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Sports Physical Exams

Question of the Week

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Updated July 03, 2011

Q. My teen needs a sports physical before he can play football this fall. Should I go to his pediatrician or is it just as good to let them do the team physical at school?

A. The reports of deaths in recent years of athletes has pushed many schools require a yearly preparticipation sports physical exam. A preparticipation exam is also endorsed by the National Federation of State High School Associations. Hopefully, a thorough history (a discussion of your child's symptoms and overall health) and physical exam will help to target children who may be at risk of health problems while playing sports.

Who should do these examinations? I am probably a little biased, but I think you should see your pediatrician. Although your child will likely have a thorough physical exam and they will make sure that he is physically able to participate in sports, if you just have a sports physical, you will be less likely to also go to your pediatrician for a yearly well child exam.

What is the benefit of seeing your pediatrician instead? In addition to the sports physical, your pediatrician will be able to discuss other problems, such as acne or your child's chronic medical problems. Your pediatrician will also likely discuss other important topics, such as how your child is doing in school and he or she will do counseling about nutrition, safety, injury prevention, avoiding using drugs, alcohol and cigarettes, puberty and sex education, and being safe on the Internet. Your pediatrician will also have all of your child's old records, will be more familiar with your families medical history and can review his overall growth and development.

During a group sports physical at school or if you go to a clinic offering $10 or $15 sports physicals, they will likely do what is required by the sports physical participation form, including checking your child's weight, height, blood pressure, heart rate and the physical exam, but they may not have the resources to discuss other important health and safety topics. And if they do find a problem, such as a heart murmur or hernia, you will likely have to see your pediatrician for further management anyway.

Wherever the exam is done, according to the American Academy of Pediatrics, some key features of the exam should be:

  • a complete medical history and physical examination, including a blood pressure check
  • precordial auscultation (listening to the heart) in both the supine (laying down) and standing positions
Important parts of your child's history that might indicate he is at risk of having health problems while playing sports include:
  • having symptoms while exercising, including chest pain, shortness of breath, fatigue or syncope/near-syncope (fainting)
  • having a heart murmur or high blood pressure in the past
  • having other family members with a 'history of premature death (sudden or otherwise), or significant disability from cardiovascular disease in close relative(s) younger than 50 years old or specific knowledge of the occurrence of certain conditions (eg, hypertrophic cardiomyopathy, dilated cardiomyopathy, long QT syndrome, Marfan syndrome, or clinically important arrhythmias)'.
Sport's physicals do have the benefit of being convenient, with many schools bringing a doctor to the school to do the exams, and they are often less expensive than seeing your pediatrician, however, if you have the opportunity, a full well child visit by your pediatrician may be better than a quick sports physical. Also, if you live in a state that does not require a yearly preparticipation physical exam, you might want to see your pediatrician before your child plays any sports anyway, especially if your child has any of the risk factors mentioned above.



Sources:

American Academy of Pediatrics. Preparticipation Physical Evaluation, 4th edition Forms

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