Every summer and fall, pediatricians brace for a wave of preparticipation sports physicals. These appointments can sometimes feel like just checking a box before a child or teen hits the field. But Ryan Kelln, DO, FAAP, says they offer something more: a unique opportunity to connect with young athletes—and promote their health and safety.
Dr. Kelln, a primary care sports medicine specialist in the Jackie and Gene Autry Orthopedic Center at Children’s Hospital Los Angeles, will speak on this topic at the upcoming American Academy of Pediatrics (AAP) conference Sept. 26-30 in Denver. In advance of his talk, he shares five ways pediatric providers can use these exams to better support patients’ overall health.
While sports physicals are sometimes performed at large school events or retail clinics, the AAP recommends that they be done in the primary care office, by a provider who knows the patient’s medical history. Dr. Kelln agrees.
“When the exam takes place in the medical home, you already have vital knowledge about the patient that can make the process faster, more accurate, and more meaningful,” he explains. “It also increases the chances that an athlete or parent will open up about injuries or other health issues.”
And while there is no universal standard screening process, Dr. Kelln recommends physicians use the AAP Preparticipation Physical Evaluation form- Opens in a new window.
For Dr. Kelln, cardiac history and symptoms are always top of mind when conducting a sports physical. Although the overall incidence of sudden cardiac death in the United States is estimated to be 1.25 cases per 100,000 high school athletes per year, these numbers are higher in certain populations like African American collegiate athletes, especially NCAA Division 1 male basketball players.
Key questions include:
Have you ever passed out, or nearly passed out, during or after exercise?
Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?
Does your heart ever race, flutter in your chest, or skip a beat during exercise?
Do you get lightheaded or feel shorter of breath than your friends during exercise?
Is there a family history of unexplained or early cardiac death?
In addition, physical exam findings such as a heart murmur or abnormal blood pressure should be taken seriously. If there are any concerns, physicians should refer to a pediatric cardiologist for further evaluation.
“Cardiac events are rare in kids, but they’re devastating.”Ryan Kelln, DO, FAAP
Dr. Kelln notes ,“In most cases things will check out OK, but it’s much better to be proactive.”
For many adolescents, the preparticipation exam may be the only time they are evaluated by a medical provider during the year. That makes it an important opportunity to screen for anxiety, depression, stress, or other concerns.
Dr. Kelln encourages physicians to spend time one-on-one with the athlete, separate from parents, to ask questions about mood, peer relationships, and school or sports pressures. “Athletes can have mental health struggles just like everyone else,” he says. “If you give them some space to talk, they are more willing to open up to those questions. It provides another chance to address their overall well-being.”
A history of musculoskeletal injury is one of the strongest predictors of future injury. So it is important to pay particular attention to past injuries during the evaluation. For example, a prior ankle sprain may warrant a closer look to determine if there is lingering joint instability, weakness, or other mechanical concerns that would put the ankle at risk for re-injury.
Not all pain should keep a child from being cleared for sports participation. But the exam can be a valuable springboard to talk with families about home exercises, physical therapy, or return-to-play precautions that can reduce the risk of further injury.
While about 98% of young athletes are cleared to play, 14% require some type of follow-up from another specialty. Yet, physicians often feel pressured to “sign off” on the preparticipation paperwork so the athlete can play immediately—even if red flags in the evaluation arise.
“It’s important to frame clearance as a step toward safe participation, not restriction,” Dr. Kelln advises. “When you discuss it that way with families, in most cases it’s received well, particularly if they already have a relationship with you.”
He also recommends urging families to schedule preparticipation physicals at least six weeks before a season begins. That buffer reduces the stress of last-minute clearance requests and allows time to investigate concerns from the exam and make referrals.
Although the sheer volume of sports physicals can be daunting for physicians and their staff, the exams can help strengthen relationships with young patients and their families. The overall goal of these physicals should be to foster good health and safety habits, and to help young patients be active and do the things they love.
“This is an opportunity not to check a box, but to check in,” Dr. Kelln says. “By taking a thoughtful approach, you can build trust with young athletes and guide them to better long-term health, both on and off the field.”
(Newswise/VK)