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August 10, 2019

Pre-Participation Physicals: It May Just Save Your Child's Life

If you are looking to sign your son or daughter up for soccer, basketball, softball, or any other sport, it’s imperative to have a pre-participation physical prior to the first day of try-outs or practice.  Even if the organization does not require one (they should), plan a visit to your pediatrician or other qualified medical practitioner.  Why is this evaluation so important?  The goal of the examination is to ensure there are no underlying conditions pertaining to the cardiovascular (heart), pulmonary (lungs), neurological (brain), musculoskeletal systems, and the likes that could potentially lead to injury or death if left undetected.

The cardiovascular health history portion of the examination is one area you as a parent can provide life-saving information.  While the incidence of sudden cardiac death is low (0.6 to 6.2 per 100,00 children in the United States), approximately 20-25% of deaths occur during sports (1,3-7).  So how can you help your doctor detect an underlying condition?  Providing a thorough family history noting any cardiovascular disease or pathology could bring to light a potential problem for which the doctor may choose to explore.  Here is the pertinent information to provide your pediatrician:

  • A detailed family history of premature death (sudden or otherwise), or significant disability from -cardiovascular disease in close relative(s) under 50 years old (8).  
  • Specific knowledge as to whether a family member was diagnosed with hypertrophic cardiomyopathy, dilated cardiomyopathy, long QT syndrome, Marfan’s syndrome, or clinically important arrhythmias (8).
  • Report any past detection of a heart murmur or increased blood pressure (8).
  • Finally, listen to your child if they complain of chest pain/discomfort, fainting/near fainting, or unexpected/unexplained shortness of breath associated with exercise.  These symptoms could be a sign of an underlying condition (8).

Screening for familial history as well as the child’s personal medical history has led to a significant decline in sudden cardiac death in young athletes according to a study in the Journal of the American Medical Association in 2006 (2).  The take-home message for parents is clear, identifying a potential risk is imperative so that follow-up testing may be performed in order to identify underlying conditions, that left untreated, could result in unnecessary injury or death.  While injuries as a result of sports are inevitable, it is up to parents, coaches, and the medical community to ensure we keep our youth as safe as possible.  Proper screening and testing during the pre-participation physical is one area where we can stack the odds in their favor.  If there is any question or doubt with regard to your family’s medical history, the child’s medical history, or complaints by your child during activity, consult your pediatrician or other qualified medical personnel as soon as possible.  


1.  Botvinick EH, Dae MW, Krishnan R, Ewing S. Hypertrophic cardiomyopathy in the young: Another form of ischemic cardiomyopathy? J Am Coll Cardiol. 1993;22:805–7.

2.  Corrado D, Basso C, Pavei A, et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening programme. JAMA. 2006;296:1593–601.

3.  Driscoll DJ, Edwards WD. Sudden unexpected death in children and adolescents. J Am Coll Cardiol. 1985;5:118B–21.

4.  Gajewski, K., Saul, P. Sudden cardiac death in children and adolscents (excluding Sudden Infant Deathy Syndrome). Ann Pediatr Cardiol, 2010; 3(2): 107-112.

5.  Garson A., Jr Sudden death in the young. Hosp Pract (Off Ed) 1991;26:51–60.

6.  Gow RM. Sudden cardiac death in the young. Can J Cardiol. 1996;12:1157–60.

7.  Liberthson RR. Sudden death from cardiac causes in children and young adults. N Engl J Med. 1996;334:1039–44.

8.  Moreau, W., Nabhan, D., Roecker, C., Kimura, M., Klein, A., Guimard, B., Pierce, K., Helma, P., Nelson, R., Shockley Bahr, K., Nelson, L., Williams, P. The American Chiropractic Board of Sports Physicians Position Statement on Pre-Participation Examinations: An Expert Consensus. J Chiropr Med. 2015; 14(3): 176-182.

9.  O’Connor FG, Kugler JP, Oriscello RG. Sudden death in young athletes: Screening for the needle in a haystack. Am Fam Physician. 1998;57:2763–70.

10.  Silka MJ. Sudden death due to cardiovascular disease during childhood. Pediatr Ann. 1991;20:360–7.

Written by Dr. Jenn Reiner-Marcello

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