Ask the Nurse: Batter up! Pediatric nurse hits a home run with safety tips for baseball and softball

CINCINNATI - Nurses provide the TLC we need to feel better and stay well. In our new "Ask the Nurse" feature, WCPO contributor Gretchen MacKnight consults a Tri-State RN for the expert and common sense answers to some of the questions we have about our health. We invite readers to submit their questions, so read on to find out how!

Spring means bats are swinging, balls are flying, and kids are sliding into bases. It's all fun and games until someone gets hurt on the diamond.

Nicole F. Garritano, MN, APRN, CPNP-AC

  • Where she works: Clinical Instructor and Director of Pediatric Nurse Practitioner Program at University of Cincinnati College of Nursing; Pediatric Nurse Practitioner at Cincinnati Children’s Hospital Medical Center
  • Specialty: pediatrics, acute care pediatrics, cardiology
  • Nursing schools attended: Master’s Degree from College of Mount Saint Joseph, Nurse Practitioner Specialty at Vanderbilt University

Nicole F. Garritano  is a member of the 2014 Faculty Policy Intensive Fellowship through the American Association of Colleges of Nursing (AACN) and is actively involved with many national organizations. Her professional interests include health policy and nursing leadership.

Ask the Nurse:

Baseball season is in full swing! It’s fun to cheer on your little leaguers, but sometimes wild pitches, near-misses, and head-on field collisions make you cringe. What should parents and coaches know to keep their ball players safe?

Baseball is definitely America’s favorite pastime, and after the long, cold winter we had this year, there is no doubt that parents and children alike are ready to hit the ball diamond and enjoy some warmer weather. However, protecting our children no matter the time of year, should always be most important. 

Fortunately, baseball safety is a topic that has been studied by some important medical groups including the American Academy of Pediatrics (AAP) who released updated Baseball and Softball Guidelines in 2012, and the American Sports Medicine Institute (ASMI) who presented Guidelines to Reduce Overuse Injuries in 2013.

Protective Gear:

According to the AAP’s guidelines, players should wear protective safety equipment. Specifically:

  • Batters should wear approved batting helmets with face protection.
  • Catchers should wear helmets, masks with throat guards, chest protectors, and shin guards.
  • All male players should wear a hard plastic athletic cup.

In light of the relatively high percentage and severity of head, face, and mouth injuries in baseball, strong consideration should be given to head and facial protection for pitchers and infielders, especially in younger age groups and for less-skilled players. Protective equipment should always be properly fitted, well-maintained, and clean. 

All baseball and softball players should also wear shoes with rubber-spiked soles, which provide the best traction in various weather conditions. Rubber-spiked soles also reduce the risk of injury should two players collide.

More about chest protectors

Catchers should always wear chest protection. When thinking of chest protectors for players other than catchers, parents and coaches are usually trying to protect children from taking a line drive to the chest, which can rattle the heart inside the chest cavity, knocking their heart out of rhythm. The medical term for this is commotio cordis. The player may collapse and possibly lose consciousness.

There is no definitive scientific evidence that chest protectors prevent players from suffering commotio cordis.  The best prevention for this type of injury is proper coaching and teaching players techniques to dodge or avoid line drives. 

Coaches should also take into consideration the developmental age of the players, realizing younger players will be less physically and mentally developed and will require repetitive teaching of such techniques.

While commotio cordis is rare, it is wise to have an automatic external defibrillator (AED) readily available (within 3 minutes) to prevent a sudden cardiac death.

It is my opinion that AEDs should be available at all athletic complexes and readily available should a player or bystander require its use -- Nurse Nicole F. Garritano

Know your kids

Everyone wants to win, but sometimes parents need to step back and say that my kid may not be ready for certain more aggressive leagues. Every child develops differently; growth, development, reflexes, and reaction times can vary.

To prevent injuries, knowing your children and their limitations is very important. As children become teenagers, reflexes and reaction times get better, and they are better able to avoid various types of injuries that a younger child is more susceptible to. Additionally, younger children are at risk of suffering injuries that may impact their long term growth, including growth plate fractures and overuse injuries.

Prevent overuse injuries

Parents and coaches must protect young baseball pitchers from throwing injuries. Players need to

develop adequate core strength and scapular muscle strength along with proper instruction in throwing mechanics, conditioning, and training.

The American Academy of Pediatrics recommends:

  1. Athletes should stop pitching immediately when signs of arm fatigue or pain occur; they should be encouraged to seek timely and appropriate treatment of significant or persistent pain.
  2. Follow league guidelines for pitch counts and rest requirements.
  3. Three months of rest from pitching each year.
  4. Young pitchers should avoid pitching on multiple teams with overlapping seasons.
  5. Youth pitchers should not pitch competitively in more than 8 months in any 12-month period.
  6. A pitcher should not also be a catcher for his or her team.
  7. Delay introduction of the curve ball until after age 14 and the slider until age 16.

Pitch counts & rest periods

Follow your league guidelines and read the policy statement from the American Sports Medicine Institute.

Head injuries & concussions

Parents and coaches need to take bumps on the head seriously. It is important to note that all concussions are considered a mild traumatic brain injury. All children with a suspected concussion need medical evaluation and time away from baseball to allow their brain to fully recover. The time away from the sport is dependent on the severity of the concussion. Repeated concussions can cause long term brain damage. MORE from the CDC

Signs and symptoms of a concussion:

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Player may report:

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not “feel right” or is “feeling down”

The Centers for Disease Control and Prevention (CDC) has wonderful resources for parents and coaches regarding children and concussions, as well as a free, online tutorial. MORE

Playing in hot weather:

Make sure children are well-hydrated. Parents need to have their children drink water at least an hour before the game to pre-hydrate and then encourage water throughout the game. After sweating, Gatorade and sports drinks are a great way to replenish electrolytes. Also hydration after the game is very important, and helps with muscle recovery.

When we hit those dog days of summer, there is also concern for heat exhaustion and heat stroke. Since a child cannot regulate heat the same way an adult does, provide shade while players are not in the game, provide water, and make cool cloths available to place around the neck and chest to help reduce this risk of heat illness.

Last but not least, be sure your child uses sunscreen to prevent skin cancer in the future. Here’s to a healthy and fun baseball season!


Editor's note: "Ask the Nurse" alternates weekly with "The Doctor Is In." Do you have a question for a local health care professional? Email

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