Ahna A. Patterson, PA-C
Have you ever wondered why your child or adolescent has to receive a physical prior to their participation in sports? Roughly 30 million children and adolescents in the United States participate in sports activities.1 A preparticipation physical exam (PPE) is an integral component in a child’s overall health management. While it is rare for a child or adolescent to be completely disqualified from participating in sports activities, conditions such as an enlarged spleen, uncontrolled seizure disorders, heart problems, and severe high blood pressure are a few examples of health issues that would restrict participation in sports activities.2
There are six major goals of preparticipation physical examinations.3 They include:
- Fostering safe participation in sports for children and adolescents
- Identifying health conditions that could pose life-threatening complications while playing sports
- Identifying health issues that may require a definitive treatment plan before or during sports participation
- Diagnosing and treating muscle injuries
- Identifying medical conditions that could inhibit the child or adolescent’s performance in sports
- Removing certain sports restrictions that may be unnecessary
The preparticipation physical exam is only one component of the visit. Prior to visiting the medical clinic, a parent or guardian should answer all the questions on the PPE history form. The medical history can serve as the most vital aspect of the evaluation. This will provide a medical provider with critical information that may be utilized in the overall assessment as to whether a child is healthy enough to participate in sports activities.
Certain elements of a child or adolescent’s medical history that can prove relevant to the examination are previous history of surgeries, family history, loss of function in a paired organ such as kidney or testis, menstrual history in girls, injury history, current immunizations, and history of current medications.4
Although several organ systems are reviewed, a child or adolescent’s cardiac history is one of the most important aspects of the medical history. This historical information can help detect possible predisposition to sudden cardiac death. The medical provider will obtain information regarding the child’s history of:5
- Chest pain
- High blood pressure
- Heart murmurs
- Cases of sudden cardiac death in the family, especially before age 50
- Unexplained seizures
A complete physical exam is performed after the child or adolescent’s medical history Is reviewed by the medical provider. Examination components include the eyes, heart, lungs, muscles, joints, abdomen, and genitals (boys). After a thorough examination, a child or adolescent could be recommended for full participation, limited participation, or no participation until other tests or specialist referrals have been completed. As an example, if a heart murmur is detected during the physical exam, the medical provider may defer sports participation until the child visits a cardiologist.
It is recommended that PPE’s are completed 6 weeks prior to the start of sports’ practice.6 This will allow the parent or guardian an appropriate amount of time to review the medical provider’s recommendations, specifically if additional testing or specialty visits are warranted. While it is important to remember that PPE’s are not meant to substitute a child or adolescent’s annual pediatric exams, they are a part of the larger health assessment for those participating in sports activities.
 Albert C. Hergenroeder, “Sports participation in children and adolescents: The preparticipation physical evaluation,” UpToDate, updated January 15, 2019, https://www.uptodate.com/contents/sports-participation-in-children-and-adolescents-the-preparticipation-physical-evaluation.
 Mark H. Mirabelli, Mathew J. Devine, Jaskaran Singh, Michael Mendoza, “The Preparticipation Sports Evaluation,” American Family Physician 92, no. 5 (2015): 371-376, accessed May 13, 2019. https://www.aafp.org/afp/2015/0901/p371.html#afp20150901p371-t1.
 Albert C. Hergenroeder, “Sports participation in children and adolescents: The preparticipation physical evaluation.”
 American Academy of Pediatrics, “Has your child had a sports physical this year?” https://www.aap.org/en-us/Documents/cosmf_ppe_flyer.pdf.