For many children, sports are an integral part of their childhood and adolescence. However, when children live with or develop heart disease, parents are understandably concerned about how safe it can be for them to play sports.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Politics
Pediatric cardiologist/electrophysiologist Akash Patel, MD, says there are many factors that determine whether a child can (or cannot) play a specific sport.
“We’ve learned that creating a proper safety net for kids can often allow us to be more liberal in allowing sports participation,” he says. “Of course, there are unique circumstances where we would want kids to avoid playing certain types of sports, or we could tailor the sports environment to be as safe as possible. But the goal is for most kids to be able to play sports with security”.
Can children with heart disease play sports?
Dr. Patel says participation in sports generally depends on the specific heart condition a child is living with. Every child is different, and even children with the same diagnosis may have different symptoms or a more severe form of the disease.
Take cardiomyopathy, or conditions that affect the heart muscle. With these, your heart may be stiff, have scar tissue, or become enlarged or thicker.
“We know that when people living with this diagnosis play sports, they are at increased risk of sudden cardiac arrest during the activity,” says Dr. Patel, noting that hypertrophic cardiomyopathy, which is when the heart muscle becomes thicker, it’s the “most worrying” type when it comes to sports.
“But not all children with a diagnosis of cardiomyopathy can be the same. So there are circumstances in which they can play certain types of sports or do certain levels of activity.”
In general, children who have had heart conditions, and perhaps even heart surgery, do not need any additional protective equipment for any 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 all sports. “We generally tell kids who wear pacemakers or defibrillators to avoid contact sports,” says Dr. Patel. “They are sports in which there can be a direct blow to the equipment that is implanted under the skin, in the abdomen or in the chest. You want to minimize any risk of damage to these devices. This does change the sports they can practice.”
Guidance on who cannot play sport may also change over time. For example, historically, children with hereditary arrhythmias or an irregular heartbeat were restricted from playing sports. Today, however, this is not always the case.
Precautions to take before practicing sports
With all that said, Dr. Patel says there are precautions that parents, children, schools and doctors can discuss before starting sports. “We want to identify children who may be at risk of having a worrisome cardiac event on the sports field,” he says. “And we want to identify them before this event happens.”
Cardiac screening prior to participation
One of the most important steps children can take is to have a pre-participation heart exam in addition to a physical exam. For athletes with diagnosed heart disease, this screening is usually done in conjunction with a cardiologist and primary care provider.
“That’s where we’ll often prescribe specific things 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 to play sports,” explains Dr. Patel. “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 get a kid back into sports.”
This screening is important because there are times when athletes die after suffering 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 projection, these events can still happen,” says Dr. Patel. “One of the big things families always have to keep in mind is, ‘How can we create the safest environment if a child were to have an event?’
cardiopulmonary resuscitation (CPR)
Another layer of protection for children with heart disease is to be around people who know CPR. “Knowing CPR is a good life skill that anyone should have,” advises Dr. Patel. “But I tell families who have children living with heart disease that everyone who cares for a child, for example parents, babysitters and babysitters, should learn CPR.”
For athletes with heart disease, families can go an extra step and make sure athletic trainers and coaches are also trained in CPR. “If a cardiac event occurs, they can perform CPR until the emergency services arrive and hopefully revive that child,” says Dr. Patel.
Automated External Defibrillator (AED)
In some cases, children can have a cardiac event 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. “This takes priority. But if you want to get a child out of danger because of an abnormal heartbeat, using an AED quickly is vitally important. The sooner you can do it, the faster you can rescue 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 available on site.
“If you have children who play sports, you may want to ask if your school has an AED available and, if so, where it is in relation to the sports fields,” suggests Dr. Patel. When schools can’t provide the AED, that’s when families can buy it on their own. “It’s not necessary for healthy kids,” she continues, “but it’s something that’s been shown to provide benefits for 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 medication and their EKG suggests they have low-risk characteristics, we can allow them to exercise,” says Dr. Patel. “But then they need to have an AED available at sporting events and people around who know how to do CPR.”
Ultimately, the decision to play (or not play) sport is a shared decision between the family, the child and their doctors and other health professionals.
“That means parents and a child are making that decision with the school or the team and the doctors,” says Dr. Patel. “We have to create an environment where they’re on the right medication, that care providers or coaches or parents know how to do CPR. And clearly, we assess their condition as low risk.
“Sport offers many benefits in terms of social-emotional development, teamwork and pure joy,” he adds. “And so it’s our job to make sure kids can play sports safely. If they’ve had an evaluation that’s shown there’s no concern, they’re often allowed to play any sport.”