Not every kid needs an electrocardiogram (ECG) before playing sports or as part of routine exams, child health experts say.
The American Academy of Pediatrics (AAP) is advising parents and pediatricians to avoid unnecessary tests, and has released a list of common medical practices and therapies that may not be needed for young patients.
The AAP and the Choosing Wisely campaign also offered additional advice for student-athletes who have had COVID-19.
For kids who have no heart symptoms, are otherwise healthy and have no personal or family history of heart disease, doctors should not order a screening ECG as part of an exam for sports or for starting attention-deficit/hyperactivity disorder (ADHD) therapy, according to the academy.
“Even during COVID-19, every child who is going to participate in any kind of sports, 6th grade and up, should have a physical exam by a pediatrician or primary care physician,” said Dr. Christopher Snyder, chairman of the AAP Section on Cardiology and Cardiac Surgery. Yet, “we have never seen a study that shows that every child needs an ECG before playing sports, not in Europe or in the United States.”
The AAP also recommends against ordering an ECG or troponin tests when doctors are routinely evaluating pediatric chest pain or fainting in patients without a concerning history or ECG abnormalities. Troponins are cardiac proteins that help doctors detect heart injury.
The experts said family history assessments should include a look at connective tissue disorders, heart muscle diseases, rare inherited enzyme defects, sudden unexplained death, and heart disease before age 50 and arrhythmias, including the need for a pacemaker or defibrillator implant.
The AAP noted that unnecessary tests and treatment can lead to false positives and more testing, expense, inconvenience for the patient and family, and even painful procedures.
For student-athletes with moderate COVID-19, AAP recommended they be free of symptoms for 14 days and have their primary care doctor’s clearance before resuming exercise and competition.
Any student who has current heart symptoms or a history of them, has concerning exam findings or who had moderate symptoms of COVID-19, including prolonged fever, should have an ECG. Such students may have to be referred to a pediatric heart specialist for further assessment to be cleared for sports, the AAP said in an academy news release.
Choosing Wisely is an initiative from the American Board of Internal Medicine. It aims to start conversations between clinicians and patients for evidence-based, not-duplicated tests and procedures.