels and nerves, combined with a brain capable of overriding physiological signals in order to achieve an abstract goal (finding food), made humans one of the most adaptable of creatures.
But our ability to exercise to survive also harbors the potential for injury. For example, we know now that even brief exercise in adults and children activates the immune system. While this is often beneficial, (it prepares the body to heal wounds incurred while hunting, for example) immune activation also can be dangerous. In rare instances, people experience anaphylactic shock with exercise – a condition in which the unregulated immune system leads to breathing difficulty and low blood pressure.
Much more common, particularly in children, is exercise-associated asthma – a narrowing of the airways that makes breathing difficult. We do not completely understand why this occurs, but exercise-induced asthma is related to poorly controlled immune response inaugurated by physical activity.
Vigorous exercise in children also can cause injury. Children's muscles are capable of producing forces so large that, on occasion, they damage the architecture of bone, ligaments and tendons that permit us to throw a football or dance on toe. Excessive training of growing muscles, bones, and joints can cause immediate injury and set the stage for chronic, lifelong injury.
Protective sports gear can help, but can never replace common sense and caution by parents and coaches.
Some studies suggest that with more children participating in competitive sports come more injuries and overuse syndromes. Like many other areas in child health, this issue is generally poorly studied. Researchers need to objectively count and categorize injuries associated with exercise in children, better understand the consequence of those injuries, and develop strategies to prevent and treat them. This will ensure that sports remain the healthiest of activities for kids and teens.
Finally, we must address the most tragic of dangers, sudden death. This is a rare event, but when an active teen dies suddenly while running cross-country or playing football, the tragedy is enormous, as we have witnessed recently in our own community.
In some cases, difficult-to-detect abnormalities in the electrical circuitry of the heart are responsible. Poorly treated asthma, severe dehydration, or impaired immune function also may play a role. There is still no consensus about how best to screen young athletes or staff and equip youth sporting events.
A first-of-its-kind Orange County task force, including leaders from Children's Hospital of Orange County, UC Irvine, Orange County Dept. of Education, County of Orange Health Care Agency, and concerned parents, teachers, and coaches is examining compelling data about ways to prevent sudden death in young athletes. It will prepare an action plan that we hope will influence policy throughout our region.
What do we do in the meantime? Those of us who believe all children have the right to play in healthy environments that promote physical and mental development can take several steps.
First, learn basic cardiopulmonary life support. Recognizing when a child is in trouble and calling for help can make the difference between life and death. Even school children can learn the basic techniques. British researchers studied children as young as 9 who had learned resuscitation techniques in the Heartstart UK program.
The small investment of time necessary to learn basic CPR could save a life. It's all part of making our "Children at Play" photo contest a fun wake-up call for a healthier Orange County.
Contact the writer: Dr. Dan Cooper is chief of pediatric pulmonology at UCI Irvine Medical Center and director of the Center of the Study of Health Effects of Exercise in Children. He can be reached at dcooper@uci.edu.
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