A sports physical may clear a child to play, but it is not the only step that families should take before the season begins.
Returning to school sports can mean going from a less-structured summer routine to practices, games and workouts in a matter of weeks. That transition can put young athletes at greater risk for strains, overuse injuries, dehydration and other problems if they are not ready for the demands of their sport.
Brittany Chan, MD, a pediatrician with Texas Children’s Pediatrics in Houston, shared with the AMA what families should know before their children return to practices and games—from scheduling a sports physical early to rebuilding conditioning, prioritizing sleep and recovery, and recognizing warning signs that should not be ignored.
Texas Children's Pediatrics is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
See the doctor well before the season
While football and some other school sports seasons already have begun, basketball, hockey, and many more sports still are ahead. Families that haven’t already scheduled a sports physical for their young athletes should aim to have the exam performed four to six weeks before the first practice, if possible, Dr. Chan recommended.
“This leaves time in case the physician finds a concern, which may require follow-up testing or a visit with a specialist,” Dr. Chan noted. “If your child is due for a well check visit, a sports physical can often be done at the same time.”
These exams, which may be required for participation in school athletics, evaluate children’s fitness for the physical demands of their chosen sports. During the exams, a pediatrician will check the child’s overall physical health, especially their cardiovascular and musculoskeletal condition. Adolescent girls also may be assessed for menstrual issues that can affect their performance at sports.
“We are not only looking for issues that may make it unsafe to participate but also trying to optimize your child's health so they can have the best season possible,” Dr. Chan explained.
In addition, if the young competitor takes medication during the school day, or may need medication in an emergency, parents or guardians should complete whatever permission forms are required and provide school staff with the medication if needed. Pediatricians can assist with this process.
Asthma inhalers, epinephrine and antihistamines for allergies, and ADHD treatments are among the common medications they approve, Dr. Chan said.
Don’t just jump right back into sports
Unless they’ve been in a summer athletics program of some kind, kids are at risk of hurting themselves by returning too quickly to strenuous activity after a more relaxed summer. Muscle sprains and strains, foot and knee pain, and general soreness are common problems, Dr. Chan said, plus elbow and shoulder pain among participants in sports with repetitive throwing (quarterbacks beware) and tendon irritation if frequent jumping is involved (limit the hang time, ballers).
“Children are also at risk for inflammation and swelling around growth plates, especially in their knee and heel,” Dr. Chan added.
To avoid such injuries, Dr. Chan advised resuming or increasing exercise and stretching at least a few weeks before the child’s sports season starts.
“Reintroduce sport-specific activities, such as throwing for a baseball player or running for a soccer player, and slowly increase the intensity and amount of practice,” she said, noting that the American Academy of Pediatrics guidelines are for no more than a 10–20% weekly increase.
Adequate sleep and proper nutrition are also important for avoiding injury and supporting athletic performance. Since children’s sleeping and eating habits often become irregular during the less-structured summer months, families may need to reset their routines.
“Enforce healthy bedtimes, a calming bedtime routine, and put the screens away at least an hour before bed,” Dr. Chan said. “Inadequate sleep affects an athlete's concentration, speed, and dexterity.”
She also suggested young athletes eat small, frequent meals and snacks throughout the day and for parents and guardians to pack food for car rides to practices and games to avoid fast food.
In addition, make sure the child is getting a day or two of rest from physical exertion each week to recover from their activities on the other days.
“Recovery allows the body to adapt to its recent training, resulting in enhanced performance,” Dr. Chan said. “Without recovery, kids run the risk of overtraining, and despite working hard they may experience fatigue and worsening ability.”
To make time for those recovery days and the nine to 10 hours of sleep recommended for middle and high school students, families likely will need to help their kids manage school, homework, practices, games and other extracurriculars.
“Kids are so busy these days, and it can feel difficult to fit it all in,” Dr. Chan acknowledged. “Prioritizing certain activities and cutting others from the schedule may be necessary so that your child has the appropriate amount of time for schoolwork and rest, and that’s OK.”
Beware of high heat and hard hits
Along with taking care of themselves, school athletes also need to take precautions against some common risks of sports. With hot weather extending further into autumn, dehydration and heat exhaustion can be a concern from August football practices to October soccer drills.
“Combined with a hot climate, kids participating in strenuous activity can experience headaches, dizziness, nausea or vomiting, or confusion,” Dr. Chan warned. “These are signs of heat exhaustion, and children experiencing any of these symptoms should stop, rest, cool down and drink fluids.”
Persisting with exertion despite the warning signs even could lead to heat stroke, a heat illness caused when the body temperature reaches or exceeds 104°F that can cause fainting, seizures, and even be fatal.
“Athletes can prevent this by staying hydrated, taking frequent breaks, and listening to their bodies,” Dr. Chan said.
Staying hydrated is important even when heat isn’t a danger.
“Speed, stamina, agility, and reaction time all decrease when an athlete is dehydrated,” Dr. Chan observed. “Dehydrated muscles are more prone to injury.”
Water still is the best source of hydration, she said, but electrolyte drinks are an option in heat and when exercise is intense or lasts more than an hour.
Concussions also are a danger, and not just among football players. Athletes who experience a head injury should stop playing or practicing until they have been assessed for concussion, even though the symptoms may not occur immediately. Those symptoms may include headache, dizziness, difficulty concentrating, nausea or vomiting, vision problems and changes in mood.
“If an athlete tries to ‘play through’ a head injury, they may risk further brain injury or worsening symptoms and prolong their recovery,” Dr. Chan cautioned. At worst, they may sustain second impact syndrome—another hit to an already injured brain—which can cause the brain to swell rapidly and is potentially fatal.
The goal is not just to get young athletes cleared to play, but to help them stay healthy throughout the season. By preparing early, building activity gradually, making time for recovery and taking symptoms seriously, families can help their children get more out of the sports they enjoy.
