GloucesterTimes.com, Gloucester, MA

Meagan Daroska, 15, chats with her friends online for hours. Especially now that school is out, she could sit at the computer literally all day, she said.

And like most teens, her posture at the computer isn't so great.

At the desktop computer in her mother's bedroom, she tends to sit with the chair pushed back. Her hand rests on the desk, with her wrist bent over the edge. If she's using her mother's laptop computer, she sets it on a bed and hunches over it.

"It does kind of hurt after a while," she said, "but I don't really worry about it."

Her mother, Kelley Shepard, wishes Meagan would worry a little bit more.

Shepard is an occupational therapist who specializes in hands, arms and shoulders. She has a practice near her Plaistow, N.H., home, where she treats, among other things, injuries related to poor posture at the computer.

Just this month, as children settle in to summer vacation, the American Society of Hand Therapists issued an "education alert" about the potential risk for video game-related hand injuries in children. A child's intense grip on a controller, repetitive button-pushing motions and sharp wrist movements on the joystick can lead to such injuries as "Nintendo thumb," and make children more prone to tennis elbow, tendonitis, bursitis and carpal tunnel syndrome.

Shepard need look no further than her son, who is nearly 5 years old and already playing video games, to see what kind of new stresses children are putting on their bodies at a young age. She wonders what it will mean down the road for this generation of young people.

"Are we going to start seeing patients earlier with the onset of thumb arthritis because of all this stuff early on?" Shepard asked. "... You have to wonder. They're starting so much earlier."

Dr. Edward Bailey, chief of pediatrics at North Shore Medical Center in Salem, Mass., said the risk of video game-related injuries is real.

His own son, who is now a pediatrician, spent one snowbound weekend during medical school playing video games in his apartment with his roommate. At the end of the weekend, he had Nintendo thumb, a repetitive stress injury that causes swelling at the base of the thumb.

"He still gets pain when he uses that thumb too much," Bailey said. "I think people should understand that this is a real injury."

Despite the popularity of video games, Shepard said it's still far more common to see a child come in for therapy for a sports-related injury than for anything related to PlayStation or Xbox.

What she worries about is the long-term impact on the child's body, and also the habits for posture and uninterrupted focus that they are developing that might carry over into adulthood.

"I don't know if the video games themselves are going to cause a problem, but I think bad habits can follow," she said.

So what is a parent to do?

Shepard started by getting her daughter a small computer desk that fits her body and promotes good posture. The chair is the right height so her knees bend at a 90-degree angle. When her forearms arms rest on the desk, her elbows are also at 90 degrees. The desk has a little platform for the monitor that raises it to eye level.

Shepard has shown her daughter good posture, and will check on her if she notices she's been at the computer for more than an hour without getting up. She tries to not only put her in the right position, but to teach her what it feels like so she can make the adjustments herself.

"Whether or not she's going to follow it when I leave the room, ..." Shepard said, looking at her daughter.

She's also encouraging her children to take frequent breaks and use some of the stretching exercises recommended by the American Society of Hand Therapists.

Bailey, however, said there are bigger problems to address when a child plays at the computer for so long they're at risk of physical injury.

"If you want your cognitive skills to grow, you have to do brain exercises and that's reading," Bailey said. "If you're spending so many hours per day in front of a Nintendo or a game machine that you're concerned about injuring thumbs, rather than sort of doing some exercises and extending the time in front of the game, consider playing baseball. Consider going outside and getting some sun and swimming, and doing other summer activities."

When children spend too much time on sedentary activities like video games, they put themselves at risk for obesity, Type 2 diabetes and metabolic syndrome, and that's a problem that can't be corrected simply by setting up a more ergonomic desk, Bailey said.

"It's getting them out and doing what kids should be doing to grow cognitive and motor skills to see that they're developing healthy bodies and healthy relationships," he said.

Healthier video gaming

* Try not to spend more than 30 minutes in one position. Break the video game trance. Get out of your chair. Have a healthy snack. Drink some water. Do a few stretches to get blood flowing to your muscles. The break can be short, but it's important to do it frequently.

* Sit in a good chair. If your controller cord isn't long enough to reach a chair, at least lean against something that will support your back. Avoid leaning forward over crossed legs and extending your neck to look up at the television screen.

* Try to position yourself so the television screen or computer monitor is at eye level.

* Hold the controller with a neutral (unbent) wrist. Try putting pillows in your lap and wresting your arms on the pillows.

* When using a computer mouse for a long time, switch hands occasionally.

* Hold the game pad or controller lightly and try to press keyboard keys with less pressure. Remind yourself to loosen up, especially when the game gets intense.

Sources: Kelley Shepard of Shepard Hand Therapy in Plaistow, N.H., and the American Society of Hand Therapists.