The school sports physical
The primary goal of a school sports physical, also referred to as a pre-participation physical evaluation (PPE), is to obtain medical clearance for sports participation by detecting or ruling out two things: medical conditions that may predispose a child to injury, typically musculoskeletal; and conditions that may be life-threatening or disabling, specifically with the heart.
Among other eligibility rules, the Kansas State High School Activities Association requires an annual PPE for all middle school and high school athlete.
After the sudden deaths of several high school athletes from cardiac arrest in recent years, American Heart Association screening guidelines now call for medical history questions and physical exam elements to help determine if a child is at cardiac risk.
AHA screening guidelines to check for cardiac risks
Personal history questions asked during child’s sports physical:
Does the patient have —
- Chest pain or discomfort upon exertion
- Unexplained fainting or near-fainting
- Excessive and unexplained fatigue associated with exercise
- Heart murmur
- High blood pressure
- One or more relatives who died of heart disease (sudden or unexpected or otherwise) before age 50
- Close relative under age 50 with disability from heart disease
- Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy in which the heart cavity or wall becomes enlarged, heart electrical rhythm problems, Marfan syndrome in which the walls of the heart’s major arteries are weakened, or clinically important arrhythmias or heart rhythms.
Sports physical examination:
- Heart murmur
- Femoral pulses to exclude narrowing of the aorta
- Physical appearance of Marfan syndrome a genetic disorder of the connective tissue. People with Marfan's tend to be unusually tall, with long limbs and long, thin fingers
- Brachial artery blood pressure (taken in a sitting and standing position)
Child’s physical exam — what to expect
After reviewing your child’s medical history, the pediatrician begins the full-screening physical examination, which will most likely include the following:
- Height and weight
- Blood pressure and pulse
- Discussion of important health and safety issues such as sexuality and the prevention of sexually transmitted diseases, the dangers of experimenting with alcohol and other drugs, dietary and exercise habits, driving safety and so on.
- Vision test. If your pediatrician detects any sign of injury or disease, or suspects that your teen might need glasses, you’ll be referred to an eye care specialist.
- Using fingers to feel the neck for swollen lymph nodes or an enlarged thyroid gland. Touching and pressing on the abdomen to feel for any problems with the spleen, liver and kidneys.
- Placing a stethoscope to your youngster’s chest and back to assess respiration and listen for any abnormal sounds from the heart.
- Checking posture. Any apparent abnormality of the spine may warrant X-rays, because adolescents are prime candidates for developing progressive curvature of the spine, such as scoliosis.
- Testing joint flexibility and muscle strength
- Both girls and boys have their breasts felt, or palpated, for lumps. At this age, a mass in a girl’s breast is almost certainly benign. As for boys, early in puberty, many will develop excess breast tissue. This condition, gynecomastia, is usually temporary and more distressing than it is serious.
- Inspect the skin for acne and suspicious looking moles.
- Ensure immunizations are current.
- Pediatricians often inspect the genitals last
Source: American Academy of Pediatrics
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