Kids and football – my thoughts as a physical therapist and a Mom

Creative-commons licensed photo by Flickr user stuseeger

Yesterday, the medical journal Neurology published a study suggesting that professional football players are 4 times more likely to die from the Alzheimer’s disease and ALS (Lou Gehrig’s disease) than the general population.  This is just the most recent addition to a growing body of evidence linking football to neurodegenerative disease.

As a pediatric health care provider, this body of research continues to be alarming and thought-provoking.  As a mother of two boys* (and another on the way), it is terrifying.  And complicated.

My husband and I both grew up in small towns where football was a huge part of the community.  I was a member of the high school pep band and attended every single home high school football game.  I loved those Friday nights when it seemed that everyone in town had come to the football field to cheer on the local team.  My husband was a player for his team and has fond memories of the physical challenges of the sport as well as the camaraderie he developed with his teammates.  We both continue to enjoy the game, and watch our Mizzou Tigers faithfully during football season.  If – when we were expecting our first son in 2006 – you would have asked us if we thought football was too unsafe to allow our son to play, we both would have laughed.  But a lot has changed since then, and there is now strong evidence (most released just within the last few years) that the repetitive trauma experienced in football is linked to depression, memory loss, suicide, and neurdegenerative disease.  My husband and I have had many thoughtful conversations about this issue, and we are both unsure we can ever let our sons play.  We agree that we will encourage other sports and interests and will be perfectly content if our sons never want to play.  And we certainly won’t sign them up to participate in local youth football leagues, where – at least in our community – children as young as 8 years old practice up to 6 hours a week in full pads.  But we haven’t decided what we will do if one of our boys asks us to play in junior high school.  Luckily we have at least 7 years to make that decision.

Many have argued that the study published yesterday applies only to professional football players, elite athletes who take much harder hits for many more years than your average youth football player.  That may be true in this case and, of course, research and statistics are tricky things.  You can’t make decisions based on one study, and – at the end of the day – statistics are good at telling you what will happen to a group of 100 people, but not necessarily good at telling you what will happen to an individual.   But isn’t about just one study or one group or one individual.  Boston University’s Center for the Study of Traumatic Encephalopathy has an entire list of published studies on the effects of concussion and repetitive head trauma on young athletes.  They are just one of the research teams finding that in football players – particularly those in “speed positions” who experience the hardest hits and are at greatest risk for concussions and repetitive head injuries – brain structure and function are altered.  It is hard to ignore heart-wrenching stories (like this one) of boys who have died because their brains were damaged from the repetitive head trauma experienced in football.  And consensus is growing among the medical community that football is bad for kids – it seems that every time I turn around, a pediatrician or orthopedic physician has written a blog post outlining why she won’t let her own children play football (see this one by Wendy Sue Swanson, MD).

Many supporters of youth football concede that the risks of neurological damage are increased, but argue that they are still small.  They say that kids can get hurt doing a lot of things, that their child enjoys the sport.  They cite the benefits of football – the exercise and physical activity, learning to be a part of a team, to be disciplined, to push themselves – and they choose to let their son play.  I don’t think those parents are necessarily wrong.  Parenting (and life, really), is about weighing benefits and risks and making informed – and often difficult – decisions.  But I would argue that kids can get all those things – exercise, team building, discipline – from other activities that don’t carry the risk of head injury (I would also argue that – given the Greg Williams “Bountygate” and recent events at Penn State – the culture of football seems to be a lot more about winning games than caring about the mental and physical health of children and players, but that’s a post for another day).

I don’t judge the parent whose child plays youth football, but I do think he would be remiss if he didn’t educate himself and thoughtfully consider the risks and benefits associated with the sport.  Taking an “I played and I turned out just fine” attitude doesn’t cut it – we have to set aside the fond memories and emotions we associate with the game and take a real look at the science and evidence before us.  We have a lot more information than we did 10 years ago, and we are fortunate we can use that information to make better decisions for our children.  And in our family, I think the decision is no football…for now.

*I in no way intend to be sexist or offensive by only referencing boys in this post.  I know that girls do play football and I encourage parents of female football players to also seriously consider the evidence before letting their child play.  But because that is a very rare occurrence – and because all research referenced in this post was done on boys – I chose to male pronouns throughout this post.

More trouble for Bumbo

Approximately 4 million Bumbo Baby Seats have been recalled by the Consumer Product Safety Commission in response to reports of injuries – including skull fractures – in babies who wiggle out of the popular (and controversial) infant seat.  The recall provides Bumbo seat owners with a free repair kit including a restraint belt, a new warning sticker, and updated safe use instructions.  All new Bumbo seats will be equipped with the restraint belt.

The Bumbo seat has been the topic of heated discussion among the pediatric physical therapy community for some time now.  For every PT who likes the Bumbo and uses the seat in practice, there is a PT who despises the seat.  I posted my own thoughts on the Bumbo a few months ago.  I own a Bumbo and have used the seat with my own children, as well as some of the infants and toddlers in my physical therapy practice.  I still believe that – for typically developing children – the Bumbo (and similar seats such as the Bebepod) isn’t any more helpful or harmful than most other infant equipment.  For children with special needs, the seat can have some benefit when used with the right child at the right time.  But I’m also thankful for the recall, not only because a restraint belt on the Bumbo is long overdue, but also because it serves as a good reminder of things parents and healthcare providers should consider when placing their baby in (or recommending) ANY piece of infant equipment.

  1. Infant equipment should be used properly.  The majority of reported Bumbo injuries occurred when the seat was placed on a raised surface, even though the seat is clearly marked with a warning to NEVER use it on a raised surface.  Parents need to remember to always use infant equipment properly, and never place a baby on a raised surface in any piece of equipment (Bumbo, “bouncy” seat, car seat carrier, etc).  For that matter, a baby shouldn’t ever be placed on a raised surface even when they aren’t in a piece of equipment and aren’t mobile yet.  You never know how they might wiggle or when they might decide to try a new trick.  How many of you have heard a friend tell the story of the time their baby rolled for the very first time…right off the couch?  Remember also that the Bumbo is simply a device to facilitate supported sitting, and you should never place a baby in supported sitting on a hard surface (without carpet, blankets, and/or pillows to break inevitable falls).
  2. Infant equipment should be used at the correct developmental stage.  Although this is not indicated in the recall, I suspect that many babies who wiggled out of the Bumbo seat were already sitting alone or were mobile (scooting or crawling).  Most infant equipment is only appropriate during a certain stage of development – the Bumbo, for example, should only be used from the time infants are able to hold their head up until they can sit unattended (the 3-7 month range for a typically-developing baby).  Once a baby can sit up alone and is mobile, the Bumbo, bouncy seat, bassinet, and even some infant swings are no longer safe or appropriate.  Placing an older, mobile baby in this type of equipment greatly increases their risk of injury as they try to use their new found mobility skills to “escape.”
  3. Babies should not be left unsupervised in infant equipment.  As the mother of young children myself, I completely understand the need to put your baby in a safe place so you can walk away and start dinner, answer the phone, or simply go to the bathroom.  For a newborn who is not yet mobile, a blanket on the floor is a safe, simple option.  Once babies become mobile, the floor is still a great place (with good baby-proofing and baby gates, of course).  A playard (what used to be called a “play pen”) works well, too, and allows baby to practice moving, sitting, pulling to stand, and playing with toys in a very contained and safe environment.
  4. Infant equipment should be used rarely.  This is the most important point of all.  The truth is – although clever marketing makes parents believe that it takes hundreds of dollars worth of equipment to properly raise a baby – none of it is really necessary.  The absolute best thing for a baby’s development is floor play, plain and simple.  There is mounting evidence that increased use of baby “containers” has led to increased instances of torticollis and plagiocephaly, as well as mild delays in the attainment of motor skills in typically-developing children.  The best way to combat that is tummy time, tummy time, tummy time!  And the only piece of equipment you need for that is a good old-fashioned blanket.

Overall, I hope the Bumbo recall will make the seats much safer for parents who choose to use them, and I also hope it will spark continued discussion about proper use of ALL infant equipment.


This year, we added social media communication as a professional competency in our Doctor of Physical Therapy curriculum.  During their 5-week Professional Interactions course, our first-year students were required to complete a number of assignments on the social media sites Twitter and LinkedIn.  For their last Twitter assignment, students were asked to reflect upon their choice of PT as a career, and to participate in a tweet chat using the hashtag #WhyIchosePT.  I tweeted an invitation for other students and professionals to join in, resulting in over one hundred #WhyIChosePT tweets from physical therapy professionals around the country and the world.

With so much talk about our “broken” health care system, it is refreshing and inspiring to read stories about why so many of us chose (and continue to choose) PT as our profession.  If you’re a physical therapy professional, #WhyIChosePT will remind you why you chose the field in the first place.  And – if you’re not – I dare you to read these tweets without wishing that you chose PT, too

This is just the beginning.  You can view the entire #WhyIChosePT story on Storify by clicking here.

Social media & physical therapy: a look back on the 2012 House of Delegates and RC 23

My view from the floor of the APTA House of Delegates

Earlier this month, I attended my very first session of the American Physical Therapy Association’s House of Delegates.  There were a couple of large issues – namely governance review and what is now known as Physical Therapist Responsibility and Accountability for the Delivery of Care (formerly discussed as RC 3-11 & RC 2-12) – that dominated House this year, as well they should have.  Both of these have to potential to bring large changes to our profession and the APTA itself.  I enjoyed these discussions and learned a lot in the process.  But, as a researcher with an intense interest in the role of social media in physical therapy practice and education, it was a much smaller motion that I was interested in this year: RC 23-12.

RC 23-12, Standards of Conduct in the use of Social Media, was proposed by the Washington Chapter.  Prior to the House, RC 23-12 caught the attention of a group of physical therapists (including myself) who actively use social media for professional and educational purposes.  This resulted in a social media discussion of the social media motion, including my post on PT Think Tank, a Google+ Hangout, and an ongoing Twitter conversation using the hashtag #RC23.  It was exciting to be a part of those conversations, and I (somewhat naively) thought that it was likely that no one was paying much attention to them besides social media users.  My intent, as a delegate, was to get feedback about this motion from physical therapy professionals who actually use social media so that I could take that feedback to the House of Delegates.  I learned that not all Delegates viewed my social media use so favorably.  Participating in the House of Delegates was an eye-opening experience and, now that the final Post-House packet and House summary documents are posted on the HOD online community (accessible to members), I think it might be time to finally share some of my experiences and lessons learned.

Lesson #1: RC 23-12 was totally unnecessary and – as written – doesn’t really DO anything

The final language of RC 23-12, adopted by the 2012 House of Delegates, is available in the House of Delegates online community (available for APTA members).  I’m told it will be “published” (I assume that means public) when it is officially approved in September.  I was very involved in modifying the language, and I do think the policy is much more positive now (the first sentence does, after all, recognize that social media offers new “opportunities” for communication).  But I still voted no on the motion, because I think the policy is unnecessary (as most social media policies are).  The APTA – like most other health care organizations and institutions – has a Code of Ethics and Standards of Conduct.  These documents outline expectations for ethical and professional conduct that apply to all forms of communication, including social media.  By adopting a social media policy, we followed other health care organizations (most notably the AMA).  And I’m sure many thought that having a policy that recognizes professional use of social media was a progressive position.  But I would argue that the true progressive position would be to recognize that social media is simply another form of communication and doesn’t warrant any additional policies.  That said, I think RC 23-12 is essentially harmless – it isn’t any more restrictive than the existing Code of Ethics, so I don’t think it is a game-changer.

Lesson #2: The APTA, as an organization, is pretty progressive when it comes to social media

As an organization, the APTA takes a lot of heat about being non-responsive to members (and non-members), and that includes criticism about its use of social media.  What I learned at the House of Delegates is that APTA staff, as well as the Board of Directors, are actually extremely progressive when it comes to social media, and seem to be excited about its potential.  There are two APTA staff members (shout-out to Jason and Amelia!) who are social media experts, and I had many exciting conversations with them about their ideas to continue to expand APTA’s social media presence.  I was also approached by several Board of Directors members who said that they followed the Twitter discussions or viewed the Google + video and were excited by what they saw.  They saw potential for future social media discussions, and appreciated the opportunity social media provided to educate members on the APTA governance process (how many of you learned how to contact your Delegate?).  From the top, the APTA seemed to be very supportive (and even a bit intrigued) by the potential use of social media to discuss association issues and even House motions.  It was my fellow APTA members who seemed a bit more uncomfortable with it, which leads me to…

Lesson #3: APTA members (or at least those who are delegates) are very traditional, which results in a lot of hesitation, skepticism, and even fear of/about social media

The only negative reaction to social media use (at least that I heard) came from my fellow Delegates, many of whom seemed to be upset about the use of social media to discuss and share House issues.  There were questions about whether the #RC23 Twitter conversations were “appropriate,” and lots of feathers were ruffled when I (and a few other Delegates) tweeted during the candidate interviews.  I heard delegates say things like “I’m not a social media kind of person, I never will be,” and there was much grumbling about how many delegates were using devices (laptops, iPads, and smart phones) during the House.  All of these comments seemed to come under the guise of concerns about “professionalism,” but I think it’s about something else altogether.  The House of Delegates is an extremely traditional environment.  Not only does social media have the potential to make House happenings more public and transparent (can someone please tell me why that would be a bad thing?), but it also levels the playing field so that everyone gets a voice.  The truth is, many delegations answer to their Chief, vote as a block, and are asked not to post to the discussion boards or discuss motions with other delegations (all that has to go through the Chief).  When you understand this, you understand why social media may make some Delegates uncomfortable, and how some (particularly Chief Delegates) may worry that one of their own delegates could  go rogue and (gasp!) post their own opinions in a public forum.  Don’t get me wrong – there are many progressive, technologically-savvy folks in the House – but there are also many who cling to (and seem to thrive on) tradition and hierarchy, and that doesn’t leave a lot of room for social media.  Frustrating, indeed, but an illustration of how far our profession (and health care in general) has to go when it comes to social media and technology.

Lesson #4: Some issues just can’t be discussed in 140 characters or less

One of the biggest lessons I learned on the House floor is that the APTA Staff, Board of Directors, and Delegates work hard to tackle tough, complex issues.  I thought I understood “RC 3” (adopted as Physical Therapist Responsibility and Accountability for the Delivery of Care) before I arrived, and quickly realized that I had no idea the breadth and complexity of this issue.  The House discussed it for an entire day, and that’s not because we were a “do nothing” House.  It’s because changing how we provide physical therapy services is a big deal, and there is much to consider.  It may seem simple to a private practice PT that we should have adopted a policy that allows physical therapists total freedom to delegate physical therapy to anyone.  But it seems equally simple to a PTA that he/she has a special skill set and should be the only support personnel qualified to provide physical therapy.  There is much uncertainty about health care reform.  Many members want the alternative payment system to be the priority of the APTA, and have concerns that any profession-altering policy may put that in jeopardy. And there are pediatric physical therapists, like me, who have concerns that the models put forth in RC 2-12 don’t represent pediatric practice (particularly school-based and early intervention therapy).  The idea here isn’t to debate this policy, but rather to illustrate how complex these issues really can be when you are trying to represent an organization of over 80,000 members that practice in extremely diverse environments.  The truth is, many (most) of these issues just can’t be discussed in 140 characters or less, or we’d conduct House business over Twitter and call it a day.  As much as I love social media, I appreciate it for what it is – a place to connect, network, share, educate, and learn.  It is a wonderful environment for gathering information and forming relationships – a jumping off point for “real-life” discussion – but isn’t really an effective place for debate.  The power of social media – its simplicity – is also the danger sometimes.  We can’t have nuanced discussions or solve complex issues facing our profession in 140 characters or less.  And so, while it was exciting to tweet news and updates from the House floor, I left the conversation when it turned to debate.  And I’ll continue to do that, because it’s not where I want to put my social media energy.

It may sound frustrating, and at times it was.  But I’m a glass-half-full kind of gal.  So here’s the silver lining…  Technology and social media are often referred to as “disruptive innovations” in education an health care.  Although social media has been around a few years, I think this year was the tipping point for the APTA.  This year, social media was just disruptive (and visible) enough to get everyone’s attention.  My hope is that this is the start some real conversations among APTA members, staff, and leadership about how to harness social media and use it to engage members and promote and advance the profession.  About how to encourage more participation in the House of Delegates and have broad, transparent discussions about House issues.  As in all professions, there is resistance to change.  There always will be.  But as we move forward, we must recognize that – in a changing world – the biggest risk associated with social media may be not using it at all.

Win, lose, or draw?

As the school year winds down, many kids’ activity levels (thankfully) start to ramp up.  With end-of-the-year field days and the beginning of summer ball, my Facebook news feed is exploding with comments and articles expressing a similar sentiment:

Remember when there were actually winners and losers?  When everybody didn’t get a medal?

Sort of has a “good old days” (or “kids these days“) ring to it, doesn’t it?

As a parent myself, I don’t neatly fall into any of the media-hyped parenting categories (who does?), but I do tend toward being a bit free range.  I believe that the world isn’t nearly as scary of a place as most people think it is, and that the best way for my children to learn to be citizens of the world is to live in it, without me hovering over them at all times.  I know my kids need to try (and fail) before they learn to do something themselves.  They won’t always be the best at everything, and I want them to know that (and also know that it’s okay).  I understand that winning and losing is part of life, and that learning to be gracious in victory and defeat – although difficult – builds character.  So you might think I would oppose the everybody-gets-a-medal-just-for-trying philosophy.  But I don’t.

I think it goes back to the first (and only) season I ran track in school.  I was in 8th grade.  I had always been okay at sports, but I had recently gone through puberty and – once my body starting changing – I became slower, weaker, clumsier, and much less confident in my physical skills.  I had never been interested in track and I’m not sure why I decided to join the team that year.  I wasn’t fast and couldn’t really jump or throw, but – to my and my coach’s surprise – I was a decent distance runner.  So my coach put me on the 800-meter relay team with 3 other girls.  At our first track meet, I was the third leg of the race and our team was in second place as I waited for the hand-off.  I took the baton and started running, overtook the girl in front of me, and finished my leg of the race with our team in first place.  It felt good, until I realized that the next member of my team wasn’t there to take the baton, the ref (a coach from the home team) was in my face yelling about something I didn’t understand, and my coach was grabbing me and pulling me off the track.  Apparently, I had my foot on the line of the handoff zone when I grabbed the baton, and I had disqualified my team.  Looking back, I realize that this was at least partially my coach’s fault – she had not thoroughly gone over handoffs with us, and I didn’t know about the handoff zone or the rules surrounding it.  I also know now that the ref who was screaming and yelling at me about how I was disqualified was totally over-the-top about the whole thing.  But I didn’t get any of that at the time.  I was a kid.  A kid who had failed not only herself, but her team.  I was mortified and embarrassed and sorry I had ever even gone out for the track team.  I finished that track season (my parents made me), but my heart wasn’t in it.  I never came close to running the 800 in the time I had run it in that first track meet, and I begged to come off the relay team for the rest of the season.

That was the beginning of the end of competitive sports for me.  I stopped playing softball and basketball, deciding to get an after-school job to earn some money instead.  The only high school sport I played was golf (a much more individual and somewhat less active sport), and I became a chubby teenager who didn’t get nearly enough physical activity.

I think the idea that participation medals are bogus and that it builds character for kids to lose rests on the assumption that all kids are competitive, and that losing a competition will drive kids to to better and work harder next time.  But there is another side to that coin, and 13-year-old Kendra is a perfect example.  For some kids, the competition itself will be enough to drive them away – they’ll never be brave enough to join the team or enter the contest.  And those who muster up the courage to participate once, like me, may never come back once they feel that first sting of defeat.  Those are usually the kids who need that physical activity the most – the kids who are clumsy or overweight, who have an intellectual or learning disability that makes it harder for them to understand the game, or who don’t have a parent who models physical activity or works with them on playing catch in the back yard.

Don’t get me wrong – I certainly think there is a time and place for competition.  That includes junior high and high school sports, and I’m sure I deserved to be disqualified from that race.  But I wonder if it would have been handled differently – if our team could have finished, if they would have quietly talked to me and explained what I did wrong and how I could do better next time, if there would been a little less emphasis on winning and losing – if I would have kept up with track and been a healthier teen.  I wasn’t a competitive kid and I’m still not competitive as an adult, so I wonder if I would have thrived in a program like Girls on the Run (that promotes self-esteem and healthy activity rather than competition) instead of a competitive track team.  I wonder if the parents and coaches who scream the loudest about how “kids need to learn that there are winners and losers” really care much about the kids at all, or if they are just somehow trying to relive their days of competitive sports.  Do they assume that, because they are driven by competition, that all kids must also have that same competitive drive?  Frankly, I suspect many of them aren’t all that interested in their own kid learning about losing, but are convinced their kid will end up in the winner’s circle so others can learn the lesson.

There is a time and place for competition, but 7-year-olds don’t need to play tackle football.  Nine-year-olds don’t need to throw 100 pitches a day 10 months out of the year.   3-year-olds don’t need to run soccer drills.  And a chunky 13-year-old who makes a mistake running her first track meet doesn’t need to be dragged off the track and disqualified in front of all her teammates in dramatic fashion.  Activity should be fun, and should be part of everyone’s daily life.

Kids are fatter and less active than ever.  Of course kids need to learn about winning and losing, but – when it comes to physical activity- the main lesson kids need to learn is that it feels good and is fun to move!  For some kids (usually the ones picked first for the team), competition is part of the fun, and those are the kids who should join competitive teams.  But in some ways, competitive sports reward the kids who are more active, who are “better” at physical skills, while the kids who aren’t so good (and frankly need more practice and activity) get cut from the team and sit the bench.  Competitive sports have their place, but they widen the gap between kids who are “athletic” and those who are not.  Perhaps we should realize that there is value in sports (and in people), even if they’re not competitive.  We need to reach out to the kids picked last for the team, and provide opportunities for healthy activity that doesn’t divide everyone into winners and losers.  Physical education class, school field days, and local parks & recreation sports should be places where ALL kids can feel comfortable participating in sports without worrying about being labeled a failure or a loser.

There are plenty of opportunities in life to learn about winning and losing.  But when it comes to physical activity, the consequences of failure – obesity, diabetes, heart disease, and premature death – are just too high.

I say keep the participant medals, and everyone wins.

[Creative-commons licensed photo by Flickr user Mike Saechang]

Get outside and get moving!

How much exercise do your kids get each day? The CDC recommends that all children participate in 60 minutes of physical activity each day, including aerobic exercise, muscle strengthening, and bone strengthening.  Sixty minutes per day may seem like a lot, but it is important to remember that children aren’t simply small adults. Kids (especially young ones) can’t stick with any activity for an hour, and they certainly aren’t going to be excited about doing 20 push-ups or 2 miles on the treadmill. The key to get kids moving is to break up activity into several shorter sessions during the day (for example, six 10-minute bouts of activity) and – most importantly – to make exercise fun. As summer approaches and we enjoy warmer temperatures, outdoor play provides the perfect opportunity to have 60 minutes (or more) of fun with movement each day.  Here are a few ideas for you and your kids to get outside and get moving:

  • Take a “penny hike.” Walk to a crossing, then flip a coin to decide which way to go. Repeat until you make it back home or are just ready to go back.
  • Go for a ride. Depending on your child’s age, a tricycle, bicycle, scooter, or roller skates are all great ways to get moving. Don’t forget the helmet!
  • On a hot day, turn on the sprinkler. Kids can run, jump, and hop through the water.
  • Have animal races. Pretend to be a bear (walking on hands and feet), dog (on hands and knees), elephant (one arm swinging like a trunk), kangaroo (jump), snake (slither), or crab (crab walk). Be creative and let your child choose his or her favorite animals.
  • Get out the sidewalk chalk. Draw a hopscotch grid for practice jumping and hopping. Create an obstacle course where kids can practice walking on a line or running, jumping, hopping, or crawling to different shapes and letters.
  • Climb, swing, and slide. Use the swing set in your back yard, or walk (don’t drive!) to your community park. Close supervision may be necessary, but let your child do the climbing, swinging, and sliding herself. It really is safer that way, and she’ll learn so much more.
  • Go back to the basics. Teach your child how to jump rope or hula hoop. Grab a ball and play catch, kick ball, or dodge ball. These inexpensive, classic toys provide almost endless opportunities for movement and play.
  • Just send them outside! If your kids are old enough and you are comfortable with the safety of the environment, turn them loose while you catch up on chores in the kitchen (stay within ear shot and check on them frequently, of course). If they’re younger or you live on a busy street, you may need to sit on the porch or patio and supervise. But the point is that kids need unstructured play, and lots of it, to learn and grow. Rolling in the grass, digging in the dirt, playing tag with siblings, or practice “tricks” like cartwheels and somersaults are important for children to learn about their bodies and the world around them. You can’t really teach a child that he’ll get dizzy when he spins around, or that he’ll fall down if he tries to walk down a hill too quickly. He needs to learn those lessons on his own terms.

Daily outdoor play is good for the whole family, and helps establish a life-long habit of regular recreational exercise for your child. Do your kids play outside every day? What are some of their favorite outdoor activities?

Barefoot is best

[Creative Commons Licensed Photo by Flickr user hlkljgk]

One of the most frequent questions parents ask me is, “What type of shoes do you recommend for my baby?” They are often surprised by my answer.

The truth is, the best shoes for emerging and new walkers are actually no shoes at all. That’s right – barefoot is best. When babies are crawling, pulling to stand, cruising around the coffee table, and even starting to take those first few steps; they need to be able to flex their forefeet and toes. They also need as much sensory input as they can get in order to feel the floor underneath their feet and know where there feet are in relation to their body. A hard-sole shoe just doesn’t allow for that (try putting on your stiffest shoes or boots and crawling around on the floor – you’ll see what I mean).

For toddlers and young children who are already walking, parents are often concerned about what appears to be “flat feet” and wonder if a special arch support or orthotic is needed. They are relieved when I tell them this is unnecessary. Flat feet are actually quite normal until age 6 or 7. Research shows that almost all typically-developing toddlers have flat feet (no visible arch in standing). At 3 years old, the majority of children continue to have flat feet. As children grow and develop strength in their feet and ankles, their arches develop. Although parents (and sometimes therapists) are tempted to place the child in a supportive shoe or order a custom or off-the-shelf arch support, there is no evidence this is helpful. In fact, it may even be harmful. Research shows that, in cultures where children under the age of 6 rarely wear shoes, there is a lower incidence of flat foot than in (Western) cultures where children typically wear shoes at young ages. So even for preschoolers, it seems that barefoot is best.

If a parent or caregiver has to put shoes on a young child who is an emerging or new walker (perhaps the childcare center requires it or the family is attending an occasion where going barefoot may not be appropriate), I tell them to simply think of shoes as foot covers. They really serve no other purpose, and they don’t need to. For crawlers and new walkers, I typically recommend a soft-soled shoe like this:

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This is a water-resistant leather or fabric shoe (foot cover) with elastic around the ankle. The sole of the shoe is also fabric, but slightly thicker and textured to prevent falls. This type of shoe allows for almost complete freedom of movement of the foot and toes, and allows quite a bit of sensation through the foot. Name brand styles of this shoe are widely available at Department stores, baby boutiques, and on the internet; but there are several off brands you can purchase for less than half the price at discount stores.

Once children are bona fide toddlers – walking exclusively and exploring by walking over many types of surfaces, including outdoors – I recommend something like one of these:

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Image from

The shoe at the top is similar to the infant shoe I recommend, but it does have a slightly thicker sole to protect the foot from things like puddles and sharp rocks. The shoe at the bottom is a more traditional shoe, but still has a soft sole. When I grasp this shoe, I can easily bend the sole in half. Again, these styles of shoes are available at multiple price points – and I have had success finding them at second-hand stores as well.

So the take-home message when it comes to infant and toddler shoes is this:

1. Barefoot is best. The best shoes for young children are no shoes at all, and hard-sole shoes should be avoided.
2. Flat feet is normal for toddlers and children up to age 6. Children need time – not expensive shoes or orthotics – to develop good arches.
3. Think of infant/toddler shoes simply as foot covers. Purchase the flimsiest, thinnest-soled shoe that will fit your needs.  There is no need to purchase an expensive “supportive” shoe, shoe insert, or orthotic for a child.

Of course, if you have concerns your child isn’t developing typically or if you notice her flat foot is so significant that her ankles are turning in, you should visit your doctor or physical therapist.  Otherwise, have fun [not] shoe shopping!

Kids these days, part 3

I recently attended a meeting for rehabilitation managers in my community titled, “New Graduates and Generation Y: Training for Emotional Intelligence and Face-To-Face Communications Skills.”  This is Part 3 in a series of posts on the themes of that discussion about the Millennial generation.  You may also want to read Part 1 and Part 2.

Yesterday, the New York Times ran a story about a kindergarten class that tweets 3 days a week.  After reading the story and viewing the accompanying video (see below), I couldn’t stop smiling.  With her class project, kindergarten teacher Jennifer Aaron is addressing the “technology gap” using a brilliant strategy, one I think we should model in our professional health care education classrooms as well as our clinics.   She has become familiar with the technology, has learned how to use it, and is teaching her students (and probably their parents) how to use it, too.

One of the themes that arose – and involved much discussion – during the area rehabilitation managers meeting I attended last week were concerns about students’ and new grads’ use of technology:

“Students and new grads are always texting, playing Words with Friends, and checking Facebook. They don’t have good professional boundaries when it comes to checking and using their mobile devices.  They know how to Facebook and text, but they struggle with “real-life” communication and relationships.”

These concerns are valid and often true.  We have some of these same frustrations with “kids these days” in professional education.  And why wouldn’t we?

Although there are many well-documented characteristics (stereotypes?) associated with the Millenial generation, what really sets them apart is their use of technology.  They are curious and fearless when it comes to technology.  They are constantly connected to their friends, family, and world in a way no other generation has before.  They enjoy mobility (smart phones) and real-time interaction (Twitter and texting).  They don’t want to be tethered to a PC (or even a laptop) or wait for email.  This technology has been around as long as they can remember, and they often identify as “digital natives.”  They are accustomed to using technology in every aspect of their lives – except education and practice.  The “head-in-the-sand, if-we-ignore-this-maybe-it-will-go-away” approach we’ve taken to technology (and – in particular – social media) in education and health care has not served our students well.  Suddenly, they enter professional education or a clinical internship (or even a first job) and they’re told they’re supposed to put their mobile device away.  But they don’t wear a watch, so how will they tell time?  And what about the anatomy app on their phone they use for quick reference?  They should hide their social media profiles (or at least make them private).  But what if they want to “like” the America Physical Therapy Association on Facebook?  Tweet a link for a new Physical Therapy Journal article they just read? Or start a blog and a Facebook page where they can (gasp!) friend their patients so they can share good, reputable health care information?

The truth is, many Millennials don’t know how to use technology and social media in a professional, appropriate way because no one is teaching them.  No one is modeling it for them.  They are figuring it out on their own, and when they make mistakes, us old folks wag our giant fingers at them and say, “I told you that texting/tweeting/Facebooking/smartphone app using wasn’t a good idea.  We should just ban it all.”  How’s that working for us?

We all need to take a cue from Ms. Aaron and her kindergarten class.  Part of the professional PT education curriculum should be about appropriate, professional use of technology and social media.  Instead of telling our students to “turn off and put away” their mobile devices, we should be using them during class as an opportunity to engage students in education and the profession, all the while teaching them to be better digital citizens.  Schools and health care facilities should re-think broad policies banning mobile devices and social media.  It is time that we recognize that social media is part of “real life,” and that the next generation of health care providers will be expected to have technology and social media skills.  Their patients (and the public) will demand that they engage with them using social media.  They will walk into a clinic with no Facebook page, no Twitter feed, and no blog; see a physical therapist walk up to them with a paper chart and a medical reference book and wonder, “Is she practicing physical therapy like it’s 1995, too?”

It is time to stop approaching technology and social media in health care and education from a risk management perspective and start approaching it as an opportunity to educate, learn, engage.  An opportunity to elevate our practice and the profession.

If Ms. Aaron and her kindergartners can do it, we can, too.

Kids these days, part 2

I recently attended a meeting for rehabilitation managers in my community titled, “New Graduates and Generation Y: Training for Emotional Intelligence and Face-To-Face Communications Skills.”  This is Part 2 in a series of posts on the themes of that discussion about the Millennial generation.  Part 1 can be accessed here.

“Students and new grads [Millennials] don’t seem to have the listening skills they once had.  And they don’t have the self-awareness to reflect and correct, and they often get defensive or emotional when criticized.”  This was one of the central themes of the rehabilitation manager meeting I attended last week.  Kids these days don’t listen, they won’t learn, and they get upset when someone with  little more experience tries to tell them how to do it better.  In other words, Millenials are immature and they don’t respect authority.

This is a common criticism of Millennials and one that – as an educator – I certainly understand.  But I think that, when we examine the characteristics of Millennials, it it clear that the problem isn’t that Millennials don’t respect authority.  It’s just that Millennials view authority differently than the generations before them.

It is true that Millennials are confident, and sometimes that confidence can seem arrogant.  It can appear that they aren’t listening or reflecting when they continue to do things “their way.”  Millennials are social and informal.  They get along well with their parents.  Similarly, they want to like their instructors and bosses and have casual, friendly relationships with them.  The boundaries between “work” and “play” are blurry, and Millennials may have difficulty hearing professional criticism from a colleague and not taking it as a personal attack from a friend.  Millennials like teamwork and value open communication.  They believe that others on the team want to hear their thoughts and ideas, and they share them freely.  When they are frustrated about a work situation or don’t agree with criticism, they aren’t afraid to express their feelings.  To a Baby Boomer or Gen Xer, this way of relating to coworkers can seem immature, unprofessional, and just plain uncomfortable.

Here are a few of my suggestions for improving the “authority gap” between Millenials and Baby Boomers or Gen Xers:

  1. Build time into the day for communication.  Allow time after a treatment session for a patient or family to provide feedback about home exercise program instruction.  Schedule time at the end of the day to communicate with a colleague or clinical instructor about an intervention technique.  These will give the student or new grad opportunities to practice receiving (and giving) constructive professional criticism.
  2. Millennials love technology  – use it!  Get permission first, then grab a video camera or smart phone and record a student or new grad conducting a patient interview or education session.  Allow him to view the video and reflect on his performance and communication skills.  Discuss what he did well, and what he should do differently next time.  Again, this gives practices with communication and provides an objective way to self-reflect.
  3. Position yourself not strictly as an authority figure, but also as a mentor and advocate.  Millennials value relationships and are fiercely loyal.  This can be a tricky one – you want to be a guide, not a friend – but once you’ve established a relationship of mutual respect, you may find the student or new grad listening a little more and accepting criticism without defensiveness or emotion.
Have you experienced the “authority gap” in your classroom or practice?  What strategies have you used  to close the gap?
[Creative Commons-licensed image by Flickr user xflickrx]

Kids these days, part 1

Last week, I was invited to a meeting for rehabilitation managers in my community. The title of the meeting was, “New Graduates and Generation Y: Training for Emotional Intelligence and Face-To-Face Communications Skills.”  Uh-oh.  I was invited because of my role as an academic faculty member in clinical education, but – with a 1978 birthday – I’m considered a member of Generation Y (also known as Millennials) according to some sources.  I’d never been to one of these meetings before, but I knew some of the key players were of the Gen X and Baby Boomer generations.  I’d be lying if I said I wasn’t a little worried I’d be spending the better half of the morning defending my students and myself.  But I knew I had an important perspective to share; that I was in the unique position to speak on this issue as an educator and a (maybe, almost) Millennial.

If you’ve spent much time with me, you know that I’m completely turned off by the entire kids these days concept.  I don’t think there’s anything wrong with kids these days or society today.  In fact, I think people and the world generally get better as time goes on.  We are safer and smarter than we’ve ever been.  And, while kids these days may be different (and why wouldn’t they be – the world is different), they have unique ideas and strengths and skills that I don’t possess.  I can learn a lot from people younger than me. And that’s a good thing. Perhaps that is why I was drawn to pediatric physical therapy and education.

Luckily, the meeting wasn’t simply a forum to vent about problems with kids these days.   It was an honest, fascinating, and enlightening discussion, with many of the Gen Xers and Boomers in attendance reflecting on their own biases and weaknesses as well as some of the “differences” they see in today’s students and new grads.  Here are a couple of the central themes that arose during the discussion:

  • Students and new grads don’t seem to have the listening skills they once had.  And they don’t have the self-awareness to reflect and correct, and they often get defensive or emotional when criticized.
  • Students and new grads aren’t as dedicated to the profession. They want to leave as soon as the day is over.  We used to stay 10 or 11 hours if needed to get all our work done.
  • Students and new grads are always texting, playing Words with Friends, and checking Facebook.  They don’t have good professional boundaries when it comes to checking and using their mobile devices.
  • Students and new grads know how to Facebook and text, but they struggle with “real-life” communication and relationships.

This generational divide isn’t unique to physical therapy or health care – the same conversations are happening in many professions.  And it isn’t unique to the Millenials – concerns about kids these days is a tale as old as time.  What’s different this time, I think, is that some of the unique characteristics seen in the Millenials may be less about a specific generation of young people and more about a vast change in the world we live in, the way we do business, and the way we communicate.  In many ways, Millennials represent the role that technology – particularly social networking and mobile devices – now plays in our lives.  We may not be able to just wait them out or ask them to grow up or adapt or change to conform to us.  The Millennials may represent what we need to become in order to stay relevant.  And that can be a frightening prospect for many of us.

Over the next several posts, I’ll tackle these generational issues in a series I’m calling (you guessed it) Kids These Days.  My next post will be about the first item on the list: students’ and new graduates’ ability to listen, communicate, and self-reflect in today’s fast-paced world of health care.  In the meantime, I’d love to hear your thoughts on the next generation of health care providers.  What do you think about kids these days?  What differences are you seeing in your classrooms, hospitals, and clinics?  What strategies are you using to close the generation gap?

[Creative commons licensed photo by Flickr user courosa]