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.

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Pediatric cardiologist/electrophysiologist Akash Patel, MD, says many factors go into determining 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 participation in sports,” he says. “Of course, there are unique circumstances where we would like kids to avoid certain sports, or could adapt the sports environment to be as safe as possible. But the goal is for most children to be able to play sport safely.

Can children living 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 – even children with the same diagnosis may have different symptoms or a more serious form of the condition.

Get cardiomyopathy, or conditions that affect the heart muscle. With these, your heart may be stiff, have scar tissue, or become enlarged or thickened.

“We know that when people living with this diagnosis play sports, they are at increased risk of having a sudden cardiac arrest during the activity,” says Dr. Patel, noting that hypertrophic cardiomyopathy, which is when the heart muscle becomes thicker, is the “most concerning” 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 types of sports or do certain levels of activity.”

In general, children who have had heart problems, and perhaps even heart surgery, do not need any additional protective equipment for whatever sports they play. They are 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 be given the green light for every sport. “We generally tell children who have pacemakers or defibrillators to avoid contact sports,” says Dr. Patel. “These are sports where there can be a direct hit to devices that are implanted under their skin, in their abdomen or chest. You want to minimize any risk of damage to these devices. It changes the sports they can play.”

Guidelines on who can’t play sports can also change over time. For example, historically, children with inherited arrhythmias, or irregular heartbeats, were restricted from playing sports. Today, however, this is not always the case.

Precautions to be taken before playing sports

With all that said, Dr. Patel says there are precautions that parents, children, schools and doctors can discuss before they start playing 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 that event happens.”

Cardiac examination before participation

One of the most important steps children can take is to have a pre-participation cardiac screening in addition to a physical exam. For athletes with a diagnosed heart condition, this screening is generally done in conjunction with a cardiologist and primary care provider.

“That’s where we’ll often outline specific things in terms of the 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 allow a kid to get back into sports.'”

This review is important because there are cases where athletes die after experiencing sudden cardiac arrest. These tragic events are rare, occurring anywhere from 1 in 50,000 to 1 in 300,000 people, but they do happen.

“Unfortunately, there are situations where, despite the best screening, these events can still occur,” says Dr. Patel. “One of the important things that families should always keep in mind is, ‘How do 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 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, nannies and nannies — should learn CPR.”

For athletes with heart disease, families can take an extra step and make sure coaches and athletic trainers are also trained in CPR. “If a cardiac event occurs, they can provide CPR until 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 get the heart back into its normal rhythm.

“You should always do CPR,” says Dr. Patel. “This has advantages. But if you want to remove a child from a dangerous situation due to an abnormal heartbeat, the quick use of an AED is extremely important. The sooner you do that, the sooner 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 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 cannot provide an AED, then families can purchase it themselves. “It’s not necessary for healthy kids,” he 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 if they’re on the right medication and their EKG suggests they have low-risk characteristics, we can let them play sports,” says Dr. Patel. “But then they have 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) sports is a shared decision between a family, the child, and their doctors and other health professionals.

“That means the parents and a child are making that decision with the school or the team and the doctors,” says Dr. Patel. “We need to create an environment where they get the right medication, so that the care providers or coaches or parents know how to give CPR. And clearly, we assess their condition as low risk.

“Sport offers many benefits in terms of social-emotional development, teamwork and just pure joy,” he adds. “And so our job is to make sure kids can play sports safely. If they have undergone an assessment that has shown that there are no concerns, they are often allowed to play a sport.”

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