Clearing Kids for Sports Participation Sparks Conflicts

Most teenagers think they're invincible, and that goes double for talented teenage athletes. They're young, immortal, at the top of their game, the envy of their friends. So when news hits that an apparently healthy, high school or college athlete has dropped dead in the midst of playing his or her favorite sport, millions of parents get understandably anxious. The uppermost question becomes: Should my child be screened before participating in sports? What tests are needed? And how can we be sure that he or she is truly healthy enough to compete? Everyone agrees that a medical checkup before participating in sports is crucial. But the agreement seems to stop there. At the core of the conflict over further testing is how extensively young athletes' hearts should be tested before they're cleared for athletic participation.

"I think everyone should have a doctor who evaluates them, and the doctor should know the child is going to be participating in athletics," said Dr. Paul Thompson, the director of preventive cardiology at Hartford Hospital in Connecticut, who helped write a joint position statement in 2007 from the American College of Sports Medicine and the American Heart Association. That statement recommends cardiovascular screening for high school and college athletes before they start participating in athletics and at two- to four-year intervals. The screening should include a family history, a personal history and an exam "focused on detecting conditions associated with exercise-related events," according to the groups' recommendation.

But, there's more: "The AHA does not recommend routine, additional noninvasive testing such as a routine EKG." The American Academy of Pediatrics seems to agree. "Every athlete should have a thorough history [taken] from the athlete as well as the athlete's family," explained Dr. Reginald Washington, a pediatric cardiologist and chief medical officer at Rocky Mountain Hospital for Children in Denver and past chairman of the academy's committee on sports medicine and fitness.The doctor should ask about any chest pain and dizziness, and whether the athlete has ever passed out or experienced a racing or unusual heartbeat, Washington said. The physician should also ask if the athlete's parents have had early heart disease, before age 55 for a man and 65 for a woman. And the physical exam, he said, should be thorough and include listening to the heart, taking blood pressure and feeling the pulse.