Is Sport Dangerous for Children?

Abstract

Daniel De Wolf Ghent University Hospital, Department of Pediatric Cardiology, De Pintelaan 185, 9000 Gent, Belgium Tel.: +32 9332 2421; Fax: +32 9332 3856; E-mail: daniel.dewolf@ ugent.be ‘The long-term beneficial effects of regular physical training by far outweigh the acute risk for sudden death in children.’ Recently, promoting physical activity in children has received much emphasis. The medical community, but also the general population, has gained conscience that physical activity offers an important shortand long-term contribution to children’s health [1]. Even in high-risk groups, such as in children with congenital heart disease, the beneficial effects of a guided sports program have been proven [2]. Guidelines for safe participation of patients with congenital heart disease in competitive sports have been established [3]. The only real drawback to vigorously promoting exercise in all children is the constant sword of Damocles, the risk of sudden death during exercise. Although rare, every event of sudden death in an apparently healthy youngster during sports is a disaster to parents and friends, which is emphasized by the immediate and mostly spectacular media coverage, thus making a deep and frightening impression on the general public. Regularly, it is questioned as to why the thorough screening of young athletes, and especially children, is not recommended and the community calls for action. After such incidents, the amount of parents self-referred to pediatric cardiologists in order to obtain ‘complete’ reassurance that their child can safely practice sports, increases dramatically. But can we really prevent sudden death in children practicing sports? And if so, then how? And to what cost? Should we limit these efforts to those engaged in competitive sports? To answer these questions, one should be aware of the real importance of the problem. Although each sudden and unexpected death of a child is absolutely devastating to parents and the community, the real incidence appears to be low. The precise frequency of sudden cardiac death during competition or training is not known, but has been estimated to be between one per 200,000 and one per 300,000 high school and college-aged athletes per year [4]. The incidence in children below the age of 16 years participating in sports is probably even lower [5]. The most common causes of exercise-related cardiac death in individuals under 35 years of age are hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular dysplasia (ARVD, especially in Italy), myocarditis, contusio cordis, abnormal coronary artery anatomy, toxic drugs and rhythm disturbances [6,7]. For the first two anomalies (HCM and ARVD), the incidence and mortality are lower in the pediatric population when compared with adults [6]. Although sudden deaths occur during or after exercise in these anomalies, this does not appear to be the most important trigger for sudden death in children overall [5,8].