Recommendations for Participation in Competitive Sports

The preparticipation physical examination is a frequent reason for adolescent visits to a pediatrician. The most commonly used list of disqualifying conditions, published by the American Medical Association, was last revised in 1976.1 It has become increasingly obsolete because of changes in both safety equipment and society's attitudes toward the rights of athletes to compete despite a medical condition that may increase the risk of sustaining an injury or aggravating a preexisting medical condition. Most, if not all, sports are associated with some risk. The physician, the athlete, and the parents must weigh whether the advantages gained by participatting in athletics are worth whatever risks are involved. To assist practitioners in deciding whether athletes should be allowed to participate in particular sports, the American Academy of Pediatrics' Committee on Sports Medicine has compiled a list of recommendations. First, sport events were divided into groups depending on their degree of strenuousness and probability for collision (Figure). These groups of sports were then assessed in light of common medical and surgical conditions to determine whether participation would create a substantial risk of injury (Table). Certain activities, such as skiing, are not inherently "contact sports." Yet, when competitors See Table in the PDF fall and collide with the ground, they are as much at risk as participants in the more traditional collision/contact sports. Hence, we have included such sports in a group called "limited contact/impact." A list of all medical conditions that would disqualify athletes from participation would be nearly endless.