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Pre-Participation Physical Evaluations (PPEs): A Primer for Parents

Important injury prevention tool but not foolproof

Conditions limiting participation

The ultimate decision on whether to participate is for the athlete and his or her parents to make.

The following abnormalities may make it unsafe for your child to participate in sports: 

  • Acute illness
  • Blood-borne pathogens. Because the risk of transmission is so low (less than 1 in 1,000,000 games), HIV-positive athletes may participate unless their health is compromised.
  • Heart disease (hypertrophic cardiomyopathy (HCM), rhythm and conduction abnormalities, systemic hypertension, and valvular heart disease, but not benign functional murmur or mild mitral valve prolapse)
  • Skin (contagious lesions or skin conditions should rule out participation in contact sports)
  • Eating disorder/female athlete triad 
  • Eyes (functionally one-eyed athletes permitted only in sports that allow protective eyewear and do not involve projected objects (swimming, track and field, gymnastics, and not allowed to participate in wresting, boxing, or martial arts) 
  • Pregnancy (no contact, collision, or strenuous sports)
  • Kidney (no high-contact sports for one-kidney athletes; flack jacket for moderate contact sports)
  • Musculoskeletal (depending on degree and type of injury, risk to athlete and demands of sport)
  • Seizure disorder (one or more seizures within last 6 months held out of competition, especially in high-risk sports (skiing, gymnastics, high diving, collision sports, shooting, archery)
  • Asthma (but only if symptoms not controlled)

1. Valovich McLeod TC, Decoster LC, Loud KJ, Micheli LJ, Parker JT, Sandrey MA, White C.  National Athletic Trainers' Association Position Statement: Prevention of Pediatric Overuse Injuries.  J Ath. Tr. 2011;46(2):206-220.

2. Preparticipation Physical Evaluation Working Group. Preparticipation Physical Evaluation. 4th ed. Grove Village, IL: American Academy of Pediatrics; 2010.

3. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258. 

4. Madsen NL, Drezner JA, Salerno JC. The Preparticipation Physical Evaluation: An Analysis of Clinical Practice. Clin J Sports Med. 2014; 24(2):142-149.

5. Kucera KL, Klossner D, Colgate D, Cantu RC. Annual Survey of Football Injury Research 1931-2013 . National Center for Catastrophic Sports Injury (March 2014)

6. Gómez JE, Lantry BR, Saathoff KN. Current use of adequate preparticipation history forms for heart disease screening of high school athletes. Arch Pediatr Adolesc Med. 1999:153:723-6

Updated and revised July 22, 2015