When news breaks about a young athlete collapsing during a game, it’s natural for parents to wonder, Could this happen to my child? While these tragedies are heartbreaking, sudden cardiac death in young athletes is very rare.
Annual sports physicals and honest conversations about symptoms and family history can help identify young athletes who may need additional evaluation. A thorough medical history and physical exam are among the most important tools for screening for heart problems before a child participates in sports.
Understanding Sudden Cardiac Death
Sudden cardiac death occurs when the heart unexpectedly stops beating effectively. Although these events are rare in children and teens, they’re often linked to an underlying heart condition that hadn’t previously been diagnosed.
Because some heart conditions don’t cause obvious symptoms, screening can help identify children who may need a closer look.
The Annual Sports Physical Is an Important Heart Screening
In New York, student athletes complete a yearly Pre-Participation Physical Evaluation (PPE). The screening includes:
- Medical history
- Family history
- Symptoms during exercise
- Physical examination
The sports physical isn’t designed to diagnose every heart condition. Instead, it’s a screening tool that helps identify children who may need additional evaluation or testing.
For most children, the history and exam provide reassurance that no concerning findings are present. For others, it can identify signs that deserve further evaluation.
What Does the Sports Physical Look For?
One of the most important parts of the sports physical is discussing symptoms. While most children with these symptoms do not have heart disease, they should be discussed with a pediatrician.
Tell your child’s healthcare provider if your child has:
- Chest pain during exercise
- Fainting or nearly fainting, especially during activity
- A racing, pounding or irregular heartbeat
- Unexplained shortness of breath during exercise
- Unusual fatigue, dizziness or shortness of breath that makes it difficult to keep up with teammates
Some young athletes may dismiss these symptoms because they don’t want to miss practice or disappoint their teammates. Encourage your child to speak up if something doesn’t feel right during exercise.
Family History Can Provide Important Clues
Many heart conditions associated with sudden cardiac death can run in families.
Tell your pediatrician if anyone in your family has had:
- Sudden or unexplained death at a young age
- Cardiomyopathy, or disease of the heart muscle
- An inherited heart rhythm disorder, such as Long QT Syndrome or Brugada Syndrome
- An inherited disorder affecting connective tissue, such as Marfan Syndrome
- Another inherited heart condition
Even if the affected relative wasn’t a parent or sibling, share what you know. Information about grandparents, aunts, uncles or cousins may help your pediatrician determine whether additional evaluation is needed.
Does Every Young Athlete Need an EKG?
Many parents wonder whether every child should have an electrocardiogram (EKG) before playing sports. For most children, the answer is no.
An EKG can be an important tool when indicated, but it isn’t recommended as a routine screening test for every young athlete. A thorough history and physical exam help identify which children may benefit from additional testing.
If concerns are identified during the sports physical, your pediatrician may recommend:
- An EKG to evaluate your child’s heart rhythm
- An echocardiogram, an ultrasound that evaluates heart structure and function
- Evaluation by a pediatric cardiologist
Start With Your Pediatrician
If you have concerns about your child’s heart health, your pediatrician is the best place to start. Whenever possible, schedule your child’s sports physical as part of your child’s annual well visit.
Because your pediatrician knows your child’s medical history, growth and development, previous health concerns and family health history, they can interpret the sports screening in the context of your child’s overall health.
Additional testing or a pediatric cardiology evaluation may be recommended if:
- The sports physical identifies concerning findings
- Your child has symptoms during exercise
- There is a significant family history of inherited heart disease or sudden cardiac death
- Additional testing suggests a heart condition
If you’re unable to schedule a sports physical with your child’s pediatrician before the season begins, an Immediate Care or walk-in clinic can be a convenient option to help meet school or sports deadlines. It’s still important to maintain regular annual well visits with your child’s pediatrician, who can track changes in symptoms, health and family history over time.
Most children who have sports physicals will never need to see a pediatric cardiologist. When additional evaluation is recommended, however, following through can help ensure your child receives the appropriate care.
