sports participation guidelines for children and teens

Medical Conditions Prohibiting Sports Participation in Children and Teens

May 2, 2016

Boy in cast and crutches looks onto baseball field

“AWWWwwwwwwhhH DAD! Mom said to ask you.”

“Look, your team can get along without you for one game. Let’s see what the doctor has to say when he sees you this afternoon.”

What do you think? Did I nail the discussion you had with your sports-crazed son after he was injured?
Sports and medical conditions, sometimes not all that fun
Spring is here (or will be soon). Baseball and soccer (US) is in the air. Time to order more crutches and cast material. Kids are going outside to play.

Children’s Sports Participation With Medical Conditions

Injury, however, is not the only time physicians are called upon to render advice about children’s sports participation. There are a number of medical issues which must be evaluated before children can be cleared for sports participation.

Medical Clearance For Children’s Sports

Many medical conditions have been found to increase risk of serious injury or damage depending upon their severity and many more have been found to merely need adaptive gear, protection, medical management or rule changes before participation is safe – for both the child and other players.

If you have any questions at all about participation, it’s better to err on the side of caution and talk to your pediatrician about it. That’s why most competitive children’s sports activities require a yearly physical examination.

However, I thought I’d put together a little summary list of a few of the more common things we see each year that need evaluation. I’ve categorized them into the three groups of: “YES” – it’s usually safe to play; “NO” – it’s not safe to participate; and, “MAYBE^✱” – It MIGHT be safe IF certain precautions are taken.

You’ll notice that there are a whole lot more “yes” and “maybe’s” than there are “no’s” – which reflects us pediatrician’s basic “no child left behind” philosophy that we’ve had long before it became “politically correct.” Sports are inherently beneficial for children and we love to have accommodations be made for as much participation as desired.

All of these recommendations have been extensively studied by experts in the AAP who used the latest research trying to keep kids participating while keeping them safe too.

Children’s Medical Conditions and Sports Clearance

Source: Caring for Your Teenager (© 2003 American Academy of Pediatrics)
Condition	Permitted?	Recommendations
Atlantoaxial Instability Instability of the joint between the two uppermost vertebrae in the neck	Maybe^✱	Teen needs evaluation to asses risk of spinal cord injury during sports participation. For example, some teens with Down’s syndrome may have atlantoaxial instability and be at increased risk for neck injury.
Bleeding Disorders including hemophilia	Maybe^✱	Evaluation needed. As a rule, hemophiliacs are counseled not to play contact/collision sports.
Cancer	Maybe^✱	Evaluation needed
Cardiovascular Diseases
Carditis Inflammation of the heart	No	Exertion may result in sudden death
Hypertension Chronically high blood pressure	Maybe^✱	Teens with significant essential (unexplained) hypertension should avoid weight and power lifting, body building, and strength training. Secondary hypertention (caused by a previously identified disease) or severe essential hypertension warrant a medical evaluation
Congenital Heart Disease Structural heart defects present at birth	Maybe^✱	Teens with mild forms may participate fully; those with moderate or severe forms, or who have undergone surgery, need evaluation
Dysrhythmia Irregular heart rhythm	Maybe^✱	Evaluation needed, because some dysrhythmias require treatment and/or make certain sports participation dangerous.
Mitral Valve Prolapse Malfuntioning heart valve	Maybe^✱	Teens with symptoms (chest pain, symptoms of possible dysrhythmia) or evidence of mitral regurgitation (leaking) on physical examination need evaluation. All others may participate fully
Heart Murmur	Maybe^✱	If the murmur is "innocent" -that is, does not indicate heart disease- full participation is permitted. Otherwise, evaluation needed.
Cerebral Palsy	Maybe^✱	Evaluation needed
Diabetes Mellitus	Yes	All sports can be played with proper attention to diet, hydration and insulin therepy (if necessary). Particular attention is needed for activities that last 30 minutes or more.
Diarrhea	No	Unless mild, the youngster is not allowed to play, because of the risk of dehydration and heat-related illness.
Eating Disorders (anorexia nervosa, bulimia nervosa)	Maybe^✱	These teens need both medical and psychiatric assessments before participation
Eye Disorders (functionally one-eyed, loss of an eye, detached retina, prior eye surgery, serious eye injury)	Maybe^✱	A functionally one-eyed teen has a best corrected visual acuity of 20/40 in the worse eye. These athletes would suffer significant disability if the healthier eye were seriously injured, as would those who have lost an eye. Some young people who have previously undergone eye surgery or had a serious eye injury may have an increased risk of injury because of weakened eye tissue. Availability of eye guards approved by the American Society for Testing Materials (ASTM) and other protective equipment may allow participation in most sports, but this must be judged on an individual basis.
Fever	No	Fever adds to the workload of the heart and lungs, and increases the chances of suffering heat exhaustion or heatstroke.
Heat Illness, history of	Maybe^✱	Because of the increased likelihood of recurrence, the athlete needs individual assessment to determine the presence of predisposing conditions and to establish a prevention strategy.
Hepatitis B (HBV) Hepatitis C (HCV) Human Immunodeficiency Virus (HIV)	Maybe^✱	The risk of these viruses being transmitted through sports participation is believed to be extremely low. Therefore, all sports should be open to athletes infected with HIV or with hepatitis B or C. However, sensible precautions must be taken, such as making sure that cuts, abrasions, wounds or other areas of broken skin are covered with a protective dressing before and during events.
Kidney, loss of one, due to injury or disease	Maybe^✱	Evaluation needed for contact/collision and limited-collision sports
Liver, enlarged (hepatomegaly)	Maybe^✱	If the liver is acutely enlarged, participation should be avoided because of risk of rupture. If the liver is chronically enlarged, evaluation needed before collision/contact or limited contact sports are played.
Musculoskeletal Disorders	Maybe^✱	Evaluation needed.
Neurologic Disorders
History of (1) Serious Head or Spinal Trauma, (2) Severe Concussions, (3) Repeat Concussion, (4) Brain Surgery	Maybe^✱	Evaluation needed for collision/contact or limited contact sports, and also for noncontact sports if there are deficits in judgment or cognition. Recent research supports a conservative approach to management of concussion.
Convulsive Disorder well controlled	Yes	If disorder is well controlled, the teen faces little risk of having a seizure while participating in sports.
Convulsive Disorder poorly controlled	Maybe^✱	If disorder is poorly controlled, evaluation needed for collision/contact or limited contact sports. The teen should avoid the following noncontact sports: archery, riflery, swimming, weight or power lifting, strength training, sports involving heights. In these sports, a convulsion, though unlikely, could pose a risk to the patient or to others.
Obesity	Maybe^✱	Because of the risk of heat illness, obese teens need careful acclimatization and hydration.
Organ Transplant Recipient	Maybe^✱	Evaluation needed.
Ovary, loss of one, due to disease	Yes	The risk of severe injury to the remaining ovary is minimal.
Respiratory Disorders
Acute Upper-Respiratory Infection	Maybe^✱	Upper-respiratory obstruction may affect pulmonary function. Evaluation needed for all but mild disease.
Asthma Well controlled	Yes	With proper medication and education, only teens with severe asthma will have to modify participation
Compromised Pulmonary Function, including from cystic fibrosis	Maybe^✱	Evaluation needed, but, generally, all sports may be played if the teen’s oxygenation remains satisfactory during a graded exercise test. Youngsters with cystic fibrosis need acclimatization and proper hydration to reduce the risk of heat illness.
Sickle-Cell Trait	Yes	It is unlikely that teens with sickle-cell trait (AS) have an increased risk of sudden death or other medical problems during athletic participation except under extreme heat, humidity and possibly increased altitude. These young people, like all athletes, should be carefully conditioned, acclimatized and hydrated to reduce any possible risk.
Skin Conditions (boils, herpes simplex, impetigo, scabies, molluscum contaglosum)	Maybe^✱	While the patient is contagious, participation in gymnastics with mats, martial arts, wrestling or other collision/contact or limited contact sports is not allowed. The herpes simplex virus probably is not transmitted via mats.
Spleen, enlarged (splenomegaly)	Maybe^✱	A teen with an acutely enlarged spleen should avoid all sports because of risk of rupture. Those with chronically enlarged spleens need evaluation before playing collision/contact or limited contact sports
Testicle, undescended or missing	Yes	Certain sports may require a protective cup

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