Exclusion from Sports: A tough choice for parents, teens and coaches
When it comes to sports participation or exclusion there is so much emotion from both parents and teens. Whilst some parents would do anything to ensure their teens’ participation, others bring their teens in to request exclusion from sports. I’ve heard everything from its hot and my child is uncomfortable running outside to other children laugh at my child because he or she is so big; exactly why the child should participate. As much as possible, every provider wants to encourage teens to participate in sports or PE both for their physical, emotional and mental wellbeing.
Unfortunately there are some reasons, when a teen may have to be temporarily or permanently excluded from sports. Parents should understand, no provider takes a teen’s exclusion from sports lightly. This decision should be made by the provider, in conjunction with the parent or guardian and of course the teen, always putting the teen’s well-being first.
1. Family History is Important
Harry was sent for sports clearance by his basketball coach because he noticed Harry appeared winded after any high intensity sport and developed chest pain. This coach was a very good coach, and realized this was unexpected in an athlete who trained faithfully and was in good shape. During the exam it came up there was a family history of heart disease. Harry’s dad died from “a heart attack” at age 42 years. His grandfather died from one at age 45 years. A family history of Myocardial Infarction or heart attack before age 50 years is a serious history and one which should not be ignored. This was especially important since Harry was already having some symptoms. Every year we hear of an athlete who just keeled over during sports and died. I’m not saying all these athletes had heart disease but we need to pay attention to these subtle signs our teens complain of and take family histories seriously. It is important to talk to your primary care provider if there is a family history of heart disease to make sure your teen is screened and cleared before sports participation.
2. Unusual Circumstances
Seth refused to get undressed for his sports clearance exam. The provider explained to him the physical form assumes the exam is done unclothed. During the exam, it was discovered he had an undescended testis, at age 16 years. This is so unusual it was shocking but somehow Seth had always been given a pass and had never undressed for his sports physical. Dad was initially upset stating he had always been cleared and why not this year. To his credit, as soon as he realized the gravity of the situation, an undescended testis is at risk for trauma, torsion, tumor formation, infertility and the list goes on, he quickly agreed to a referral to see a urologist to resolve this serious condition.
3. Individual Circumstances
Belinda was a star swimmer. She was on the swim team and was one of the best swimmers. One day in class, Belinda literally keeled over and started foaming at the mouth and having jerking movements. The ambulance was called and it became evident that Belinda was having a seizure. After an extensive work up, no reason could be found for the seizure and Belinda’s family was relieved. Unfortunately she went on to have two or three more seizures and she was ultimately diagnosed with epilepsy and put on medication. Belinda’s family asked the neurologist if she could return to swimming and were so disappointed when the neurologist said not yet. The decision to allow a child with epilepsy to participate in sports is usually made on an individual basis. Sports participation is good for children with epilepsy, however important factors to consider include the particular sport involved, whether there will be adult supervision and whether the child is seizure free on the current medication. In Belinda’s case, since she was having new onset seizures, it was decided that it was not safe for her to participate just yet.
4. Exclusion is a tough decision to make
There are other reasons for sports exclusion. Obviously if a teen has a fracture he cannot compete in sports. That is an easy one for parents to accept. The problem is when the child has a sprain, or strain or soft tissue injury. Even when there is a sprain, healing should be allowed to take place and the child slowly return to sports as he heals. Returning to sports too soon can lead to more serious injury which will keep the child away even longer.
Concussion is another serious reason for non-participation in sports. After several studies demonstrated the significant impact concussion can have on the brain, especially the developing brain, the American Academy of Pediatrics and Concussion in Sports Group consensus have issued guidelines which have to be followed before an athlete can return to sports. These guidelines are for the ultimate good of the athlete and must be adhered to faithfully.
Exclusion from any sport is a decision which is taken very seriously by the primary care provider, in conjunction with the teen and the parents or guardians. We are all on the same team and always want to do what is in the best interest of the participant. All parties, including the sports coaches, working together should ultimately decide on the best decision for that child, for the ultimate physical, mental and emotional well-being of each child.
References to Consider
Concussions and other mild traumatic head injuries can be serious and require assessment and care from concussion professionals.