The Right Amount of Exercise

In normally active children, exercise-related injuries and problems are few and far between. Physical education teachers, coaches, and doctors can typically provide the supervision necessary to prevent harm from occurring. Teachers and coaches are educated specifically about exercise in children. Professionals who work closely with children can help each child determine his or her own limits.

The primary risk associated with exercise is overuse injuries such as muscle strains, tendonitis, stress fractures, and other soft tissue damage. These are typically caused by doing too much too soon and are usually repaired by resting the injured area.

Two areas of concern specific to children are injuries to the growth plate and increased risk of heat ex haustion/heat stroke. Children's bones have weak areas near each end where growth takes place. These are called growth plates and are susceptible to breakage. Also, for children competing at an elite level in high-impact sports such as gymnastics there is an increased risk of a premature closing of this growth plate, which could result in stunted growth. By increasing exercise intensities gradually over time, these types of injuries can be avoided.

Children's body temperature regulation has not yet matured so there is increased risk of temperature misregulation during exercise. Children are more susceptible than adults to heat exhaustion and heat stroke in extreme heat conditions and to hypothermia in chilly water. These extreme temperature conditions should be avoided whenever possible or children should be closely monitored while exercising at these times.

Parents of preteen girls are often concerned about exercise's impact on the menstrual cycle. Endurance sports such as running and swimming promote lean body mass, yet a certain amount of body fat is necessary for proper menstrual function. Late onset of menstruation or the cessation of menstruation can be caused by extreme lean body composition. This does not, however, appear to lead to long-term reproductive health problems.

All children, even those with chronic illnesses such as asthma and diabetes and those with motor dysfunction, must include exercise as part of a total fitness program. All children can engage in exercise that will increase their overall heath. In special cases, professionals such as doctors, teachers, and coaches can work together to create an exercise program that will benefit the health and self-esteem of a child.

Regular exercise is important to the development of healthy children. With proper use of exercise principles and good professional supervision, exercise can help all children develop into healthy adults.

See also: MOTOR DEVELOPMENT

Bibliography

Armstrong, Neil, and Joanne Welsman. Young People and Physical

Activity. New York: Oxford University Press, 1997. ''Exercise (Physical Activity) and Children.'' In the American Heart Association [web site]. Dallas, Texas, 2000. Available from http://www.americanheart.org/Heart_and_Stroke_A_Z_ Guide/exercisek.html; INTERNET. Parizkova, Jana. Nutrition, Physical Activity, and Health in Early Life.

Boca Raton, FL: CRC Press, 1996. Rowland, Thomas W. Exercise and Children's Health. Champaign, IL: Human Kinetics Books, 1990.

Shawn R. A. Svoboda-Barber

FACILITATED COMMUNICATION

Facilitated communication is a controversial technique for assisting individuals with autism and related language impairments to communicate. It typically involves an adult facilitator who physically guides the individual's hand to select letters or symbols from a communication device, such as an alphabet board. When facilitated, many individuals with autism have supposedly shown unexpectedly advanced language skills, including the ability to spell and compose highly sophisticated messages. The technique is controversial because the facilitator may intentionally or unintentionally influence the selection of letters or symbols. Indeed, considerable experimental evidence has shown that, more often than not, it is the facilitator, rather than the individual being facilitated, who is responsible for the content of the resulting messages. In light of this evidence, numerous professional groups have issued position statements highlighting the lack of empirical support for facilitated communication and the need to verify that facilitated communications are free from facilitator influence.

See also: AUTISM

Bibliography

Jacobson, J. W., J. A. Mulick, and A. A. Schwartz. ''A History of Facilitated Communication: Science, Pseudoscience, and Antiscience Science Working Group on Facilitated Communication.'' American Psychologist 50 (1995):750-765. Konstantareas, M., and G. Gravelle. "Facilitated Communication.'' Autism 2 (1998):389-414.

Jeffrey Sigafoos

FAILURE TO THRIVE

Children who fail to grow properly have always existed. In earlier times when many children did not survive the first few years, small or sickly children were a fact of life. More recently, medicine has increasingly turned its attention to the unique problems of children, among them the problems of growth failure and most interestingly to the problem of malnutrition and growth failure in children without obvious organic illness. The case of so-called nonorganic failure to thrive, growth failure without apparent medical cause, is the main focus of this discussion.

The medical concept of ''failure to thrive'' in infants and young children dates back about a century. L. Emmett Holt's 1897 edition of Diseases of Infancy and Childhood included a discussion of a child who ''ceased to thrive.'' Chapin correctly recognized in 1908 that growth failure was primarily caused by malnutrition, but that temporarily correcting caloric intake and improving growth often proved futile after the child returned to her (often impoverished) environment. By 1933 the term ''failure to thrive'' formally entered the medical literature in the tenth edition of Holt's text.

Failure to thrive is not a discreet diagnosis or a single medical condition (such as chicken pox), but rather a sign of illness or abnormal function (as a rash or fever may be a sign of chicken pox virus infection). In infants and young children, the term ''failure to thrive'' is most broadly defined as physical growth that for whatever reason falls short of what is expected of a normal, healthy child. Statistical norms have been published for the growth patterns of normal children. Plotting a child's height, weight, and head circumference on such charts yields valuable diagnostic information. In children younger than age two, inadequate growth may be defined as falling below the third or fifth percentile for the age, where weight is less than 80 percent of the ideal weight for the age, or where weight crosses two major percentiles sequentially downward on a standardized growth chart.

The concept of failure to thrive, however, encompasses not just disturbances of the more obvious aspects of physical development but the more subtle aspects of psychosocial development in infancy and early childhood. ''Thriving'' is a concept that implies that a child not only grows physically in accordance with published norms for age and sex, but also exhibits the characteristics of normal progress of developmental milestones in all spheres—neurological, psychosocial, and emotional.

Early observations that an organic illness could not be found in many cases of failure to thrive led to the categorization of failure to thrive into the subclasses of organic and nonorganic causal factors. This classification ultimately proved too simplistic, both organic and environmental factors acting together may cause poor growth, but it served to sharpen thinking about the nonorganic causes.

Autism

Autism

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