Promoting healthy play

A year has passed since UC Irvine inaugurated the “Children at Play” photo contest to raise awareness about the role of exercise in children’s health and growth. The response has been great, as evidenced by the wonderful photos seen here. And, 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, such as the use of performance enhancing drugs. And, oh yes, how old were those gymnasts?

These issues bring into focus a troubling aspect of children’s exercise. Vigorous physical activity is necessary for 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 certain 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 surprising. For our distant ancestors, the ability to flee a rapidly advancing saber-toothed tiger was clearly life saving. Humans pushed themselves to journey over yet another hill, overcoming thirst, hunger and fatigue, to search for new food sources. Their internal structure of muscle, bones, blood vessels and nerves, combined with a brain capable of overriding physiological signals in order to achieve an abstract goal (e.g., finding food), made humans one of the most adaptable creatures.

But those abilities harbor the potential for injury. For example, we know that even brief exercise in adults and children activates the immune system. While this is often beneficial (it prepares the body to heal wounds), immune activation also can be dangerous. In rare instances, people experience anaphylactic shock with exercise – a condition in which the activated but 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 understand completely why this occurs, but exercise-induced asthma is related to a 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 otherwise permit them safely to throw a football or dance on toe. Excessive training of growing muscles, bones and joints can cause harm that sets the stage for chronic, lifelong injury. Protective sports gear can help, but it never can replace common sense and caution by parents and coaches.

Some studies suggest that with more children participating in competitive sports, more injuries and overuse syndromes will occur. Like many other areas in child health, this issue is generally poorly studied. To better understand the consequences of these injuries, researchers need to analyze them and the circumstances under which they occur, 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 exercise danger − 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. 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 no consensus about how to best screen young athletes for latent conditions, or how to staff and equip youth sporting events with potentially life-saving personnel and equipment.

A first-of-its-kind Orange County task force, including leaders from Children’s Hospital of Orange County, UC Irvine, Orange County Department 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. The group 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.

About the contest: Winning entries in the “Children at Play” photo contest will be on display all day Saturday, Sept. 27, at the Festival of Children in South Coast Plaza, 3333 Bristol St., Costa Mesa. Prizes will be awarded at a 4 p.m. presentation onstage at the plaza’s Carousel Court. The second annual contest, sponsored by UC Irvine, Children’s Hospital of Orange County and The Orange County Register kicked off in July and concluded Sept. 1.