What does a sports physical for a 12-year-old boy consist of?

Components of a Sports Physical for a 12-Year-Old Boy

A sports physical for a 12-year-old boy should follow the American Heart Association's comprehensive 14-element preparticipation screening protocol, consisting of a detailed personal and family history along with a physical examination. 1

Personal History Assessment

• Inquire about chest pain, discomfort, tightness, or pressure related to exertion 1
• Ask about unexplained syncope (fainting) or near-syncope episodes 1
• Evaluate for excessive and unexplained dyspnea (shortness of breath), fatigue, or palpitations during exercise 1
• Determine if there has been prior recognition of a heart murmur 1
• Check for history of elevated systemic blood pressure 1
• Assess if there has been any prior restriction from sports participation 1
• Inquire about any previous cardiac testing ordered by a physician 1

Family History Assessment

• Ask about premature death (sudden and unexpected) before age 50 attributable to heart disease in any relatives 1
• Inquire about disability from heart disease in close relatives under age 50 1
• Determine if there is a family history of hypertrophic or dilated cardiomyopathy, long-QT syndrome, other ion channelopathies, Marfan syndrome, or clinically significant arrhythmias 1

Physical Examination

• Carefully auscultate for heart murmurs in both supine and standing positions (to identify dynamic left ventricular outflow tract obstruction) 1
• Check femoral pulses to exclude aortic coarctation 1
• Look for physical stigmata of Marfan syndrome 1
• Measure brachial artery blood pressure in sitting position (preferably in both arms) 1

Musculoskeletal Assessment

• Evaluate for musculoskeletal conditions, which are among the most common reasons for denying clearance to play 2
• Perform targeted examination of joints, particularly focusing on areas of previous injury 3
• Assess range of motion, strength, and stability of major joints (ankles, knees, hips, shoulders, elbows) 4
• Evaluate for common growth-related conditions in adolescents such as Osgood-Schlatter disease (knee), Sever's disease (heel), and Little League Elbow 4

Additional Components

• Vision screening to identify visual acuity problems that may affect sports performance 2
• Height and weight measurements to track growth and development 5
• Assessment of general health status and immunization records 6
• Discussion of sports-specific injury prevention strategies 4

Special Considerations

• ECG screening is not universally mandated in the US but may be considered in some settings to enhance detection of cardiovascular abnormalities 1
• If the history and physical examination reveal any abnormalities, further evaluation with additional testing such as ECG or echocardiography may be warranted 1
• The presence of concerning symptoms (syncope, chest pain with exertion) or family history of sudden cardiac death should trigger more comprehensive evaluation 1

Common Pitfalls to Avoid

• Relying solely on physical examination findings, which may miss important cardiac conditions (e.g., hypertrophic cardiomyopathy often has no audible murmur at rest) 1
• Failing to perform auscultation in both supine and standing positions, which can unmask dynamic outflow tract obstruction 1
• Not obtaining adequate family history, particularly regarding premature cardiac death or inherited cardiac conditions 1
• Overlooking the importance of the 14-point AHA screening protocol, which remains the standard of care in the United States despite its limitations 1