Pediatricians urge later school start time

This article explains why pediatricians are urging for later school start times for older kids in middle and high schools.

U.S. high schools and middle schools should start classes later in the morning to allow kids some much-needed sleep, a leading group of pediatricians is urging.

Ideally, the American Academy of Pediatrics says, the first bell should ring at 8:30 a.m. or later -- which is the case at only 15 percent of U.S. high schools right now.

At the very least, classes should start no earlier than 8 a.m., said Dr. Judith Owens, the lead author of a new academy policy statement on school start times.

The recommendations, published in the academy's journal Pediatrics, are based on research showing that U.S. kids are sleep-deprived, which has consequences for their health, school performance and safety.

"This is an important issue," said Dr. Marcel Deray, a Florida sleep specialist who wasn't involved in the recommendations.

"I see a lot of teenagers who are tired and have problems in school because they have to get up so early," said Deray, who directs the Sleep Disorders Center at Miami Children's Hospital. "Some kids are getting up at 5 a.m., 6 a.m."

Many people think the answer is for kids to just get to bed earlier, Owens noted. But it's not that easy, she said, because biology has other plans.

Around puberty, the body's natural sleep-wake cycle shifts, and it's actually hard for teenagers to fall asleep earlier than 11 p.m.

"Teenagers' bodies release melatonin later than (adults') do," Deray explained, referring to a hormone the brain secretes in the evening to induce drowsiness.

"The other issue," Owens said, "is that teenagers' sleep needs are greater than many people think. They need nine to nine-and-a-half hours."

Yet, 43 percent of U.S. public high schools start classes before 8 a.m., according to the U.S. Department of Education. Middle schools, meanwhile, typically start classes at 8 a.m. -- with about 20 percent starting earlier than that.

"And that's the first bell," Owens said. "That's not even counting the commute time."

So in areas where kids take the school bus, the actual school day could begin before sunrise.

According to Owens, U.S. high schools started bumping up start times back in the 1950s and '60s, mainly to space out bus runs. Many school districts start high schools and middle schools first, then circle buses back to pick up elementary school kids.

One option would be to flip elementary and high school start times, but parents often oppose that -- since young children could be standing at bus stops in the early-morning dark, or have no one at home after school. Another option -- running more buses -- would be expensive.

Transportation is not the only obstacle, according to the National Sleep Foundation, which supports pushing back school start times. Some other arguments are that sports and extracurricular activities would end too late; teenagers would have no time for after-school jobs; and a later start could conflict with working parents' schedules.

Owens acknowledged the logistical challenges, and said parents and school staff sometimes oppose later start times. As an example, she said the Fairfax County, Va., school district has been debating the issue for years. Four options, including one with a 9:15 a.m. high school start, will be put to a vote this fall.

Some districts have found "creative solutions" to certain obstacles -- like having high school students switch from school buses to public ones, according to the academy.

Deray thinks tackling the practical challenges is worthwhile. He said studies have linked kids' sleep deprivation not only to poorer school performance, but also to higher rates of car accidents, obesity and depression.

In a recent study of eight U.S. high schools that delayed their start times, researchers found improvements in kids' grades, attendance and car crash rates.

Later school starts are just one way to help sleepy kids, however. Deray offered parents some tips.

"All electronic devices should be turned off an hour or two before bed," he said. "The blue light from them suppresses melatonin production."

He also advised avoiding physical and mental stimulation close to bedtime -- which means exercise and homework should be done earlier in the evening. And while teenagers love to sleep till noon on weekends, that will only further disturb their sleep/wake cycle. Deray said kids should get up by 9 a.m. on weekends and get plenty of morning sunlight.

He acknowledged, though, that all of that is easier said than done.

Owens agreed. "One of the issues is that kids are overscheduled," she said. "Don't give them so many things to do that they can't get to bed before midnight."

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Study claims concussions are common in middle school-aged girls playing soccer

A recent study claims that girls who are middle school-aged and play soccer commonly have concussions.

Girls who play soccer in middle school are vulnerable to concussions, new research shows.

And despite medical advice to the contrary, many play through their injury, increasing the risk of a second concussion, the study found.

Although awareness has increased about sports concussions, little research has been done on middle school athletes, especially girls, noted study co-author Dr. Melissa Schiff, a professor of epidemiology at the University of Washington School of Public Health in Seattle.

In the study, which evaluated 351 soccer players between the ages of 11 and 14, Schiff and her colleagues found 59 concussions. A concussion is defined as a traumatic injury to the brain after a blow, shaking or spinning. In the study, the girls' symptoms included headache, dizziness, drowsiness and concentration problems.

That rate of injuries, Schiff said, is higher than what has been reported at either high school or college level of women's soccer.

Heading the ball was to blame for about 30 percent of the injuries. This involves hitting the ball with your forehead to redirect the ball in play. More than half of the concussions were from contact with another player.

Experts recommend those who have a concussion be evaluated by a doctor or other health care professional trained in the injury, but Schiff found that ''56 percent were never evaluated." Experts also advise that players not return to practice or games until symptoms disappear, but 58 percent of the players in the study continued to play even with symptoms persisting, she said.

The study was published online Jan. 20 in the journal JAMA Pediatrics.

Awareness about the dangers of concussions has increased, Schiff said, beginning with the National Football League's attention to the problem. Research about the problem has slowly increased to encompass college-level, high school, and now middle school players, she said.

In this study, the researchers randomly selected 33 of 72 elite teams from four youth soccer clubs in the Puget Sound region of Washington state. The study continued from 2008 to 2012. Players reported injuries and symptoms.

With so many injuries blamed on heading the ball, should it be banned?

Schiff thinks that is unrealistic. "It's part of the soccer sport," she said. However, it was found to result in concussion 23 times more often in a game than in practice. One suggestion, she said, is to teach middle school athletes heading in practice but tell them not to do it in games until they are older. The researchers speculate that younger players' less mature brains and weaker neck muscles, along with poorer heading technique, may contribute to the number of concussions.

The new study ''calls attention to the high incidence of concussion in this age group," said Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital.

The number of injuries blamed on heading the ball, 30 percent, is not surprising, he said. "I see it all the time," Kuluz explained. Often, he noted, a heading injury occurs along with colliding with another player.

Kuluz advises young athletes who have had a concussion to avoid heading the ball.

Parents need to pay attention to their child during and after soccer, he suggested. "In the event of an injury, pay attention to symptoms," Kuluz said. He added that if a concussion is suspected, a young athlete must be evaluated by a doctor or trainer who has experience with concussions.

"Soccer can be done safely," he said, but parents and coaches need to be aware of concussion symptoms and obtain good medical evaluation and care.

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