Transitioning suddenly from an over-scheduled routine to an under-scheduled, and hopefully temporary lifestyle, may not be such a bad thing for kids. We know they are happy while at school and active in their sports, but a little pause might be good too.
Our team has a few suggestions for making the most out of this time and helping your family cope and come out on the other side ready to go.
Physical Activity and Good Nutrition
It might seem obvious to some, but the consequences of dropping hours of physical activity may sneak up on kids. Missing daily playground, sports practices and games and even birthday parties at venues or parks, dramatically reduces energy expenditure. Taking action to keep physical activity up and nutrition balanced to meet those demands and not exceed them requires a little planning.
Look for ways to be physically active for 60 minutes each day.
Search online for ideas and resources like videos for kids’ yoga and active games.
Make play time a family event.
Get outside and take a walk.
Young athletes will benefit from a rest from intense training in their primary sports.
Consider “cross-training” activities that are unlike the primary sport.
Keep working on individual skills for sports.
Help your kids replicate activities from the practice that are independent or in very small groups.
Check out our warm-up programs for golfers and basketball players.
Each day, more websites and organizations are making their creative ideas accessible to the public.
Matters of Their Minds
Pediatric psychology postdoctoral fellow, Emily Stapleton, Psy.D., advises families to talk about COVID-19 in a calm, non-reactionary way and limit exposure to the news. Parents should select resources like the American Academy of Pediatrics (AAP) blog for advice on helping children through this challenging time. A recent article specifically addresses keeping a consistent daily routine in spite of school closures and how to talk to your children in an age-appropriate and honest way about the situation.
Be a Good Role Model
Whether it’s good hand hygiene or creative exercise, consider the impact watching you has on your child’s health. Stay calm and connected and help your children do the same.
Key messages from Joseph (I-Yuan) Chang, M.D., and a panel discussion by pediatric orthopedic and sports medicine surgeon Henry B. Ellis, M.D., and Gerad Montgomery, B.S.N., FNP-C, at Coffee, Kids and Sports Medicine.
How Advances in Radiographic Imaging Can Protect Patients
Though digital X-rays are the gold standard for many musculoskeletal evaluations, EOS is a relatively new technology designed to achieve results with less radiation. These devices are well-suited for pediatric orthopedics because many treatments, like lower extremity and spine straightening procedures, require periodic imaging to monitor growth and success over time.
Here are several features of how EOS is the best option for some evaluations:
Uses very low-dose radiation – uses 1/7 the amount of radiation, compared to traditional X-rays
Facilitates accurate assessment of standing alignment – evaluating alignment while a patient is weight-bearing posture provides a more accurate picture of the interaction between the joints of the spine, hips and legs.
Creates a single image immediately – with a traditional X-ray, separate films in supine or standing are “stitched” together. This process can be negatively affected by human error (this is done relatively quickly by using computer software at a work station, but may be done incorrectly due to inexperience or carelessness).
IMPORTANT NOTE: It does require a child to stand still for a short period of time, so can only be used when the patient is able to bear weight and can stand still for approximately 10 seconds.
Scottish Rite Hospital has been using the EOS Imaging System since 2016 and had a second system installed with the opening of the Frisco campus in 2018. As pediatric providers, we are committed to using the lowest dosage of radiation possible for studies. EOS has been a useful tool in caring for patients with spinal deformities, lower extremity limb differences and malalignment.
Ordering and Reading Pediatric or Adolescent Elbow X-rays
These tips can be helpful with other X-rays. Watch the full lecture to see how they are applied to ordering and reading an elbow X-ray.
Tips for Ordering X-rays:
Always order two perpendicular views – X-rays are 2-dimensional. To evaluate a 3-dimensional object, a bone or joint, two views are necessary. In most cases, the anteroposterior (AP) view and the lateral (LAT) view will suffice.
When reading a radiology report, remember that the radiologist does not have the advantage of the complementary physical exam. This is critical to pair with the reading of the imaging. When placing an order, include a note about the clinical exam in the order to provide context for the radiologist.
Tips for Reviewing X-rays: Joseph Chang, M.D., pediatric musculoskeletal radiologist offered “five easy steps” to reading an X-ray.
Is there a positive ‘fat pad sign’? A fat pad sign, also known as a sail sign, is a sign of a joint effusion. A joint effusion is an imaging finding that is highly predictive of radiographically occult injury in the joint. A pediatric elbow has so much more cartilage than an adult, making certain injuries invisible on radiographs.
Is the alignment normal? In the elbow, assess the anterior humeral line (lateral view) and radiocapitellar line (AP and lateral view). Disruptions to these lines are signs of a fracture or dislocation and need to be treated.
Are the ossification centers normal? Ossification centers have a strict order of appearance and disappearance – if one is missing or out of place, an injury may have occurred. The acronym “CRITOE” can be used to help recall the growth plates in the elbow but knowing to look for them is a good first step. Because growth disturbances can be prevented with proper management, refer to a pediatric orthopedic specialist when you are unsure.
Is there a subtle fracture? Evaluate the metaphysis of the bone. The bony cortex should have a nice, smooth slope. Children have soft and more flexible bone, therefore the bone sometimes buckles instead of breaking. These injuries may appear as a blip on the X-rays.
CLINICAL TIP: Be careful not to miss a buckle fracture (also known as torus fracture or incomplete fracture) in your imaging review when a patient has these symptoms.
Wrist AND elbow pain
Loss of terminal extension and pronation/supination
Pain over the radial neck
Did you consider the normal variants? Before you finalize your diagnosis, take a step back and see if what looks abnormal is a normal, developmental appearance in a growing child. Skeletally immature patients may have radiolucent growth centers composed of cartridge and sometimes bone. Secondary ossification centers (i.e. trochlea, lateral epicondyle) can have irregular margins or appear as separate ossicles, mimicking traction stress injury or fractures.
“I think that a practitioner correlating a good clinical exam with the first three steps above will help you identify 90% of elbow injuries and fractures in this population” says Henry B. Ellis, M.D., pediatric orthopedic surgeon.
Joseph (I-Yuan) Chang, M.D., is a radiologist with specialty experience in pediatric musculoskeletal radiology practicing at Scottish Rite for Children Orthopedic and Sports Medicine Center. He completed his training at the University of Cincinnati College of Medicine followed by a residency at Cleveland Clinic Foundation.
The radiology staff at Scottish Rite Hospital participates in interactive, preoperative and postoperative conferences with the pediatric orthopedic specialists. Imaging services include X-ray, EOS, musculoskeletal ultrasound, CT and state-of-the-art MRI capabilities on both campuses. They offer on-demand consultations for our team to support high quality and efficient care.
With the start of the new school year upon us, it is important to fuel active children and young athletes’ bodies with the proper food. From healthy snacks to making sure you are drinking enough water, our team has the tips on setting your adolescent up for success. We sat down with the hospital’s sports dietitian Taylor Morrison, M.S., R.D., CSSD, L.D., to learn more about nutrition and the importance of giving your body the right amount of energy.
Consistent Meals & Snacks
Three meals a day
One to two or more snacks a day (depending on the athlete, sport and training level)
Originally presented by Corey S. Gill, M.D., at the Sports Medicine for Young Athlete: How Do We Keep Our Kids Safe Conference in Frisco. Childhood obesity is a significant public health problem and significantly increases the risk of developing a number of debilitating medical conditions, such as diabetes and heart disease. The prevalence of childhood obesity nationwide is approximately 15%, but is often much higher in pediatric orthopedic patients. For example, more than one third of my patients who require surgery for orthopedic problems are obese. Obesity may play a causative role in disorders such as slipped capital femoral epiphysis (SCFE) and Blount’s disease, and often increases the severity and complexity of fractures and other orthopedic injuries.
Conditions Often Found in This Population SCFE is a condition that can develop in the hips of obese children and adolescents. The excess body weight increases the stress across the cartilage growth plate of the femur near the hip joint and can lead to a stress fracture or complete fracture. This condition always requires surgical intervention and may lead to significant long-term damage to the hip joint that necessitates additional surgery or even hip replacements at a young age. This condition is often difficult to diagnose, as the hip pain can be vague or even manifest as knee pain. All obese adolescents with significant hip/knee pain, or a noticeable limp, should be evaluated by a pediatric orthopedic surgeon.
Blount’s disease is another condition correlated with obesity. In this condition, there is severe bowing of the knees that leads to pain, joint damage and a significant visible deformity. Surgical treatment for mild Blount’s disease is called growth modulation. This treatment involves tethering a growth plate near the knee with a metal plate and screws, so that the leg can gradually straighten over approximately one to two years. In more severe cases, larger surgeries are often required to cut and realign the tibia bone, often with an external metal frame attached to the leg for stability.
Fractures or broken bones are relatively common in growing children. Obese children are more likely to sustain arm and leg fractures after a fall compared to normal weight peers. In addition, these fractures are usually more severe and more complicated to fix in obese children. Finally, the excessive soft tissue present in obese limbs makes fractures more difficult to hold in position in a cast. Consequently, many fractures that can be treated nonsurgically in normal weight children require surgical intervention in obese children.
Peri-operative Risks in Obese Children Overweight and obese children often have medical comorbidities that increase risk of complications during and after surgery, such as anesthesia-related complications, infection and wound problems. A thorough preoperative evaluation is recommended in obese patients undergoing surgery in order to optimize perioperative care. For example, sleep apnea is found in 85% of patients with Blount’s disease and hypertension is present in 65% of Blount’s and SCFE patients. Oftentimes, these medical comorbidities are undiagnosed at the time of presentation, so orthopedic surgeons play an important role in the recognition and diagnosis of these diseases.
Now What? Childhood obesity is a difficult problem, and there are no easy solutions to eliminate the epidemic. A multidisciplinary approach with frequent communication between surgeons, pediatricians, nutritionists and other health care providers is mandatory to optimize orthopedic care of the obese patient. The pediatric and orthopedic communities must continue to support initiatives to encourage kids to be active and to eat a healthy balanced diet. Regarding diet, healthy eating habits need to be established at a young age, as studies have shown that obese children as young as 11 are already consuming in excess of 1100 to 1300 extra calories per day. Regarding activity, children and adolescents should be encouraged to participate in at least 60 minutes of physical activity each day. Participation in team sport, or other activities such as walking, running or biking, may decrease obesity rates and promote a lifelong love of a healthy activity.
Learn more about injury prevention and pediatric sports medicine.
If you are on the grounds of the hospital, take a moment to explore the James F. Chambers, Jr. Youth Fitness Park. The park features a large green lawn surrounded by an inviting walking path, which winds past decorative sculptures and recreational areas.
In this tranquil outdoor setting you will also find a brick pathway. Upon closer inspection, you will discover that these bricks are unique. Many of them are engraved with a name or personalized message to honor a loved one or celebrate a milestone.
But one thing these amber-colored blocks have in common is that each one is a symbol of hope and support for Scottish Rite Hospital patients.
“Participating in our brick program is a meaningful and affordable way for our donors to leave a legacy on the grounds of Scottish Rite Hospital,” says Stephanie Brigger, the hospital’s vice president of Development.
One of the longtime supporters, Dallas-area donor Michael Turner, began creating a legacy when the program started 20 years ago. Since then, he has donated more than 100 bricks to the hospital.
“I give from my heart,” Turner explains. “I give bricks rather than flowers because a brick will last forever.”
Individuals, families, corporations and anyone who wants to create a bright future for the patients of Scottish Rite Hospital can participate in the program. The cost of each brick is $150 and multiple bricks can be purchased, with all funds supporting the hospital.
Remember a loved one, commemorate a milestone or celebrate a special occasion, while benefiting hospital patients. To purchase a brick or receive more information, call 214-559-7618. You may also fill out an engraved brick donation form on our website here.
IF YOU ARE READING THESE WORDS WITH EASE, you likely acquired the skill shortly after mastering the alphabet. But what if you lacked the ability to match the proper sounds to the corresponding letters? What if that didn’t come to you naturally? Imagine, sitting at a desk in silent dread as your peers are called upon to read aloud. You stare at the page before you, trying desperately to decode it. Then, it’s your turn. You struggle to voice the words and suddenly, all eyes are on you.
That feeling was all too familiar for McKinleigh, age 12, of Arlington. The difficulty she faced didn’t catch her entirely by surprise, however. Her older brothers, Garrison and Garrett, had undergone testing for the same challenges. At age 5, she couldn’t read words but she could read the signs that told her, like them, she had dyslexia.
“It felt like everybody else could read and I just couldn’t,” McKinleigh explains. “I was scared of what people would think of me.”
In 1965, pioneering neurologist Lucius “Luke” Waites, Jr., M.D., came to Scottish Rite Hospital to improve the lives of children like McKinleigh. At the time, the field of dyslexia was often misunderstood and discredited. Undaunted, Waites hosted a meeting of the World Federation of Neurology in 1968. At that meeting, the first consensus definition of dyslexia was formed, recognizing it as a medical condition.
This year, the Luke Waites Center for Dyslexia and Learning Disorders marks the 50thanniversary of hosting that momentous meeting. Scottish Rite Hospital continues to be an internationally recognized leader in the field, advancing teaching methods and conducting leading-edge research. We want the world of reading to be an open book for children because from there — the sky is the limit
“Children with this condition go to school expecting to be successful, just like they have been when learning to speak, play and interact with others,” explains Gladys Kolenovsky, administrative director of the Luke Waites Center. “When reading comes easily to other kids but not to them, it often leads to a sense of anxiety and failure.” Dyslexia, which affects roughly 10 percent of children in the U.S., is characterized as a language-based problem connecting speech sounds to the letters of the alphabet. Children with the condition have difficulty learning to read and spell. As a result, comprehension of written material can also be challenging.
“It is not a vision or intellect problem,” Kolenovsky says. “Children who have this condition are bright, talented and often gifted.”
In some cases, like McKinleigh’s, genetics can play a role. A child with a parent or sibling who has the learningdisorder has a 30 to 50 percent chance of being born with it. “Our nieces and nephews started getting diagnosed with dyslexia,” McKinleigh’s mom, Deborah, recalls. Concerned about her own children, she received a referral to the hospital’s Luke Waites Center. Ultimately, all three children were found to have the condition as well.
Fortunately, their family was at the place where dyslexia was originally defined, a place that has remained at the forefront of dyslexia care and management at a national and international level —Scottish Rite Hospital.
“We are the experts and we share our knowledge,” Kolenovsky explains, “whether it’s through training educators to employ our techniques, developing specialized curriculum programs or advancing research.”
One of the most influential ways that knowledge is imparted is through the center’s two-year therapist training program, which focuses on the application of a specialized curriculum. Jeffrey Black, M.D., who has been the medical director of the Luke Waites Center since 1990, has expanded the center’s research program. This led to the production ofTake Flight: A Comprehensive Intervention for Students with Dyslexia, the hospital’s award-winning curriculum.
The enormous success of this program is reflected in the use of Take Flight at educator training centers throughout the U.S., each of which has at least one instructor trained at the hospital’s Luke Waiter Center.(See the graphic below.)
“We continue to be leaders in dyslexia intervention, helping improve the quality of services children receive in their schools,” says Black. “Through our training in dyslexia identification and the application of our curriculum, our center has had a broad influence across the country and on a global scale.”
The team is also pioneering approaches to identify the condition in children as young as kindergarten and first grade. In addition, the staff has partnered with The University of Texas at Dallas to develop an innovative technology that will reduce teacher training-time.
Fifty years later, the center continues to lead the dyslexia field with the pioneering spirit upon which it was founded.
“Once the barrier of not being able to read is removed, a child’s gifts and abilities can be revealed and then, the sky truly is the limit,” Kolenovsky says.
McKinleigh’s mother agrees. “To have children who didn’t think they could ever read, who felt like they didn’t fit in andnowhave great plans for their future, it’s priceless,” says Deborah of her family’s hospital experience.
Like her brothers before her, McKinleigh recently graduated from Scottish Rite Hospital’s Take Flight program. Her future plans are to be a marine and a doctor. She loves God, her family, horses and now, reading — especially in class.
“I always wanted to read but once people heard me struggle, they would just tell me to stop and call on somebody else,” McKinleigh says. “And now, I read out loud and they won’t stop me, because I can.”
Interested in reading this issue of Rite Up? Click here!
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