Weightlifting for children
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Sam_I_Am77 wrote: »My son has been competing with me in powerlifting since he was 11 years old. He has no developmental issues, etc... that everyone said he would have. He trains really heavy just like I do but I am very strict about constantly improving his technique. At 11 years old he deadlifted 205lbs at 97lbs bw after 3 months of training. Now he is 13 and is closing in on a 315 deadlift at 125lbs. My point is that kids can train and they can do so with high intensity as long as it is executed properly. People seem to think that kids need to lift baby weights or they'll get hurt. If that were true then every kid that grew up on a farm or a ranch would have died a horrible death by now.
That's really awesome Lofteren. How heavy in relation to 1RM do you actually push the loading with him? How often do you train him?
He trains 3 days a week with weights, he does kickboxing 2 days a week and has football 5 days a week. In the powerlifting off season (read: football season)we work up to max sets of 5 reps usually but leading up to a meet we will taper the reps and increase the intensity gradually until he hits a few singles at 90-95% of his goal weights. Then he'll deload for a week and then compete. After a comp he takes another week or two off of weights.0 -
I forgot to mention that I try to limit his "grinders" to on the platform. If he can't lift it with a smooth cadence, which could be slow as long as it never sticks, then he doesn't do it in training. Taking small weight increases between heavier sets protects against this.0
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I don't think the physiological aspect is an issue. I would be more concerned with them having the maturity to use strict form in a disciplined manner. If they have that then go for it.0
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My kids want to lift with me. My 11yo would be able to focus enough for form, but my 7yo has the attention span of a fish.
But they recently came up with their own bodyweight "training schedule" lol
Pushups, planks, squats and a few other things. The 7yo does it once and the 11yo does it through twice. They have done it every morning except on the mornings when the 11yo is at swim training (3x week at 5am
).
The best bit? They can both do proper toe pushups, and my 11yo girl can beat all the boys in her class - she's pretty chuffed with that
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I would worry if they lifted too heavy. I remember this guy in 7th grade who had big muscled arms, bragged how he had been lifting weights since he was 10. But the problem was his arms were extremely short in proportion to his body. I asked my parents about it and they told me that too heavy lifting can damage your growth plates. I would do more research before I let a child lift heavy, so no permanent damage is done.0
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dieter1200 wrote: »I would worry if they lifted too heavy. I remember this guy in 7th grade who had big muscled arms, bragged how he had been lifting weights since he was 10. But the problem was his arms were extremely short in proportion to his body. I asked my parents about it and they told me that too heavy lifting can damage your growth plates. I would do more research before I let a child lift heavy, so no permanent damage is done.
The whole first half of this thread was the research. I would be happy to read anything in regards to growth plate damage resulting from heavy lifting if you have it though.
Multiple sources I found claim that it is a myth.
http://www.acsm.org/access-public-information/articles/2012/01/13/youth-strength-training-facts-and-fallaciesMyth: Strength training will stunt the growth of children.
Fact: There is no current evidence to indicate a decrease in stature in children who regularly strength train in a supervised environment with qualified instruction. In all likelihood, participation in weight-bearing physical activities (including strength training) will have a favorable influence on growth at any stage of development but will not affect a child’s genetic height potential.0 -
http://www.mayoclinic.org/healthy-living/tween-and-teen-health/in-depth/strength-training/art-20047758
"Strength training: OK for kids?
Strength training offers kids many benefits, but there are important caveats to keep in mind. Here's what you need to know about youth strength training. By Mayo Clinic Staff
Strength training for kids? You bet! Done properly, strength training offers many bonuses to young athletes. Strength training is even a good idea for kids who simply want to look and feel better. In fact, strength training can put your child on a lifetime path to better health and fitness.
Strength training, not weightlifting
For kids, light resistance and controlled movements are best — with a special emphasis on proper technique and safety. Your child can do many strength training exercises with his or her own body weight or inexpensive resistance tubing. Free weights and machine weights are other options.
Don't confuse strength training with weightlifting, bodybuilding or powerlifting. These activities are largely driven by competition, with participants vying to lift heavier weights or build bigger muscles than those of other athletes. This can put too much strain on young muscles, tendons and areas of cartilage that haven't yet turned to bone (growth plates) — especially when proper technique is sacrificed in favor of lifting larger amounts of weight. "
I guess I confused strength training with weightlifting0 -
dieter1200 wrote: »http://www.mayoclinic.org/healthy-living/tween-and-teen-health/in-depth/strength-training/art-20047758
"Strength training: OK for kids?
Strength training offers kids many benefits, but there are important caveats to keep in mind. Here's what you need to know about youth strength training. By Mayo Clinic Staff
Strength training for kids? You bet! Done properly, strength training offers many bonuses to young athletes. Strength training is even a good idea for kids who simply want to look and feel better. In fact, strength training can put your child on a lifetime path to better health and fitness.
Strength training, not weightlifting
For kids, light resistance and controlled movements are best — with a special emphasis on proper technique and safety. Your child can do many strength training exercises with his or her own body weight or inexpensive resistance tubing. Free weights and machine weights are other options.
Don't confuse strength training with weightlifting, bodybuilding or powerlifting. These activities are largely driven by competition, with participants vying to lift heavier weights or build bigger muscles than those of other athletes. This can put too much strain on young muscles, tendons and areas of cartilage that haven't yet turned to bone (growth plates) — especially when proper technique is sacrificed in favor of lifting larger amounts of weight. "
I guess I confused strength training with weightlifting
Thanks for the link. Im not sure I understand the distinction between the strength training and weightlifting when they give free weights and machines as options for strength training. I am going to assume they are talking about Olympic style weightlifting as a sport.
I still have not seen any evidence that growth plate damage has been recorded in all the studies I looked at. There were even a few that tested 1RM's.
Of course none of them are going to test how often and how much it takes to get damage. I think Lofteren has the right idea about how to avoid the potential risk and keeps the heaviest lifting to the actual competitions.0 -
dieter1200 wrote: »http://www.mayoclinic.org/healthy-living/tween-and-teen-health/in-depth/strength-training/art-20047758
deleted rest of quote to decrease length of post
I guess I confused strength training with weightlifting
Hmm, I do not understand that link. The author apparently doesn't understand what they are writing about. With strength training comes increased muscle mass. Yes, I know not immediately, but as you max out the strength you can have with existing muscle, your muscles will increase in size to accommodate the increased weight you are able to lift. Even body weight only exercises will cause hypertropy.
Also, if kids were supposed to wait till after adolescents to start officially weight training or body building, there would be an aweful lot of wimpy people on the college football fields
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So, do you just let your kids do this when/how they want. Or do you start having them do it when you do? I would love for my daughter to do some weights/circuit with me. But she does one thing and gets bored. She definitly needs more exercise.0
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mustgetmuscles1 wrote: »dieter1200 wrote: »http://www.mayoclinic.org/healthy-living/tween-and-teen-health/in-depth/strength-training/art-20047758
"Strength training: OK for kids?
Strength training offers kids many benefits, but there are important caveats to keep in mind. Here's what you need to know about youth strength training. By Mayo Clinic Staff
Strength training for kids? You bet! Done properly, strength training offers many bonuses to young athletes. Strength training is even a good idea for kids who simply want to look and feel better. In fact, strength training can put your child on a lifetime path to better health and fitness.
Strength training, not weightlifting
For kids, light resistance and controlled movements are best — with a special emphasis on proper technique and safety. Your child can do many strength training exercises with his or her own body weight or inexpensive resistance tubing. Free weights and machine weights are other options.
Don't confuse strength training with weightlifting, bodybuilding or powerlifting. These activities are largely driven by competition, with participants vying to lift heavier weights or build bigger muscles than those of other athletes. This can put too much strain on young muscles, tendons and areas of cartilage that haven't yet turned to bone (growth plates) — especially when proper technique is sacrificed in favor of lifting larger amounts of weight. "
I guess I confused strength training with weightlifting
Thanks for the link. Im not sure I understand the distinction between the strength training and weightlifting when they give free weights and machines as options for strength training. I am going to assume they are talking about Olympic style weightlifting as a sport.
I still have not seen any evidence that growth plate damage has been recorded in all the studies I looked at. There were even a few that tested 1RM's.
Of course none of them are going to test how often and how much it takes to get damage. I think Lofteren has the right idea about how to avoid the potential risk and keeps the heaviest lifting to the actual competitions.
Olympic weightlifting actually has a lower injury rate than any other sport; whereas, soccer has the highest rates of injury. I find it funny that parents would put their kids on a soccer team with absolutely no worries but wouldn't let them touch a barbell.
That being said, I work with a mayo-trained neuromuscular specialist who knows absolutely nothing about exercise, diet, strength training, etc..... I mean NOTHING AT ALL. I would really question the validity of a study on weight lifting coming out of the mayo clinic. I would even be somewhat skeptical of studies on weight training coming out of the NSCA and the ACSM because I've seen some absolute garbage in their journals.
That being said, I started lifting when I was 12 years old and wound up being the tallest person in my entire family by 2 inches. The only "side effect" that has occurred from me lifting is an increased amount of muscle mass and strength. The old wives tale that lifting stunts your growth holds about as much weight as "coffee will stunt your growth", "masturbating will make your palms hairy" and "bigfoot is real".0 -
mustgetmuscles1 wrote: »dieter1200 wrote: »http://www.mayoclinic.org/healthy-living/tween-and-teen-health/in-depth/strength-training/art-20047758
"Strength training: OK for kids?
Strength training offers kids many benefits, but there are important caveats to keep in mind. Here's what you need to know about youth strength training. By Mayo Clinic Staff
Strength training for kids? You bet! Done properly, strength training offers many bonuses to young athletes. Strength training is even a good idea for kids who simply want to look and feel better. In fact, strength training can put your child on a lifetime path to better health and fitness.
Strength training, not weightlifting
For kids, light resistance and controlled movements are best — with a special emphasis on proper technique and safety. Your child can do many strength training exercises with his or her own body weight or inexpensive resistance tubing. Free weights and machine weights are other options.
Don't confuse strength training with weightlifting, bodybuilding or powerlifting. These activities are largely driven by competition, with participants vying to lift heavier weights or build bigger muscles than those of other athletes. This can put too much strain on young muscles, tendons and areas of cartilage that haven't yet turned to bone (growth plates) — especially when proper technique is sacrificed in favor of lifting larger amounts of weight. "
I guess I confused strength training with weightlifting
Thanks for the link. Im not sure I understand the distinction between the strength training and weightlifting when they give free weights and machines as options for strength training. I am going to assume they are talking about Olympic style weightlifting as a sport.
I still have not seen any evidence that growth plate damage has been recorded in all the studies I looked at. There were even a few that tested 1RM's.
Of course none of them are going to test how often and how much it takes to get damage. I think Lofteren has the right idea about how to avoid the potential risk and keeps the heaviest lifting to the actual competitions.
Olympic weightlifting actually has a lower injury rate than any other sport; whereas, soccer has the highest rates of injury. I find it funny that parents would put their kids on a soccer team with absolutely no worries but wouldn't let them touch a barbell.
That being said, I work with a mayo-trained neuromuscular specialist who knows absolutely nothing about exercise, diet, strength training, etc..... I mean NOTHING AT ALL. I would really question the validity of a study on weight lifting coming out of the mayo clinic. I would even be somewhat skeptical of studies on weight training coming out of the NSCA and the ACSM because I've seen some absolute garbage in their journals.
That being said, I started lifting when I was 12 years old and wound up being the tallest person in my entire family by 2 inches. The only "side effect" that has occurred from me lifting is an increased amount of muscle mass and strength. The old wives tale that lifting stunts your growth holds about as much weight as "coffee will stunt your growth", "masturbating will make your palms hairy" and "bigfoot is real".
Very true. No one suggests doing research before putting a kid in gymnastics, dance, football, bike riding and so on. The last paragraph in the Mayo Clinic article could be said about any of them.
http://www.niams.nih.gov/health_info/Growth_Plate_Injuries/default.aspWho Gets Growth Plate Injuries?
Growth plate injuries can occur in growing children and adolescents. In a child, a serious injury to a joint is more likely to damage a growth plate than the ligaments that stabilize the joint. Trauma that would cause a sprain in an adult might cause a growth plate fracture in a child.
Growth plate fractures occur twice as often in boys as in girls, because girls’ bodies mature at an earlier age than boys. As a result, their bones finish growing sooner, and their growth plates are replaced by stronger, solid bone.
Growth plate injuries often occur in competitive sports such as football, basketball, or gymnastics, or as a result of recreational activities such as biking, sledding, skiing, or skateboarding.
Fractures can result from a single traumatic event, such as a fall or automobile accident, or from chronic stress and overuse. Most growth plate fractures occur in the long bones of the fingers (phalanges) and the outer bone of the forearm (radius). They are also common in the lower bones of the leg (the tibia and fibula).
I am glad there is research on strength training for kids out there though.0 -
This is interesting. My boys are preteens. I'm glad to see it's not physically damaging, but I don't think weightlifting is the best activity for young children (under 12 or so). I'd rather see them doing something more social that involves teamwork and sportsmanship, so yes, I'd rather see them on the monkey bars doing chinups with other kids than doing chinups in the gym around adults.
I also have concerns about setting up unrealistic body image expectations. My opinion is that boys are as damaged by the "superhero" image of the perfect male body as girls are by the "supermodel" look. I want to make sure that my kids are comfortable in their own skins.
My younger son does extensive bodyweight work in his martial arts classes (he can do 50 burpees or 50 pushups in a row and mostly maintain form), and the older kids at his dojo seem to spend a lot of time in the weights room at our neighborhood gym. He'll probably naturally gravitate toward weights when he's a teen doing football, hockey, and/or wrestling.
My older son isn't that physical, so I plan to start bringing him to the gym with me when he's 13, which is the youngest age allowed with parental supervision. He's mildly autistic and I suspect he may enjoy the routine and "self-challenge" of weights over other activities. It doesn't require speed nor adapting to others. All the sports he likes (rock climbing, diving, swimming, batting cage, driving range) are individual sports that are all about technique, so strength training is a natural fit for him.
I'm looking forward to making the gym a family event. I think keeping it off-limits for now and making it more of an "adult" activity has actually piqued their interest and they're looking forward to being allowed to join me 0 -
mustgetmuscles1 wrote: »dieter1200 wrote: »http://www.mayoclinic.org/healthy-living/tween-and-teen-health/in-depth/strength-training/art-20047758
"Strength training: OK for kids?
Strength training offers kids many benefits, but there are important caveats to keep in mind. Here's what you need to know about youth strength training. By Mayo Clinic Staff
Strength training for kids? You bet! Done properly, strength training offers many bonuses to young athletes. Strength training is even a good idea for kids who simply want to look and feel better. In fact, strength training can put your child on a lifetime path to better health and fitness.
Strength training, not weightlifting
For kids, light resistance and controlled movements are best — with a special emphasis on proper technique and safety. Your child can do many strength training exercises with his or her own body weight or inexpensive resistance tubing. Free weights and machine weights are other options.
Don't confuse strength training with weightlifting, bodybuilding or powerlifting. These activities are largely driven by competition, with participants vying to lift heavier weights or build bigger muscles than those of other athletes. This can put too much strain on young muscles, tendons and areas of cartilage that haven't yet turned to bone (growth plates) — especially when proper technique is sacrificed in favor of lifting larger amounts of weight. "
I guess I confused strength training with weightlifting
Thanks for the link. Im not sure I understand the distinction between the strength training and weightlifting when they give free weights and machines as options for strength training. I am going to assume they are talking about Olympic style weightlifting as a sport.
I still have not seen any evidence that growth plate damage has been recorded in all the studies I looked at. There were even a few that tested 1RM's.
Of course none of them are going to test how often and how much it takes to get damage. I think Lofteren has the right idea about how to avoid the potential risk and keeps the heaviest lifting to the actual competitions.
Olympic weightlifting actually has a lower injury rate than any other sport; whereas, soccer has the highest rates of injury. I find it funny that parents would put their kids on a soccer team with absolutely no worries but wouldn't let them touch a barbell.
That being said, I work with a mayo-trained neuromuscular specialist who knows absolutely nothing about exercise, diet, strength training, etc..... I mean NOTHING AT ALL. I would really question the validity of a study on weight lifting coming out of the mayo clinic. I would even be somewhat skeptical of studies on weight training coming out of the NSCA and the ACSM because I've seen some absolute garbage in their journals.
That being said, I started lifting when I was 12 years old and wound up being the tallest person in my entire family by 2 inches. The only "side effect" that has occurred from me lifting is an increased amount of muscle mass and strength. The old wives tale that lifting stunts your growth holds about as much weight as "coffee will stunt your growth", "masturbating will make your palms hairy" and "bigfoot is real".
Lofteren, that is really an excellent point that you brought up about injuries and sports. The incidence of non-contact ACL injuries in adolescents is on the rise. I wish I was home to pull some of the research I did last semester for class, but it's fairly significant. A lot of it just kids in-need of some basic strength training to counter-balance deficiencies in their movement. How many parents that don't let their kids strength training for old myths sign their kids up for football when that's a 100% injury sport?
The Mayo Clinic is definitely well respected for their treatment of diseases and what not, but I would definitely question their information here. There is plenty of easily accessible research related to adolescent resistance-training that shows it is safe as long as they are supervised by somebody that knows what they're doing.
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Sam_I_Am77 wrote: »mustgetmuscles1 wrote: »dieter1200 wrote: »http://www.mayoclinic.org/healthy-living/tween-and-teen-health/in-depth/strength-training/art-20047758
"Strength training: OK for kids?
Strength training offers kids many benefits, but there are important caveats to keep in mind. Here's what you need to know about youth strength training. By Mayo Clinic Staff
Strength training for kids? You bet! Done properly, strength training offers many bonuses to young athletes. Strength training is even a good idea for kids who simply want to look and feel better. In fact, strength training can put your child on a lifetime path to better health and fitness.
Strength training, not weightlifting
For kids, light resistance and controlled movements are best — with a special emphasis on proper technique and safety. Your child can do many strength training exercises with his or her own body weight or inexpensive resistance tubing. Free weights and machine weights are other options.
Don't confuse strength training with weightlifting, bodybuilding or powerlifting. These activities are largely driven by competition, with participants vying to lift heavier weights or build bigger muscles than those of other athletes. This can put too much strain on young muscles, tendons and areas of cartilage that haven't yet turned to bone (growth plates) — especially when proper technique is sacrificed in favor of lifting larger amounts of weight. "
I guess I confused strength training with weightlifting
Thanks for the link. Im not sure I understand the distinction between the strength training and weightlifting when they give free weights and machines as options for strength training. I am going to assume they are talking about Olympic style weightlifting as a sport.
I still have not seen any evidence that growth plate damage has been recorded in all the studies I looked at. There were even a few that tested 1RM's.
Of course none of them are going to test how often and how much it takes to get damage. I think Lofteren has the right idea about how to avoid the potential risk and keeps the heaviest lifting to the actual competitions.
Olympic weightlifting actually has a lower injury rate than any other sport; whereas, soccer has the highest rates of injury. I find it funny that parents would put their kids on a soccer team with absolutely no worries but wouldn't let them touch a barbell.
That being said, I work with a mayo-trained neuromuscular specialist who knows absolutely nothing about exercise, diet, strength training, etc..... I mean NOTHING AT ALL. I would really question the validity of a study on weight lifting coming out of the mayo clinic. I would even be somewhat skeptical of studies on weight training coming out of the NSCA and the ACSM because I've seen some absolute garbage in their journals.
That being said, I started lifting when I was 12 years old and wound up being the tallest person in my entire family by 2 inches. The only "side effect" that has occurred from me lifting is an increased amount of muscle mass and strength. The old wives tale that lifting stunts your growth holds about as much weight as "coffee will stunt your growth", "masturbating will make your palms hairy" and "bigfoot is real".
Lofteren, that is really an excellent point that you brought up about injuries and sports. The incidence of non-contact ACL injuries in adolescents is on the rise. I wish I was home to pull some of the research I did last semester for class, but it's fairly significant. A lot of it just kids in-need of some basic strength training to counter-balance deficiencies in their movement. How many parents that don't let their kids strength training for old myths sign their kids up for football when that's a 100% injury sport?
The Mayo Clinic is definitely well respected for their treatment of diseases and what not, but I would definitely question their information here. There is plenty of easily accessible research related to adolescent resistance-training that shows it is safe as long as they are supervised by somebody that knows what they're doing.
Strength training as possible injury prevention was mentioned in a few of the links I posted here. It is also mentioned in a lot of articles on strength training for the elderly.
Hopefully some the info will get out there and people will start to lose their fear of it.0 -
mustgetmuscles1 wrote: »Strength training as possible injury prevention was mentioned in a few of the links I posted here. It is also mentioned in a lot of articles on strength training for the elderly.
Hopefully some the info will get out there and people will start to lose their fear of it.
I've read more research on preventing non-contact ACL injuries than I care to admit to this year. Unfortunately most people associate resistance-training only with being "jacked-and-tan" but there's more to it for the athletic population and just for general health.
For elderly it's very important because it can help improve basic quality of life. One study indicated that resistance-training alone was enough to help improve cardiovascular ability as well.0 -
In. Just saw you post this on Brad's facebook status-- really hope he replies to you as I'd be curious what he has to say.0
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In to read - and as I just mentioned to SS who pointed this thread out - I am very happy that I was a small part of turning them to the dark side!!
Thanks for all the research linked also.0 -
In. Just saw you post this on Brad's facebook status-- really hope he replies to you as I'd be curious what he has to say.
Yeah that would be great. I would definitely post here if he responds. Hopefully he thinks about doing an article and getting the word out to others. Pretty huge pool of new trainees out there if you could educate parents about the benefits of strength training.In to read - and as I just mentioned to SS who pointed this thread out - I am very happy that I was a small part of turning them to the dark side!!
Thanks for all the research linked also.
No problem. Thank you for inspiring them and spurring me to look into the available info out there.
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Proud soccer mom. But I give the kids plenty of strength work. Using Halloween colored resistance bands makes it fun. Also playing more than one sport. Indoor winter rock climbing gymnastics scarf twirling whatever gets them using different muscles.
My seven year old can do fifty knuckle push-ups, chest touching a book.
Also lots of research about not irradiating those young bones. On the east coast the worst are the soccer girls with spinal cord injuries. Sorry for the rant but my 17 yo niece is in the surgical icu in ny.0 -
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Here's the aap draft position statement on radiation. The american academy of pediatrics says
AAP Headquarters
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019 Phone: 847/434-4000
Fax: 847/434-8000
E-mail: kidsdocs@aap.org www.aap.org
Reply to
Department of Federal Affairs Homer Building, Suite 400 N 601 13th St NW
Washington, DC 20005
Phone: 202/347-8600
Fax: 202/393-6137
E-mail: kids1st@aap.org
Executive Committee President
Robert W. Block, MD, FAAP
President-Elect
Thomas K. McInerny, MD, FAAP
Immediate Past President
O. Marion Burton, MD, FAAP
Executive Director/CEO
Errol R. Alden, MD, FAAP
Board of Directors
District I
Carole E. Allen, MD, FAAP Arlington, MA
District II
Danielle Laraque, MD, FAAP Brooklyn, NY
District III
Sandra Gibson Hassink, MD, FAAP Wilmington, DE
District IV
Francis E. Rushton, Jr, MD, FAAP Beaufort, SC
District V
Marilyn J. Bull, MD, FAAP Indianapolis, IN
District VI
Michael V. Severson, MD, FAAP Shakopee, MN
District VII
Kenneth E. Matthews, MD, FAAP College Station, TX
District VIII
Kyle Yasuda, MD, FAAP Seattle, WA
District IX
Myles B. Abbott, MD, FAAP Berkeley, CA
District X
Sara H. Goza, MD, FAAP Fayetteville, GA
September 6, 2012
The Honorable Margaret Hamburg, MD Commissioner
Food and Drug Administration
Division of Dockets Management (HFA– 305) 5630 Fishers Lane, rm. 1061
Rockville, MD 20852
Docket No. FDA–2012–D–0384 Dear Dr. Hamburg:
On behalf of the American Academy of Pediatrics (AAP), a professional organization of 62,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults, we appreciate this opportunity to provide comments regarding the draft guidance on pediatric information for x-ray imaging device premarket notification. We would also like to thank you for allowing the AAP to speak at the recent public workshop on the draft guidance.
The AAP values the longstanding relationship we have had with the Food and Drug Administration (FDA) on a range of pediatric issues, including the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act, and we thank you for this important step in the promotion of radiation protection for children. As you know, children are not small adults. Radiation risk in children warrants special attention because children are more radiosensitive than adults, have a longer expected lifetime for effects of radiation exposure to manifest, and are often treated with equipment and exposure settings designed for adults, which can result in excessive radiation exposure for smaller patients. Additionally, many children receive treatment from facilities that lack pediatric imaging expertise.
The AAP is encouraged that the draft guidance offers voluntary guidelines for manufacturers regarding documentation of design features and risk mitigation strategies, specifications for pediatric protocols and settings, laboratory tests for dosimetry and image quality, instructions and educational materials directed to technologists, radiologists, physicists, and other imaging professionals, and the means by which individual facilities can contact the sponsor for assistance when developing pediatric dose reduction protocols and procedures.
Page 2 American Academy of Pediatrics
The AAP agrees that optimizing imaging equipment - maximizing image quality, while minimizing radiation dose - is important for all ages, but it is particularly important in pediatric patients. Improvements in the hardware and software for optimization are important, as is the accessibility of training manuals for the appropriate use of equipment for pediatric patients. Training and education of the end-users need to be understandable to all those involved in imaging and must be easily accessed.
As most pediatric imaging is conducted primarily in adult facilities, equipment manufacturers should assume that their equipment will be used both for children and adults. Children’s body size varies from the premature infant to the obese adolescent and covers the spectrum of adult body size. Devices optimized for pediatric use therefore can be appropriate for the adult population as well. As such, we support FDA efforts that promote equipment modifications that optimize radiation dose for patients of all body sizes, standardization of nomenclature, and reduction of technique variables.
Education of the end-users on optimization is important during the initial installation of the equipment, as well as on a continuing basis. Learning the dose optimization of patients of all body sizes will benefit both adult and pediatric patients. These educational materials should be easily accessible, on-line, and open source for all purchasers.
There are a few areas where further consideration and clarification may be necessary in order to prevent unintended consequences. For example, the draft guidance proposes that manufacturers label equipment with a warning not to use on children below a certain height or weight. The AAP is concerned that this could limit the choice of imaging equipment available for centers that work primarily with pediatric patients. Similarly, we are concerned about whether it would limit the ability of adult centers to provide pediatric imaging. Accessibility to imaging for all children is as important as the optimization of available equipment.
Children already face fewer medical treatment options and many medical technology advances for adults simply are not available to children due to their relatively smaller market share, cost of production, and liability and ethical considerations. As such, the draft guidance should take care to balance safety and dose optimization for pediatric patients with costs to manufacturers so that children do not face even fewer options. Off-label use of medical technologies is an unfortunate, but necessary, standard of care in pediatrics. As the FDA finalizes the draft guidance, careful attention should be paid to the unintended consequence of increasing, rather than decreasing, off- label use of imaging devices in children.
The AAP agrees with the FDA that standardized dose information for pediatric patients is the ideal. However, real questions exist about the evidence base for measuring such a standardized dose. Similarly, the goal of radiation equipment that displays patient dose or dose index is a good one, but how would accuracy be assured and are there quality assurance tools to track radiation
Page 3 American Academy of Pediatrics
dose management? More research is needed to better understand and measure dose optimization. The AAP encourages the Agency to pursue this needed investment and we would welcome the opportunity to pursue this further with the Agency.
The AAP strongly encourages the FDA to clarify how the guidance affects the use of “home grown” pediatric positioning aids that are not included in the vendor’s 510(k) application but are developed by the end user. While we would be concerned if such a modification caused a device to be unsafe or caused injury to a child, these types of end-user modifications can be critical to the care we give our patients. Further clarification on their use in the final guidance document would be helpful.
The AAP applauds the FDA for this thoughtful initiative to protect unnecessary exposure to radiation in children. We are grateful for the opportunity to comment on the draft guidance. If the AAP can be of further assistance, please do not hesitate to contact Tamar Magarik Haro in AAP’s Department of Federal Affairs at 202-347-8600.
Sincerely,
Robert W. Block, MD, FAAP President
RWB/bd0 -
Facebook video so I dont know how well the link will work.
https://www.facebook.com/video.php?v=866767396674785&set=vb.100000245977182&type=2&theater
video info.
"Jennifer Combs
Well guys I ended with a world record of 360 lbs weighing in at 147 junior raw class. Super amped that I'm here, all the glory be to God! Love and miss you momma, I could feel you cheering me on all the way from heaven! Went for 370 and got red lighted on depth but I'm okay with that, leaves me hungry for more!"
Not a child but setting those kind of numbers in the junior class Im sure she has been at it awhile.0 -
I remember in science class once, the professor set a pendulum swinging and then asked the class, "what stops the period' and my friend said, "gymnastics". I would say just keep an eye on her body fat and don't let it get too low. Broscience maybe but it seems like it could interfere with puberty.0
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