It’s every parent's nightmare: A seemingly healthy young athlete collapses on the field. Though this tragedy is rare, it’s easy to see why parents might worry about their child's heart health before they hit the court, field or track.
Does every student athlete need baseline heart screening? Premchand Anne, M.D., a pediatric cardiologist at Henry Ford Health, shares what parents should know about heart screening for young athletes.
Guidelines on Heart Screening for Young Athletes
There is no universal recommendation in the United States for heart screening before a child or teen begins playing sports. Major organizations such as the American Academy of Pediatrics and the American Heart Association have stated that heart tests are neither necessary nor recommended for every student athlete.
There are several reasons for these guidelines. “With millions of athletes nationwide, universal heart screening would be enormously expensive,” says Dr. Anne. “Our current health system could not support the cost.”
And though sudden cardiac death is tragic and gets a lot of media attention, it’s rare in young people. “In most cases, children who have no heart disease risk factors or symptoms of a heart problem do not benefit from testing,” says Dr. Anne.
Finally, false alarms are also very common with heart tests like electrocardiograms (EKGs), which are usually the first test athletes would receive. “False positives on EKGs can lead to unnecessary follow-up tests and anxiety for the family,” says Dr. Anne.
How Baseline Heart Screening Works
If there's no universal screening, what should parents do to help ensure their child is safe? The answer starts with answering some questions on your child’s physical form before they begin sports.
“The American Heart Association has a 14-point screening questionnaire that's part of the pre-participation sports physical," Dr. Anne explains. "It's a template that evaluates personal history and family history. Your answers to these questions provide important information about whether your child may benefit from cardiac testing.”
The questions aim to get more information about your child's heart health and underlying risks: Has your child ever fainted during exercise? Do they have chest pain with activity? Has anyone in the family died suddenly before age 50?
If your answers indicate a possible issue, the doctor will perform an exam. From there, they determine whether your child may need cardiac testing.
The Power (and Limitations) of an EKG
An EKG is a valuable tool, but it's not perfect. “An EKG is a 10-second recording of the electrical activity of the heart," Dr. Anne notes. "If you have an arrhythmia (abnormal heart rhythm) that happens outside of those 10 seconds, the EKG may look normal."
For example, someone with SVT (supraventricular tachycardia)—where the heart suddenly races—might have a completely normal EKG if they're not having an episode during the test. This is why the questionnaire is so critical. If a student reports fainting during basketball practice, that history matters more than a single normal EKG.
What Parents Should Do
Don't assume that because your child seems healthy and active, their heart is fine. Some dangerous heart conditions cause no symptoms until it's too late.
The most important thing to do is answer the screening questionnaire honestly and completely.
"Parents should make sure the questionnaire is filled out at sports physicals," Dr. Anne advises. "If there are any concerns—fainting, chest pain with exercise, a family history of sudden death—those need to be brought up."
If your child's doctor recommends further testing, follow through. "If the questionnaire indicates concerns, the next step is usually a more detailed family history, an EKG and then possibly an echocardiogram," says Dr. Anne.
Finally, advocate for CPR-trained personnel and automated external defibrillators (AEDs) in schools and at school-sponsored athletic activities. Timely and effective administration of CPR, with and without AEDs, improves survival rates for out-of-hospital cardiac arrests.
Athlete Heart Screening Resources
If your child has potential risk factors and cost is a concern, talk to your provider. Several health systems and nonprofit organizations host heart screening events for athletes. These events are designed to test athletes for hypertrophic cardiomyopathy (HCM) at low or no cost. HCM is the top cause of sudden cardiac death in young athletes.
“Low-cost screening events are a great way to help more athletes get screened,” says Dr. Anne. “I encourage parents to look for these resources in their community if their child might have any heart risk factors.”
It’s normal to worry about your child’s health and safety. But remember that most young people do not have serious heart problems.
Regular well visits can help provide reassurance and peace of mind. And if you have concerns between visits, be sure to ask. “Your child's health is always worth the conversation,” says Dr. Anne.
Reviewed by Premchand Anne, M.D., a pediatric cardiologist who sees patients at Henry Ford St. John Hospital.
