Medical examination in sports practices in children

Playing a sport is one of the healthiest options in life, since childhood. It is very common for those in a playful way, end up competing and doing many hours of training. But, just as no one doubts the need to carry out a medical examination in elite athletes, the truth is that there is no legal regulation in Spain that regulates sports-medical examinations. Would it be necessary?

Sports practices in children and youth

One of the pillars of a person's health is physical exercise. That is why it is practiced in a curricular way in schools and institutes. In these cases, sports practices are not competitive, but playful and educational to train children in good habits from infancy. Hence, many of our children's extracurricular activities have sport as the protagonist. In addition, it is increasingly common for them to start at a younger age in regulated practices that lead them to compete (even high competition) and, therefore, to more intense, demanding and frequent training. It is these children who are one step below those, where, in many cases, there is no preventive medical control prior to their practice, since there is no firm legislation in this regard.

Who recommends the medical examination?

Some pediatric and sports societies recommend performing a medical examination before participation in a competitive sport, even if it is not high performance. These exams are performed by a sports doctor, which is a medical specialty dedicated to sports medicine.

A detailed medical history, a thorough physical examination, focusing on the cardiovascular system and the musculoskeletal system, and some simple assessment of physical condition are advised. There is no consensus on the need to perform a resting procedure in children without symptoms or without a family or personal history of heart disease, sudden death and whose physical examination is normal. Because it is necessary?

The purpose of the medical examination sports fitness is to detect, fundamentally, heart disease, that disable or limit sports practice and assess musculoskeletal alterations that may increase the risk of injury. What worries most during sports practice is sudden death.

What is sudden death?

Is the sudden and unexpected onset of cardiac arrest in a person who is apparently healthy and in good condition. In those under 35 years of age, it has been estimated at 1 / 200,000 / year. In American schoolchildren and high school students (where there is statistical data) it is between 1.33 and 14.5 deaths per million per year.

Only a small percentage of children and adolescents (0.3-1.2%) are detected during the medical examination, some disease for which sports practice is absolutely contraindicated. These cases are directly related to the risk of suffering a heart problem or sudden death. It is more frequent, up to 10% of cases, to diagnose small alterations that require taking special precautions when performing sports practices.

Despite efforts to detect young people at risk of sudden death, it is not always possible. This is easy to understand when we mourn the death of an elite player, such as a footballer, on the field of play, during a game, despite all the routine medical tests carried out during his professional life.

Main objectives of the sports fitness medical examination

The mission of these tests is to guide the young athlete on issues such as precautions during training, practice and competition and assess whether the sport he has chosen is suitable for him.

The main objectives would be:

• Detect diseases or malformations that can cause sudden death.
• Detect other diseases that limit sports practices.
• Advise on the type of sport and the level of competition suitable for the child based on their health.
• Individualize the sport practice in every child.
• Prevention of musculoskeletal injuries.
• Guide the appropriate treatment in the case of existing injuries before starting training or competition.
• Give guidelines for the practice of healthy exercise: diet, equipment, rest ...
• Educate for injury prevention.

What is the recognition of sports aptitude (RAD)?

There is no consensus or standardization, but what everyone agrees on is that they should be individualized medical check-ups, that is, they should be carried out one by one, not massively in a group, as is usual. It is advisable to do them annually.

The parts of the RAD are:

• Clinic history: it is advisable to have a standardized questionnaire. Ask about habits, family history of sudden death and inherited diseases, chest pain during physical exertion, chronic diseases, allergies, or episodes of syncope (loss of consciousness).
• Physical exploration: focuses on the review of the cardiovascular and locomotor systems.
• Supplementary tests: they are not always necessary and, in some cases, there is no consensus among medical associations.
• Resting electrocardiogram: seems useful (not always) in the prevention of some kind of sudden death in competitive sports.
• Imaging tests: in the case of detecting asymmetries, musculoskeletal alterations or for the evaluation of previous injuries.
• Physical assessment test: test that assesses the reaction of physical constants to effort. An example would be running on a treadmill.

Are there other diseases that limit sports practices?

There are situations such as children with reduced vision, absence of a kidney or clotting problems, where contact sports are not convenient.

Children with poor control of the disease, it is not recommended to practice water sports.

Children with well-controlled asthma can be physically active without problems. In addition, it can help them improve their quality of life and control seizures.

• Some pediatric and sports societies recommend a medical evaluation before participation in a competitive sport, even if it is not a high-performance one.
• The objective of the recognition of sports fitness is to detect, fundamentally, heart disease, and assess musculoskeletal disorders that may increase the risk of injury.
• The objective of these tests is to guide the young athlete on issues such as precautions when training and competing, and assess whether the sport he has chosen is suitable for him.

Pediatric Specialist