Baseball-Pitcher-2As baseball’s All-Stars gather at Target Field in Minneapolis, some young players (and aspiring All-stars) are being sidelined by Little League Shoulder. This overuse injury most commonly strikes pitchers between the ages of 12 and 14 years and may take them off the field for three months or longer, depending on the severity of the injury. Benton Heyworth, MD, from Boston Children’s Hospital’s Sports Medicine Division, explains the condition and offers some strategies for prevention. Heyworth presented research about risk factors, treatment options and return to play for children diagnosed with Little League Shoulder at the American Orthopaedic Society for Sports Medicine annual meeting in July.

“Little League Shoulder is an overuse injury that can be prevented,” says Heyworth. The primary prevention strategy is to set limits—on pitch counts and the playing season.

  • Players aged 11 to 12 years should be limited to 100 pitches per week, and a maximum of 3,000 pitches per year.
  • Players age 13 to 14 years should be limited to 125 pitches per week, and a maximum of 3,000 pitches per year.
  • Players of all ages should avoid year-round baseball, limiting participation to eight months a year.

What are the symptoms of Little League Shoulder?

“Pain is the hallmark of Little League Shoulder. Young kids should not be experiencing a pattern of pain with throwing,” explains Heyworth.

Sometimes players or parents may try to cope with pain before consulting a physician. That’s a mistake, says Heyworth.  The sooner a child sees a specialist who treats throwing injuries, the sooner treatment can begin.

The specialist, typically an orthopedic surgeon or sports medicine physician, can diagnose Little League Shoulder by history, physical exam and x-rays. The standard prescription is physical therapy and three months of rest from pitching. The physical therapist will focus on stretching and proper warm-ups and address any biomechanical issues, like subtle restricted range of motion in the throwing motion, which may be related to Little League Shoulder.

It’s important to address issues that may have contributed to Little League Shoulder, says Heyworth. Most children outgrow the injury, but if underlying issues aren’t addressed, players may have recurrence of the condition as they return to play.

To learn more about preventing common baseball injuries, download Boston Children’s Injury Prevention guide.

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Life after cleft lip surgery: Finding Brooks’ smile

by Tripp Underwood on July 14, 2014

Brooks 4When Rick and Aimee Bellew learned that their second child Brooks would be born with a cleft lip and soft palate, they weren’t sure what to expect. So like most people looking for information, they took their questions to the Internet—which turned out to be a mistake.

“Just minutes into our first cleft lip search on Google and we were already devastated,” Aimee remembers. “The pictures staring back at us from the computer screen were so severe. We thought ‘there’s no way a child with a condition this serious looking can be otherwise healthy.’ It was very overwhelming.”

In the coming weeks, they met with doctors and specialists for further testing, and everything indicated that—aside from Brooks’s cleft—he was developing like any other healthy baby. And while the Bellews’ local care team gave them good news, they didn’t have the information on cleft lip repair that the family was looking for. Full story »

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SOG_2071_14-2Boston Mayor Marty Walsh recently gave the keynote address at Dana-Farber’s Living Proof: Celebrating Survivorship event. He shared his experience as a child being treated for Burkitt’s lymphoma at Dana-Farber and Boston Children’s Hospital.

Boston Children’s Hospital is proud to have been involved in the Mayor’s treatment all those years ago. Stories like his, and all of our patients, inspire the team at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center to provide the most advanced care and develop innovative treatments so the children they treat today can go on to do great things tomorrow.

The following excerpts from his speech, originally appeared on Insight, Dana-Farber’s blog :

I was diagnosed with cancer at age 7. I went through treatment for almost four years.

At 7-years old, I didn’t really know what was going on and how serious it was – and it was pretty serious. For many years I missed a lot of school. I missed most of my second and third grades. Full story »

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Helping your child through a transition

by Guest Blogger on July 9, 2014

Meaghan O’Keeffe, RN, BSN, is a mother, writer and nurse. She worked at Boston Children’s Hospital for nearly a decade, in both the Cardiac Intensive Care Unit and the Pre-op Clinic.  She is a regular contributor to Thriving.

Meaghan_OKeeffe_1A few months ago I hit a parenting rut. It was the end of February. Between the holidays, the snow days, and some sick days, we hadn’t had a solid three-day week of pre-school in almost two months. My four-year-old son, Tommy, began to have extreme meltdowns several times a day. Because it was time to leave the house. Or it was time to put a toy down. Or it was time for bed. (Or, as it seemed to me, just because.) Each moment was an intense battle and no matter what I tried, I couldn’t navigate around the rough waters. I kept hitting the rapids. I was at my wit’s end. Enough that I pulled his pre-school teacher aside one morning, and whispered, near tears, “I don’t know what to do with him.” She reassured me this was normal and gave me some tips. I made a few changes, and within a couple of weeks, it appeared we had emerged from the whirlpool. Full story »

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Chikungunya reported in the Boston area

by Tripp Underwood on July 8, 2014

tiger mosquitoFour people in the Boston area have been diagnosed with chikungunya, a viral disease spread to people by way of mosquitoes.

Typically, outbreaks of the disease are restricted to Africa, Asia, Europe and the Indian and Pacific Oceans. But as of late, there has been an increase in reported cases in the Caribbean islands, which some believe may eventually lead to more cases in the U.S.

“With the disease now appearing more frequently in islands neighboring the U.S., it’s quite possible we’ll begin seeing more cases of infected travelers bringing chikungunya home with them,” says Jeffrey Dvorin, MD, PhD, of Boston Children’s Hospital’s Division of Infectious Diseases. “And because the types of mosquitoes that can carry and transfer the disease are present in Massachusetts, there’s an increased risk that it could spread more easily once here, like has happened recently with the West Nile virus. There’s a good chance we’ll be hearing much more about it in the coming years.”

People with chikungunya often develop a fever, rash and joint pain a few days after being infected. It rarely results in death—usually only among the very young, old or sick—but the symptoms can be severe in children.

And because chikungunya is transmitted via the Aedes aegypti and Aedes albopictus mosquitos—which are aggressive biters that feed throughout the day instead of just at dawn or dusk—protecting against their bite requires a bit more effort.

To keep your family free of mosquito bites this summer, Dvorin recommends:

Using insect repellents

  • Bug sprays with DEET or picaridin provide the longest lasting protection.
  • If you use sunscreen and insect repellent, put sunscreen on first and the repellent last.
  • Spray repellent on your clothing, not just exposed skin.
  • Always follow the label instructions when using insect repellent or sunscreen.

Knowing your environment

  • Don’t let children play around water that has been standing for a few days, like puddles or small pockets of rainwater as they may be a mosquito breeding ground. If you have a kiddie pool in your yard, drain it daily to keep the water from getting stagnant.
  • Leave doors shut and make sure all your windows have screens without holes. Replace or repair screens if necessary.
  • Wear long sleeves and pants when weather allows, especially when in areas with large mosquito populations like swamps or woods.

“Though a few cases of chikungunya have been discovered in the area, it’s not yet considered a public threat, so parents shouldn’t be afraid to send their children outside,” Dvorin says. “But before you do, make sure they’re protected with the right repellents and clothing. And if a child does come down with an illness with a fever accompanied by a rash and joint pains, you should contact your doctor.”


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When school is online, how much screen time is too much?

by Michael Rich MD MPH on July 7, 2014

Michael RichMichael Rich, MD, MPH, is Boston Children’s Hospital’s media expert and director of Boston Children’s Center on Media and Child Health. Send him a media-related parenting question via and follow him on Twitter @CMCH_Boston.

Q: I teach for an online school that serves students in 4th through 12th grades. All of our lesson content is web-based, and the school would like to add three hours of synchronous lesson delivery four days a week. I believe that the school is trying to satisfy the parent desire for face-to-face contact between students and teachers—in this scenario, students can ask questions in real time and get their answers right away. Personally, I think that it is too much screen time for the students. All of the data I see indicates that screen-time does not count when it is for educational purposes, but that does not seem quite right to me. What are your thoughts on online education and how much time a student in an online school should spend using screens?
- Skeptical about Screen Time, in Alberta, Canada

A: Dear Skeptical, Full story »

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Determined to overcome HLHS

by Tripp Underwood on June 30, 2014

Peter-Dunn-3 Kerri Dunn can always tell when her son Peter is determined to do something because when he gets deeply focused his face scrunches up and he squints one eye tightly shut, which his mother says makes him look like a cute, 2-year-old version of Popeye.

It’s a face Kerri sees a lot, because Peter is a very determined little boy. The youngest of six children, Peter is always trying to keep up with his older brothers and sisters—or “my kids” as he calls them. And, despite his smaller size, he still manages to do so—whether they’re walking, running or even climbing trees.

While his determination to keep pace with his older siblings may seem cute on the surface, it’s actually an incredible testament to Peter’s strong will. Not only is he managing to follow in their much larger footsteps, he’s doing so with only fifty percent of a working heart beating inside his chest. Full story »

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When Priya Moorthy first learned she was pregnant, her plan was to defer medical school for a year, then finish her education when her baby had grown. But shortly after her daughter Vaidehi was born, Priya realized that caring for her would be a full-time responsibility. Even though she wouldn’t be returning to med school in the foreseeable future, raising Vaidehi would give Priya a unique medical education all its own.

A very special type of IBD

Vaidehi-bakesAt just three months old, Vaidehi was diagnosed with chronic granulomatous disease (CGD), a rare genetic immune deficiency that prevents her body from effectively protecting against certain bacteria and fungi. Because CGD is rare (it only effects around 1 out of every 250,000 people), there is a lot the medical community still needs to learn about the disease, especially when it presents with other gastrointestinal conditions Full story »

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