Any teenager can have sudden cardiac arrest, and the American Academy of Pediatrics now recommends screening all children, not just those involved in sports, during pediatrician visits.

Published: January 18, 2022 | Updated: February 21, 2023

You occasionally hear about it on the news: A seemingly healthy child suddenly collapses or dies after cardiac arrest on the football field or basketball court, or during another sporting event. But any teenager can have sudden cardiac arrest, and the American Academy of Pediatrics (AAP) now recommends screening all children, not just those involved in sports, during pediatrician visits.

Initial screening doesn’t involve any special tests. The focus is on a physical exam, family health history and any previous episodes the child has experienced such as chest pain and shortness of breath.

“If a child is not involved in athletics, they may not have to undergo an annual sports physical, but they still should be screened at least every few years,” said Delwyn E. McOmber, M.D., pediatric cardiologist with Norton Children’s Heart Institute, affiliated with the UofL School of Medicine.

According to Dr. McOmber, who is medical director of the exercise stress lab, the AAP recommends screening all children and teens for risks for sudden cardiac arrest or sudden cardiac death at the following intervals:

• An annual sports physical, before participation in the upcoming activity
• At least every three years
• When a child is entering middle/junior high school and high school

Risk assessment starts with a physical examination, plus a thorough patient history and family health history. If a concern or risk factor is identified, an electrocardiogram (ECG) is often the first test performed.

Part of the routine screening for a child or teenager’s risk of sudden cardiac arrest involves four main questions:

• Have you ever fainted, passed out or had an unexplained seizure suddenly and without warning, especially during exercise or in response to sudden loud noises such as doorbells, alarm clocks and ringing telephones?
• Have you ever had exercise-related chest pain or shortness of breath?
• Has anyone in your immediate family (parents, grandparents, siblings) or other more distant relatives (aunts, uncles, cousins) died of heart issues or had an unexpected sudden death before age 50? This would include unexpected drownings, unexplained car accidents in which the relative was driving or sudden infant death syndrome.
• Are you related to anyone with hypertrophic cardiomyopathy or hypertrophic obstructive cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome or catecholaminergic polymorphic ventricular tachycardia, or anyone younger than 50 with a pacemaker or implantable defibrillator?

“Many children with congenital heart disease are not at increased risk for having sudden cardiac arrest.  Even if they do have an increased risk due to their diagnosis, many can still safely participate in exercise with appropriate restrictions and monitoring,” Dr. McOmber said. “Screening them before they have an issue allows us to monitor their condition, plan follow-ups and help prevent a serious condition.”