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For Little Leaguers, Chest Protectors Strike Out

They don't guard the chest wall, leaving kids open to serious injury

FRIDAY, May 21, 2004 (HealthDayNews) -- A Little League catcher bundled in protective gear guards the plate as a runner rounds third and heads for home. The throw from short comes in hard, fast and chest high.

The runner is safe, but the catcher -- despite the bulky pads -- may be in danger of a serious cardiac injury.

That's the conclusion of a study of youth baseball equipment presented May 21 at the Heart Rhythm Society annual scientific sessions in San Francisco.

The study findings show chest protectors don't offer any substantial protection from chest wall trauma that can result in sudden cardiac death (SCD).

An estimated 14,000 U.S. children die each year from SCD, a condition in which the heart abruptly stops beating. The most common cause is a heart rhythm disorder known as ventricular fibrillation. Without prompt emergency help, death follows within minutes of an episode of ventricular fibrillation. A small but increasing number of SCD episodes occur during youth sports, experts say.

"The lack of protection afforded by chest wall protectors is alarming news for young athletes," said Dr. Michael E. Cain, Heart Rhythm Society president and a professor at Washington University School of Medicine in St. Louis. "It is obvious that improvements must be made in these pads so that they actually protect these children."

The study, conducted by physicians at Tufts-New England Medical Center and the Minneapolis Heart Institute Foundation, tested seven commercially manufactured chest protectors marketed to youth baseball players, including foam and hard plastic models.

According to Dr. Mark S. Link, an associate professor of medicine at Tufts University School of Medicine and a member of the research team, half of the protectors evaluated were designed for use by young catchers, and half were designed for use by batters, pitchers and fielders.

It turns out the materials and their intended use on the diamond didn't much matter.

"Frankly, none of the pads work," said Link. "And there was little or no difference in their performance under game conditions. Uniformly they do not offer adequate protection for a child's chest wall."

Baseball is only one of several youth sports where chest protection to prevent serious cardiac trouble is important. Hockey, soccer and lacrosse are others. The number of children involved in these sports is significant. A 2001 study of baseball injuries, for example, estimated that more than 6 million boys and girls in the United States participate in youth baseball leagues each year.

According to Link, the number of fatalities reported in these leagues has been on the rise, from about four deaths a year in the 1980s to 20 last year. Whether this reflects an increase in surveillance and reporting, an increase in the number of children playing baseball, or an increase in children's exposure to serious chest wall injuries is not yet known, he said.

"What I do know is that there's an implicit claim that a chest wall protector protects a child's chest wall," he said. "At a minimum, protection is what children should get when they put one on -- and they don't."

Link and other physicians acknowledged that the use of protectors isn't very widespread in children's athletics.

"Catchers are the only players who routinely wear chest protection," said Link, "even though they are not the only ones at risk of cardiac trauma which can lead to SCD. Of course, since the protectors don't actually provide protection, it's hard to be concerned about their levels of use."

Some pediatricians think concerns about whether chest wall protectors are effective or whether they are used consistently are off-base.

Dr. Charles Shubin, director of pediatrics at Mercy FamilyCare in Baltimore, for example, believes that young children shouldn't be playing sports where the risk of injury is so high that chest wall protectors or other cumbersome pieces of safety equipment are needed to keep them injury-free.

"Young children should be engaged in activities that are appropriate for their age and developmental stage," he said. "The question is not whether you can get enough of the right protective gear on a child to prevent her from being hurt, but whether the child is involved in a sport she shouldn't even be playing."

"The issue here isn't an equipment failure," Shubin continued, "it's a common sense failure. My pitch as a pediatrician is that children need to be playing the right sports, not looking for equipment to protect them from injuries from activities they shouldn't be involved in."

More information

For more on children and sports safety, visit the American Academy of Orthopaedic Surgeons or the Nemours Foundation.

SOURCES: Charles Shubin, M.D., director of pediatrics at Mercy FamilyCare, Baltimore; Michael E. Cain, M.D., Heart Rhythm Society president, and professor at Washington University School of Medicine, St Louis; Mark S. Link, M.D., associate professor of edicine at Tufts University School of Medicine, Boston; May 21, 2004, presentation, Heart Rhythm Society annual scientific sessions, San Francisco
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