For many children, sports are an integral part of childhood and adolescence. However, when children live with or develop heart disease, parents understandably worry about how safe it might be for them to play sports.
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Pediatric cardiologist/electrophysiologist Akash Patel, MD, says many factors go into determining whether a child can (or can’t) play a certain sport.
“We’ve learned that creating a proper safety net for kids can often allow us to be more liberal in allowing participation in sports,” he says. “Of course, there are unique circumstances where we would like kids to avoid playing certain sports or we can adjust the sports environment to be as safe as possible. But the goal is for most kids to be able to play sports safely.”
Can children living with heart disease play sports?
Dr. Patel says that participation in sports usually depends on the specific heart condition the child is living with. Every child is different – and even children with the same diagnosis may have different symptoms or a more serious form of the disease.
Take cardiomyopathy or conditions that affect the heart muscle. With these, your heart may be stiff, scarred, or enlarged or thicker.
“We know that when people living with this diagnosis exercise, they are at increased risk of sudden cardiac arrest during activity,” says Dr. Patel, noting that hypertrophic cardiomyopathy, in which the heart muscle becomes more fat, is the “most concerned” type when it comes to sports.
“But not all children diagnosed with cardiomyopathy may be the same. So there are circumstances where they may be able to play certain sports or do certain levels of activity.
In general, children who have had heart disease and perhaps even had heart surgery do not need extra protective gear for whatever sport they play. They are also usually not prevented from playing certain positions – for example, they are allowed to be a catcher but not a first baseman in baseball.
But Dr. Patel says some kids may not get the green light for every sport. “We usually tell kids who have pacemakers or defibrillators to avoid contact sports,” says Dr. Patel. “These are sports where there can be a direct impact on the equipment implanted under their skin, in their abdomen or chest. You want to minimize any risk of damage to these devices. It really changes the sports they can play.
Guidelines on who can’t exercise can also change over time. For example, historically, children with hereditary arrhythmias or irregular heart rhythms were restricted from playing sports. Today, however, this is not always the case.
Precautions to take before exercising
With all that said, Dr. Patel says there are precautions that parents, kids, schools and doctors can discuss before starting to exercise. “We want to identify children who may be at risk of worrisome heart disease on the playing field,” he says. “And we want to identify them before that event happens.”
Cardiac screening before participation
One of the most important steps kids can take is to have a pre-participation heart screening in addition to a physical. For athletes with diagnosed heart disease, this screening is usually done in tandem with a cardiologist and primary care provider.
“We often prescribe specific things there in terms of what sports they can play, how they should play, when and how they should limit themselves, and any kind of safety net they need around playing sports,” Dr. Patel explains. “A cardiologist would work with the primary care provider because we are focused on the heart. We can say, “From a heart standpoint, these are the things that would allow a child to return to sports.”
This screening is important because there are times when athletes die after sudden cardiac arrest. These tragic events are rare, occurring between 1 in 50,000 and 1 in 300,000 people, but they do happen.
“Unfortunately, there are situations where, despite the best screening, these events can still happen,” says Dr. Patel. “One of the big things families always have to think about is, ‘How do we create the safest environment if a child has an event?’
Cardiopulmonary Resuscitation (CPR)
Another level of protection for children with heart problems is to be around people who know CPR. “Knowing CPR is a good life skill that every person should have,” advises Dr. Patel. “But I tell families who have children living with heart disease that all people who care for a child — for example, parents, babysitters and nannies — need to learn CPR.”
For athletes with heart disease, families can take an extra step and make sure athletic trainers and coaches are also trained in CPR. “If a cardiac event occurs, they can provide CPR until emergency services arrive and hopefully resuscitate that child,” says Dr. Patel.
Automated External Defibrillator (AED)
In some cases, children may have a heart attack where their heart rhythm becomes abnormal and dangerous. Using an AED or automated external defibrillator can help the heart return to its normal rhythm.
“You should always do CPR,” says Dr. Patel. “It has an advantage. But if you want to get a child out of a dangerous situation due to an abnormal heart rhythm, quick use of an AED is extremely important. The sooner you can do it, the faster you can save a child.
When you call 911, the police, fire department, or EMS will bring a defibrillator to the scene. But today, more and more schools have AEDs on site.
“If you have children who play sports, you may want to ask if your school has an AED—and if so, where it is relative to the sports fields,” suggests Dr. Patel. When schools cannot provide an AED, then families can purchase one themselves. “It’s not necessary for healthy kids,” he continues, “but it’s something that’s been shown to benefit kids who are at risk.”
For example, children who have a condition called long QT syndrome, which affects the heart’s electrical system, should be near an AED. “We know that if they’re on the right treatment and their EKG suggests they have low-risk characteristics, we may allow them to exercise,” says Dr. Patel. “But then they have to have AEDs at sporting events and people around who know how to do CPR.”
Ultimately, the decision to play (or not to play) is a shared decision between the family, the child, and their doctors and other health professionals.
“That means the parents and the child make that decision with the school or the team and the doctors,” says Dr Patel. “We need to create an environment where they’re on the right medications, that care providers or trainers or parents know how to do CPR. And of course, we assess that their condition is low risk.
“Sport offers many benefits in terms of social-emotional development, teamwork and just pure joy,” he adds. “So our job is to make sure kids can play sports safely. If they have gone through an assessment that has shown there are no concerns, they are often allowed to play any sport.”