pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Medical Conditions Prohibiting Sports Participation in Children and Teens

AWWWwwwwwwhhH DAD! Mom said to ask you.”

“Look, your team can get along without you for one game. Let’s see what the doctor has to say when he sees you this afternoon.”

What do you think? Did I nail the discussion you had with your sports-crazed son after he was injured?
Sports and medical conditions, sometimes not all that fun
Spring is here (or will be soon). Baseball and soccer (US) is in the air. Time to order more crutches and cast material. Kids are going outside to play.
 

Children’s Sports Participation With Medical Conditions

Injury, however, is not the only time physicians are called upon to render advice about children’s sports participation. There are a number of medical issues which must be evaluated before children can be cleared for sports participation.

Medical Clearance For Children’s Sports

Many medical conditions have been found to increase risk of serious injury or damage depending upon their severity and many more have been found to merely need adaptive gear, protection, medical management or rule changes before participation is safe – for both the child and other players.

If you have any questions at all about participation, it’s better to err on the side of caution and talk to your pediatrician about it. That’s why most competitive children’s sports activities require a yearly physical examination.

However, I thought I’d put together a little summary list of a few of the more common things we see each year that need evaluation. I’ve categorized them into the three groups of: “YES” – it’s usually safe to play; “NO” – it’s not safe to participate; and, “MAYBE” – It MIGHT be safe IF certain precautions are taken.

You’ll notice that there are a whole lot more “yes” and “maybe’s” than there are “no’s” – which reflects us pediatrician’s basic “no child left behind” philosophy that we’ve had long before it became “politically correct.” Sports are inherently beneficial for children and we love to have accommodations be made for as much participation as desired.

All of these recommendations have been extensively studied by experts in the AAP who used the latest research trying to keep kids participating while keeping them safe too.
 

Children’s Medical Conditions and Sports Clearance

Source: Caring for Your Teenager (© 2003 American Academy of Pediatrics)
Condition Permitted? Recommendations

Atlantoaxial Instability
Instability of the joint between the two uppermost vertebrae in the neck

Maybe

Teen needs evaluation to asses risk of spinal cord injury during sports participation. For example, some teens with Down’s syndrome may have atlantoaxial instability and be at increased risk for neck injury.

Bleeding Disorders
including hemophilia

Maybe

Evaluation needed. As a rule, hemophiliacs are counseled not to play contact/collision sports.

Cancer

Maybe

Evaluation needed

Cardiovascular Diseases

Carditis
Inflammation of the heart

No

Exertion may result in sudden death

Hypertension
Chronically high blood pressure

Maybe

Teens with significant essential (unexplained) hypertension should avoid weight and power lifting, body building, and strength training. Secondary hypertention (caused by a previously identified disease) or severe essential hypertension warrant a medical evaluation

Congenital Heart Disease
Structural heart defects present at birth

Maybe

Teens with mild forms may participate fully; those with moderate or severe forms, or who have undergone surgery, need evaluation

Dysrhythmia
Irregular heart rhythm

Maybe

Evaluation needed, because some dysrhythmias require treatment and/or make certain sports participation dangerous.

Mitral Valve Prolapse
Malfuntioning heart valve

Maybe

Teens with symptoms (chest pain, symptoms of possible dysrhythmia) or evidence of mitral regurgitation (leaking) on physical examination need evaluation. All others may participate fully

Heart Murmur

Maybe

If the murmur is "innocent" -that is, does not indicate heart disease- full participation is permitted. Otherwise, evaluation needed.

Cerebral Palsy

Maybe

Evaluation needed

Diabetes Mellitus

Yes

All sports can be played with proper attention to diet, hydration and insulin therepy (if necessary). Particular attention is needed for activities that last 30 minutes or more.

Diarrhea

No

Unless mild, the youngster is not allowed to play, because of the risk of dehydration and heat-related illness.

Eating Disorders
(anorexia nervosa, bulimia nervosa)

Maybe

These teens need both medical and psychiatric assessments before participation

Eye Disorders
(functionally one-eyed, loss of an eye, detached retina, prior eye surgery, serious eye injury)

Maybe

A functionally one-eyed teen has a best corrected visual acuity of 20/40 in the worse eye. These athletes would suffer significant disability if the healthier eye were seriously injured, as would those who have lost an eye. Some young people who have previously undergone eye surgery or had a serious eye injury may have an increased risk of injury because of weakened eye tissue. Availability of eye guards approved by the American Society for Testing Materials (ASTM) and other protective equipment may allow participation in most sports, but this must be judged on an individual basis.

Fever

No

Fever adds to the workload of the heart and lungs, and increases the chances of suffering heat exhaustion or heatstroke.

Heat Illness,
history of

Maybe

Because of the increased likelihood of recurrence, the athlete needs individual assessment to determine the presence of predisposing conditions and to establish a prevention strategy.

Hepatitis B (HBV)
Hepatitis C (HCV)
Human Immunodeficiency Virus (HIV)

Maybe

The risk of these viruses being transmitted through sports participation is believed to be extremely low. Therefore, all sports should be open to athletes infected with HIV or with hepatitis B or C. However, sensible precautions must be taken, such as making sure that cuts, abrasions, wounds or other areas of broken skin are covered with a protective dressing before and during events.

Kidney,
loss of one, due to injury or disease

Maybe

Evaluation needed for contact/collision and limited-collision sports

Liver,
enlarged (hepatomegaly)

Maybe

If the liver is acutely enlarged, participation should be avoided because of risk of rupture. If the liver is chronically enlarged, evaluation needed before collision/contact or limited contact sports are played.

Musculoskeletal Disorders

Maybe

Evaluation needed.

Neurologic Disorders

History of (1) Serious Head or Spinal Trauma,
(2) Severe Concussions,
(3) Repeat Concussion,
(4) Brain Surgery

Maybe

Evaluation needed for collision/contact or limited contact sports, and also for noncontact sports if there are deficits in judgment or cognition. Recent research supports a conservative approach to management of concussion.

Convulsive Disorder
well controlled

Yes

If disorder is well controlled, the teen faces little risk of having a seizure while participating in sports.

Convulsive Disorder
poorly controlled

Maybe

If disorder is poorly controlled, evaluation needed for collision/contact or limited contact sports. The teen should avoid the following noncontact sports: archery, riflery, swimming, weight or power lifting, strength training, sports involving heights. In these sports, a convulsion, though unlikely, could pose a risk to the patient or to others.

Obesity

Maybe

Because of the risk of heat illness, obese teens need careful acclimatization and hydration.

Organ Transplant Recipient

Maybe

Evaluation needed.

Ovary,
loss of one, due to disease

Yes

The risk of severe injury to the remaining ovary is minimal.

Respiratory Disorders

Acute Upper-Respiratory Infection

Maybe

Upper-respiratory obstruction may affect pulmonary function. Evaluation needed for all but mild disease.

Asthma
Well controlled

Yes

With proper medication and education, only teens with severe asthma will have to modify participation

Compromised Pulmonary Function,
including from cystic fibrosis

Maybe

Evaluation needed, but, generally, all sports may be played if the teen’s oxygenation remains satisfactory during a graded exercise test. Youngsters with cystic fibrosis need acclimatization and proper hydration to reduce the risk of heat illness.

Sickle-Cell Trait

Yes

It is unlikely that teens with sickle-cell trait (AS) have an increased risk of sudden death or other medical problems during athletic participation except under extreme heat, humidity and possibly increased altitude. These young people, like all athletes, should be carefully conditioned, acclimatized and hydrated to reduce any possible risk.

Skin Conditions
(boils, herpes simplex, impetigo, scabies, molluscum contaglosum)

Maybe

While the patient is contagious, participation in gymnastics with mats, martial arts, wrestling or other collision/contact or limited contact sports is not allowed. The herpes simplex virus probably is not transmitted via mats.

Spleen,
enlarged (splenomegaly)

Maybe

A teen with an acutely enlarged spleen should avoid all sports because of risk of rupture. Those with chronically enlarged spleens need evaluation before playing collision/contact or limited contact sports

Testicle,
undescended or missing

Yes

Certain sports may require a protective cup

 

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