What tests should my children require for starting a high intensity sports?
Recommendations from professional organizations and government agencies have increased public awareness of the health benefits associated with regular physical activity. Increased levels of physical activity and fitness during childhood and adolescence are associated with reduced risk of disease in adulthood. Children should be encouraged to participate in regular physical activity to establish healthy lifestyle habits at an early age. Organized sport-specific programs for children under the age of five, especially team sport activity, are unnecessary and inappropriate. Children this age should be creating their own learning opportunities through creative thinking and exploratory play.
Parents may have questions about the timing, safety, volume, risks, and benefits of strength/ competitive training for their child. The standard of care is that these athletes have a preparticipation physical evaluation (PPE) before the season begins. Requirements for the frequency of PPE vary by countries but most state high school athletic associations require annual evaluations. The American Heart Association recommends that a history and physical examination be performed every two years during sports participation, with an interim history taken in the intervening years
The PPE includes a targeted medical and family history and a targeted physical examination, with particular emphasis on the musculoskeletal and cardiovascular systems.The American Academy of Family Physicians, American Academy of Pediatrics (AAP), American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine have endorsed a standardized preparticipation athletic evaluation form that addresses important aspects of the history and examination. It is available through the AAP website. The medical history is the most sensitive and specific component of the PPE for detecting conditions that preclude participation in sports. Personal and family history and review of systems detect approximately 75 percent of conditions that restrict participation or require further evaluation. The cardiovascular history is aimed at identifying conditions that predispose athletes to sudden death.
If cardiovascular abnormalities are identified or suspected on the basis of the history and physical examination, the athlete should undergo further evaluation, which may include EKG, event capture monitor, echocardiogram, and/or a maximum stress test. A EKG is required in some countries (as Spain or Italy) above 6-7 years of age for becoming a member in a competition sport team.
Referral to a pediatric cardiologist is generally warranted to help guide the diagnostic evaluation, and athletes should be excluded from participation in competitive sports pending the cardiac evaluation.
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