Definition and Overview

A pediatric sports physical, also known as a pre-participation physical evaluation, is required for all children and adolescents who wish to participate in organized sports. It is conducted before the start of every sports season to ensure that the child is in good condition to perform strenuous sports activities. Undergoing this procedure can help protect them from possible medical problems that may lead to complications when exacerbated by physical activities.

Who Should Undergo and Expected Results

All children who participate in sports need to undergo a physical evaluation to obtain clearance to play. This procedure is very similar to the physical evaluation that athletes undergo, but it is suited to the needs of children and adolescents who are planning to participate in sports, either through organized clubs or their schools.

The evaluation offers the following benefits:

  • It ensures that a child is physically capable of training and competing safely.
  • It identifies potential health risks that may put the child’s life and safety in danger during sports participation.
  • It helps reduce the child’s risk of suffering from sports-related injuries.

The four possible end-results of the evaluation are the following:

  • The child will be given clearance to play – If a child is found to be fit to participate in sports, he will be allowed to play without the need for any medical intervention.

  • The child will be provided with recommendations on how to improve a certain area of his or her health – If potential problems are found, such as a medical condition or an existing injury that may interfere with the child’s ability to participate, the physician can recommend treatment or therapy to improve the child’s condition before the season begins. If there is not enough time, the patient may be asked to sit out the sports season (or a part of it) until he completes the said plan.

  • The child will be prohibited from playing – If there is a serious condition that makes sports participation risky and life-threatening for the child, he will not be allowed to play. However, this is quite rare and only applies to about 2% of all pediatric sports physical evaluations. In most cases, and as much as possible, the child is first given a rehabilitation plan before being disqualified from sports.

  • The child will be allowed to play but with restrictions – There are some special conditions that may allow a child to participate as long as certain sports and activities are avoided. The details of the clearance will depend on the child's health problem/s. For example, a child who has controlled epilepsy may be fit to play sports, but for his safety and that of his fellow athletes or opponents, he may not be allowed to engage in contact or collision sports.

    How the Procedure Works

A pediatric sports physical is usually performed at the request of the school or sports organization that the child is about to join in. It is done to complete the standard requirements for young athletes, usually by the athlete’s or his school’s physician and can take place in a hospital, private clinic, or school clinic. The athlete’s trainer or coach is usually present during the evaluation.

The evaluation may take up to an hour or even longer, and is best performed at least six weeks before the start of the season so that there would be enough time for treatment and rehabilitation if some health problems are identified.

A pediatric sports physical is made up of two main parts, the medical history evaluation, and actual physical examination.

The medical history evaluation checks the patient’s:

  • Immunization status
  • Weight changes (drastic weight changes may indicate diet problems or eating disorders)
  • History of previous illnesses
  • Allergies
  • Family history of serious diseases
  • History of fainting or dizziness caused by strenuous activity
  • History of injuries such as fractures and concussions
  • Menstrual history (for female athletes)
  • Dental history, i.e. the use of braces or other dental appliances
  • Use of drugs, alcohol, and dietary supplements
  • Use of steroids or performance-enhancing drugs


Meanwhile, the physical examination checks the patient’s:

  • Eyes, i.e. to determine whether there is a need to wear contact lenses during sports participation
  • Head and neck
  • Lungs
  • Heart
  • Vital signs
  • Respiratory rate
  • Body mass index
  • Blood pressure
  • Genitals
  • Abdomen


    Musculoskeletal conditions, which includes:

  • Posture

  • Gait
  • Arms and legs function
  • Joint range of motion
  • Knee extension
  • Flexibility
  • Balance


If some special tests are required, the physician may order more laboratory tests, such as echocardiography, if heart problems are suspected.

If any problems are found, the doctor will provide a treatment or rehabilitation plan. Possible treatment plans are discussed closely with the trainer/coach and the parents/guardians of the child.

Possible Risks and Complications

A pediatric sports physical evaluation may involve some tests, but all of these are safe for children and are customized based on the patient’s age. There is no risk involved in undergoing a physical exam. In fact, doing so can help protect the patient from the risks of physical exertion, such as:

  • Accident-related injuries
  • Overuse injuries (or stress fractures)
  • Concussions
  • Dehydration
  • Heat illness – This is a common concern in youth sports and causes heat exhaustion, muscle cramps, fainting, dizziness, and heat strokes caused by the long hours of training and competition.
  • Eating disorders – There is a tendency for some young athletes to develop eating disorders. These are more common among athletes who participate in sports where weight is an important factor. Examples of these sports are wrestling and gymnastics.
  • Sports-related death – The majority of sports-related death are caused by sudden cardiac arrest, heat illness, and severe concussions.


Perhaps the only risk of this procedure is getting disqualified, but this is only the case if there is a severe and untreated health condition that makes it dangerous for the child to participate in sports. Most disqualifications are ruled on account of cardiac conditions, such as:

  • Pulmonary stenosis
  • Pulmonary vascular disease
  • Aortic stenosis
  • Mitral stenosis
  • Cardiomyopathy
  • Acute pericarditis
  • Acute myocarditis

    Reference

  • Centers for Disease Control and Prevention (CDC). School health guidelines to promote healthy eating and physical activity. MMWR Recomm Rep. 2011; 6;60(RR-5):1-76. PMID: 21918496 www.ncbi.nlm.nih.gov/pubmed/21918496.

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