Kids Phys Ed Injuries Increase

A recent study shows kids are getting injured at a much higher rate in gym class than in years past. But the high rate of child obesity, has advocates pushing for more physical education at school. A roundtable of moms experts tackles the issue.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News. They say it takes a village to raise a child, but maybe you just need a few moms in your corner. We visit with a diverse group of parents each week for their common sense and savvy parenting advice.

Today we're talking about the increasing risk in P.E. classes. Now, maybe you remember P.E. fondly as a time of free-wheeling games of dodge ball, or maybe with dread as the bigger, stronger, faster kids had their way with the gym. Either way, in recent years, public-health advocates have been touting physical education as a way to tackle the growing problem of kids gaining too much weight, but now a new study suggests that that solution has hazards of its own.

According to a recent study released by the Research Institute at Nationwide Children's Hospital, published in the journal Pediatrics, kids appear to be getting injured at a much higher rate in gym class than in years past.

Between 1997 and 2007, the number of injuries related to physical education annually increased 150 percent, from 24,000 to more than 60,000.

Joining us to talk more about this are Lara McKenzie. She's the principal investigator with the Research Institute at Nationwide Children's Hospital, the organization responsible for this study.

Also with us is Charlene Burgeson, executive director of the National Association for Sport and Physical Education. And regular TELL ME MORE parenting contributor Leslie Morgan Steiner is here with me in the studio. Ladies, moms, welcome. Thank you for joining us.

Ms. LARA McKENZIE (Research Institute, Nationwide Children's Hospital): Great to be here.

Ms. CHARLENE BURGESON (Executive Director, National Association for Sport and Physical Education): Thank you.

LESLIE MORGAN STEINER: Great to be here.

MARTIN: Lara, please start, and tell us, what do you make of these findings? Why is this happening, and is there a gender difference?

Ms. McKENZIE: Well, we looked at physical education injuries across an 11-year period, injuries that were severe enough to be treated in emergency departments, and what we found, as you mentioned, was 150-percent increase in P.E.-related injuries presenting to emergency departments. This was consistent across gender and age groups.

MARTIN: Are boys and girls having different kinds of injuries, or are they the same?

Ms. McKENZIE: Boys and girls are definitely being injured differently. Some of the differences that we saw between boys and girls were high-school-aged boys, for example, were more likely to be injured than were elementary or middle school boys. Girls were more likely to have a lower-extremity injury compared to other body parts and more likely to have a strain or a sprain than other types of injuries.

MARTIN: Now, obviously - and Charlene, I'm going to ask you to weigh in on this, too, but Lara, obviously the question one wants to ask is: Why is this happening? Particularly because I think a lot of us are under the impression that in fact P.E. is not emphasized as much as it has been in the past. So why this huge increase in injuries? And I think we all agree this is a big number, correct?

Ms. McKENZIE: Absolutely. This is a lot of injuries, more than 400,000 over the 11-year period, but it's unlikely that this increase was attributable to an increase in P.E. participation, and as you mentioned, it's - participation has gone down in the past decade.

So we don't think it's because more kids are actually participating in P.E.. So we speculate that it may be due to a couple of things. There's a shift to promote active individual fitness and lifelong activities over team sports. So the types of activities that kids are doing in gym may have changed, as well as the class size could be a factor.

The student-teacher ratio could be such that teachers are supervising really large classes of kids, and maybe there's not enough supervision.

MARTIN: That's interesting, a lot to chew on here. Charlene, what is your take on this? First of all, have you been hearing this in the field? Have you been seeing, with your teachers, your members, parents, complaining about a higher rate of injury? Or is this number a surprise to you too?

Ms. BURGESON: No, we have not been hearing this. It is a surprise to us, but it is something that we definitely want to try to understand what the causes are. In physical education, our first priority is safety and injury prevention, and much like doctors that take the Hippocratic oath, we feel that, you know, above all we should be doing no harm. And so while physical education poses so many benefits to kids, we also don't want that to be at the risk of them having injury.

MARTIN: Do you have a theory? I mean, Lara pointed out a number of possibilities here: increased class size, people undertaking different activities without as much supervision. Do you have a theory? And it's okay if you don't, but I thought you might, given that you represent a range of people who are in this field.

Ms. BURGESON: Well, we have a couple of theories. It may be that more injuries are not actually occurring but that more are being seen in the emergency departments. The loss of school nurses in so many schools could be a factor in that.

Administrators are very aware of the litigious society that we live in and how important it is to know, if a child is injured, exactly what has happened and what treatment should occur and that more kids are going to emergency departments. That could be one situation.

Another is that in the effort to make sure that kids are getting physical education and physical activity in schools, it could be that class sizes are increasing and more kids are being active in a smaller space. And of course that poses hazards around contact with other students, which is one of the findings in the study, or objects in the gymnasium and that sort of thing.

MARTIN: Leslie, let's bring you in. You have three children all of school age. Is this something that the moms are talking about in your circle? And how is physical education handled in your children's schools?

STEINER: Well, I have three kids 12 and under, a boy and two girls, and we're a really sports-oriented family. In fact, my husband and I were married on a tennis court, and our kids play just every sport possible.

Our son plays AU basketball and competitive tennis, and the girls play soccer and basketball, and they swim and bike, and my husband coaches four kids' rec sports teams, so sports is really a lot of our lives...

MARTIN: I'm getting tired just hearing it.

(Soundbite of laughter)

STEINER: It's really, really fun.

MARTIN: I want some Gatorade.

STEINER: We don't do much but sports in our house, and I think that we've been lucky in some ways because none of our kids have had an injury that's required us to take them to an emergency room in all of the years that they've been playing their crazy sports. But what I would say is that motherhood has changed so much. Family size has gotten smaller and it's led to this incredible rise in helicopter parenting.

And what I find, instead of parents being able to shrug it off, we have this burden that we've got to take it really, really seriously, and so we take our kids to the emergency room when maybe a generation ago parents wouldn't have done it.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. We're talking about a new study that documents a sharp rise in the number of injuries associated with physical education classes from 1997 to 2007.

I'm speaking with our regular TELL ME MORE parenting contributor, Leslie Morgan Steiner. Also Lara McKenzie, principal researcher on this study. And Charlene Burgeson. She is the executive director of the National Association for Sport and Physical Education.

You know, Leslie, it's interesting because we hear countervailing narratives around this. On the one hand you hear about helicopter parents. On the other hand we keep hearing about kids who are so involved in sports at such a high level, at such a young age, you kind of do wonder who it is that we're talking about.

STEINER: I know, you know, it's really so true and I - because our kids are so active, I try to be really careful that they get a variety of exercise. But I also remember my own childhood. It was a childhood in motion. I was always on a bike or running out the door. I think that's normal to have a really active childhood, and I think kids need it.

MARTIN: Lara, as we mentioned, childhood obesity is a serious concern. The Centers for Disease Control estimate that more than 16 percent of American kids are overweight or obese. I understand that there's so many more questions we have related to this study, but could the fact that some of the kids are coming in not great physical condition to begin with are driving up the injury rate?

Ms. MCKENZIE: That's a real possibility. Physical education in schools is one of the main tools used to increase physical activity and prevent child obesity. However, being healthy doesn't have to hurt. We want kids to have a physically active lifestyle and it's very important, especially for children. And I would say that the long term effects of inactivity outweigh the relatively minor cost and effects of P.E.-related injuries.

MARTIN: Charlene, do you have a theory about whether it's kids who aren't getting enough physical activity outside of school and therefore perhaps when they're in school are more prone to injury? Or are we talking about kids who are just stressing their little bodies out because they're just doing everything? You know, they're doing, you know, soccer and lacrosse and tennis and basketball or Little League.

Ms. BURGESON: I think we're probably talking about a little bit of both. And I think we're also talking about the setting in which kids are being active. And I think this is an important thing for parents to think about, since they're the one sending their kids to school and they're the taxpayers, that it's not so much what is being taught but it's how it's being taught.

And parents should go into their schools and take a look at the settings that their kids are having physical education in, both the gymnasium and the outdoor field settings, and look and see if the teachers are setting ground rules and enforcing those safety-related rules and to see what kind of space is available and what the equipment is like and whether or not young kids are doing age-appropriate things like learning skills or playing in very small-sided games like two against two or three against three.

MARTIN: You know, that makes so much sense to me because I'm sure parents have got clued into the idea that they should check homework, maybe drop into school to see how class is being conducted. But I'm not sure it ever would've occurred to me to drop in on a P.E. class.

Ms. BURGESON: Right.

MARTIN: Charlene, any other tips?

Ms. BURGESON: It's really important for the parents to make sure that their kids are receiving physical education from someone who is certified as a physical education teacher. And you know, there's sort of this misunderstanding that anyone could teach or guide kids in play.

And any parent who has led a birthday, an active birthday party in their backyard or led a scouting group, knows that getting a large group of kids to be active and engage in game playing, it's not a free-for-all or it shouldn't be a free for all, that there's definitely certain rules and parameters and strategies that should be used to do it safely.

They're taught to conduct these activities in a manner that is highly attentive to safety and to skill prerequisites, like how do we know a kid is ready to take on a certain activity. We need to make sure they have a certain level of fitness and certain basic skills.

MARTIN: What tips do you have, Leslie, for making sure your kids are, have a great time but don't get...

STEINER: You know, I think...

MARTIN: ...aren't frequent flyers in the emergency room?

STEINER: Well, one thing I would say is that part of childhood sometimes is learning the limits of your own body, and I don't encourage people to have their kids do reckless things or break bones, but also just to relax, that a trip to the emergency room is not, it's really common, so don't worry so much about it.

We should support our kids without going crazy in terms of trying to make sure that they only have exercise like in a padded room.

MARTIN: I know exactly what you're saying but I got to tell you, I keep thinking about all the people in this country who don't have health insurance and how catastrophic an injury could be...

STEINER: And maybe that's part of why there are all these emergency rooms visits too. We can't lose track of the fact that these are emergency room visits, and it may be the tip of the iceberg or there may be many more kids being injured or it may be something really different.

I think the study is great because it points everybody in the direction of thinking more about this and studying it more.

MARTIN: Lara, a final word from you. Is there anything else you would like to know? Is there any further study that you would like to see take place? And do you have any tips for parents who want to think about how they can still have their kids get the exercise they need but be safe while doing it?

Ms. MCKENZIE: Yeah. I think our study was really the first step towards identifying patterns of P.E.-related injuries, and injury prevention education should be made a priority for all P.E. activities, especially for those activities with the highest injury rate.

And some other tips for parents - I really liked Charlene's comments about how to interact and be proactive in your children's participation in P.E. (unintelligible) questions for parents might be: Does your school have an emergency response plan to activate in the event of a P.E. class injury? Does your child's school have a health care professional on site?

What is the teacher to student ratio in your child's class? Those kinds of questions would be great. And I agree, going to the place where your kids are going to participate in P.E. is a great idea, see the facilities, see the setup, see the space, see the equipment that they're going to use.

MARTIN: Lara McKenzie is a principal investigator with the Research Institute at Nationwide Children's Hospital. She joined us from WOSU in Columbus. Charlene Burgeson is the executive director of the National Association for Sport and Physical Education. She joined us from her home office in Oakton, Virginia. And regular TELL ME MORE parenting contributor Leslie Morgan Steiner joined us here in our Washington, D.C. studios.

If you want to read the article we're talking about in its entirety, it was published, as I said, in the journal Pediatrics. We'll have a link on our Web site at the new NPR.org.

Ladies, moms, thank you.

STEINER: Thank you, Michel.

Ms. BURGESON: Thanks.

Ms. MCKENZIE: Thank you.

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