What is involved in a sports physical for a healthy child with no pre-existing medical conditions?

Sports Physical for a Healthy Child

A sports physical for a healthy child should include a structured cardiovascular, musculoskeletal, and neurologic examination, along with screening for mental health conditions and assessment of general health status to identify any conditions that could predispose to sudden cardiac arrest, injury, or illness during athletic participation. 1, 2

Core Components of the Preparticipation Physical Evaluation

Medical History Assessment

The history should specifically evaluate:

• Cardiovascular red flags: Personal history of exertional chest pain, syncope, near-syncope, palpitations, or unexplained shortness of breath 1
• Family history: Sudden cardiac death before age 50, cardiomyopathy, long QT syndrome, or other inherited cardiac conditions in first-degree relatives 1
• Prior injuries: Previous musculoskeletal injuries, concussions, and their residual effects 2, 3
• Current medications and supplements: Including caffeine, stimulants, or performance-enhancing substances 1
• Menstrual history in females: To screen for relative energy deficiency in sport (RED-S) syndrome 2, 4

Physical Examination Focus Areas

Cardiovascular examination should include:

• Auscultation for murmurs, gallops, or irregular rhythms in both supine and standing positions 1, 5
• Blood pressure measurement in both arms 1, 5
• Assessment for Marfanoid features (arm span, joint hypermobility) 1

Musculoskeletal screening must evaluate:

• Joint range of motion, stability, and strength in major joints 3
• Spine alignment and flexibility 3
• Gait assessment and single-leg balance 3
• Previous injury sites for adequate healing and function 3

Neurologic assessment should check:

• Coordination and balance 2
• Cranial nerve function if history of concussion 2
• Mental status and cognitive function 2

Mental Health Screening

Screen for depression, anxiety, and attention-deficit/hyperactivity disorder as these conditions are common in adolescent athletes and can affect performance and safety 2. This represents a critical opportunity to identify mental health concerns, as the majority of deaths in collegiate athletes are related to accidents, homicides, or suicides rather than cardiac causes 1.

Additional Assessments

Nutritional evaluation should address:

• Adequate caloric intake for age and activity level (1,000-1,300 kcal/day for ages 1-3 years; adjusted upward for older children) 4
• Hydration practices with emphasis on plain water as primary beverage 4
• Signs of disordered eating or relative energy deficiency in sport syndrome 2, 4
• Iron intake adequacy, particularly in female athletes 4

General health screening includes:

• Height, weight, and BMI calculation 1, 4
• Blood pressure measurement 1
• Vision and hearing screening 2
• Immunization status review 2

Timing and Setting Recommendations

The evaluation should occur in the physician's office rather than in a group setting to allow for privacy, thorough examination, and meaningful discussion 2. This individual approach enables better detection of sensitive issues and allows for shared decision-making with the athlete and family 1.

Timing should be 4-6 weeks before the sports season begins to allow adequate time for further evaluation or treatment of any identified conditions 2.

Common Pitfalls to Avoid

• Do not dismiss common pediatric symptoms as benign without proper evaluation: Chest pain and syncope are common in children but require careful assessment to rule out cardiac disease 1
• Recognize that children may not accurately characterize symptoms: Direct questioning about specific scenarios (e.g., "Have you ever felt dizzy during exercise?") is more effective than open-ended questions 1
• Avoid overlooking the "gray zone" between athlete's heart and pathology: Exercise-induced cardiac remodeling can occur in children as young as 12 years old, making it challenging to distinguish normal adaptation from disease 1
• Do not neglect mental health screening: This is as important as physical screening given the high rate of non-cardiac deaths in young athletes 1, 2

When to Refer or Restrict Participation

Immediate cardiology referral is warranted for:

• Abnormal ECG findings 5
• Palpitations with syncope or specifically during exercise 5
• Family history of sudden cardiac death or inherited cardiac conditions 1
• Exertional chest pain or syncope 1, 5

Temporary restriction from high-static sports (wrestling, gymnastics, rock climbing) should occur for:

• Stage 1 or 2 hypertension until blood pressure normalizes 1
• Acute illness requiring evaluation 6
• Uncontrolled medical conditions 7, 8

Documentation and Clearance

The examination should conclude with clear documentation of:

• Fitness for participation without restrictions, or
• Clearance with specific modifications or restrictions, or
• Temporary or permanent disqualification with explanation 2, 7

Preparticipation cardiac screening is the standard of care for all athletes, serving not only to identify life-threatening conditions but also as an entry point into the healthcare system for children without established primary care 1, 2.