Sports Physicals: Q&A with a Pediatric Cardiologist

Understanding Sports Physicals

What is a sports physical, and why is it important for children and teens?
A sports physical is a targeted history and medical exam designed to find children and teens more at risk for injury and medical complications during sports, including conditions associated with sudden cardiac arrest. Unfortunately, even with a sports physical, there is no way to provide 100% protection against sudden cardiac arrest. It is important for athletes to also have an emergency plan, including those trained in CPR and the use of an AED. Knowing the location and how to use an AED can save lives. Learn more about Heart Safe Schools at choa.org/projectSAVE.

At what age should kids start getting sports physicals?
A sports physical is recommended starting in middle school. Some elementary schools may require them as well.

How often does my child need a sports physical?
Yearly. The American Academy of Pediatrics recommends including it in your child’s annual well check. Schedule in advance to allow time for referrals or additional testing if needed.

Do schools accept sports physicals done by a pediatric cardiologist?
Typically, your pediatrician should perform the sports physical, as it evaluates more than heart health.

Is there anything about Georgia’s sports physical requirements parents should know?
Yes, Georgia schools require a specific pre-participation form that must be submitted every year.

Heart Health & Risk Factors

What conditions are you looking for during a sports physical, from a heart perspective?
We aim to identify athletes at increased risk for sudden cardiac arrest, though it’s rare. We also check for high blood pressure and other cardiac concerns.

When is additional testing like an EKG or echo needed?
If there are abnormal exam findings, or symptoms like chest pain, fainting, palpitations, or family history of inherited cardiac conditions, further testing is recommended.

When might a child with a heart condition be restricted from sports?
Most children with heart conditions are encouraged to participate in sports. Temporary restrictions may apply during diagnosis or treatment planning.

Sports and Children with Heart Conditions

Can my child still play sports if they have a heart condition?
Yes, depending on the diagnosis and severity. Physical activity offers many benefits, and most children with heart conditions can and should be active.

Safety Precautions:

Emergency plan in place at school or sports events
Coaches and caregivers should be informed and trained
Encourage healthy lifestyle habits and regular checkups

A cardiologist can help with:

Recommending safe activity levels
Providing individualized exercise guidelines
Educating families about risks and benefits

Benefits of Exercise

Physical Health:

Improved cardiovascular function
Better weight management
Stronger bones and muscles
Lower risk of stroke, diabetes, and hypertension

Mental and Emotional:

Reduced anxiety and depression
Better sleep
Higher self-esteem and confidence

Developmental:

Increased energy and endurance
Improved coordination
Social connection

Exercise should be tailored to each child. A pediatric cardiologist can help determine safe activity levels and if monitoring is needed.

Is fainting during or after exercise normal?
Fainting should always be taken seriously. It may signal an underlying heart issue. A pediatric cardiologist should evaluate it with a history, exam, and tests like EKG or stress test.

What is the role of family history in evaluating a child for sports participation?
Certain heart conditions are inherited. A comprehensive family history can help identify risks. Genetic testing may help diagnose and protect other family members.

Are there symptoms parents should mention before a sports physical?
Yes. The AHA recommends screening for:

Chest pain with exercise
Fainting or near-fainting
Excessive shortness of breath or fatigue
Palpitations or irregular heartbeats
Heart murmur
High blood pressure
Previous restriction from sports
Prior cardiac testing
Family history of sudden death before 50
Disability from heart disease in relatives under 59
Inherited cardiac conditions (e.g., HCM, Long QT, Marfan)

What should I do if I’m concerned about my child’s heart even after they pass a physical?
Start by discussing with your primary care provider. If concerns persist, ask for a referral to a pediatric cardiologist.

What happens if something abnormal is found during the physical?
Don’t panic. Many findings turn out to be harmless. A pediatric cardiologist can evaluate and perform additional testing if needed.

Preparing for and Participating in Sports

Are there specific sports that are riskier for children with heart disease?
Risk depends on the type of heart condition. Contact or high-intensity sports (football, hockey, martial arts) may carry higher risk. Lower-risk options include walking, yoga, light swimming, and cycling.

What’s your advice for parents whose kids are starting sports for the first time?
Complete the AHA pre-participation cardiac screening and schedule a sports physical. The risk of sudden death is very low (1–2 per 100,000 athlete-years), and the benefits of sports—physical, emotional, social—are numerous.

Sports Physicals Can Identify ‘Red Flags’ for Heart Disease

Heart Warriors Can Still Get into the Game

Physicians with Heart: Dr. Neill Videlefsky

Physicians with Heart: Dr. Andrea Kropf

Sudden Cardiac Arrest in Young Athletes: Questions & Answers

Schedule an Appointment at Children’s Healthcare of Atlanta Cardiology

For more information about Children’s Healthcare of Atlanta Cardiology and our pediatric cardiology specialists, click here.

Contributing Cardiologists: Andrea Kropf, MD, & Neill Videlefsky, MD