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Ask an Expert: Should my child play sports?

J. Tod Olin is a pediatric pulmonologist at National Jewish Health in Denver. He specializes in exercise intolerance among children.

I often have parents ask me whether their child with asthma should be involved in sports and express concerns about their child’s involvement in sports in the wake of recent deaths due to extreme heat or other medical issue.

My main answer is that it’s good for young people to be involved in sports.

But there are things to look out for, which I will attempt to explain in this question-and-answer format.

Q. What is exercise intolerance?

A. This is a relatively new area of study. There are no diagnostic criteria.  I would define it as an inability to exercise that is out of proportion to what other kids the same age are doing or to the same child’s ability to exercise at a certain point in the past.

Q. How common is it for young people to die during sporting activities and how do I know whether my child might have an undiagnosed heart condition?

A. This is very rare, but you hear about it and it is always tragic. If your child is a little out of breath, it’s probably not a heart condition simply because there are millions of kids with asthma and the heart conditions that cause sudden death are very rare. Doctors generally discover structural heart lesions in the first few months of a child’s life. What we worry about most in terms of sudden death is a family history of sudden death at an early age. That sets off red flags.

Q. So can my child with asthma participate in a sport?

A. Almost unequivocally ‘yes.’

Q. I have noticed that my child shies away from physical activity. My husband just thinks he’s lazy, but I think something more may be going on.

A. In the young child who does not have a medical diagnosis, it is very difficult to find a reason for activity avoidance. Mood and motivation as well as problems with a number of organs can cause children to avoid activity. Asthma should always be a consideration, especially with a family history, simply because asthma is so common.

In the child with known asthma, activity avoidance may be a signal that the doctor and patient may not be in perfect control of the condition. In asthma, things should be generally well-controlled and he should be able to participate. If there’s a problem, it’s a signal to me I have to do my job better.

Q. How common are breathing problems in children?

A. One in 10 children has asthma, probably more. If you live near a freeway, it’s one in five. The classic signs are coughing after exercise, coughing on the way home from a sports practice or coughing at half-time. Wheezing is common, but not nearly as common as a cough.

Q. I’m noticing that my child doesn’t run much, and I have heard some wheezing. What do I do next?

A. Start with your pediatrician. In the case of unusual or severe symptoms, you may then be referred to a specialist.

If the symptoms seem unusual or especially severe, I would suggest videotaping your child when he/she is experiencing symptoms. It is quite simple with technology in most people’s pockets today. I can then hear the breathing and see how fast they are breathing and compare that to the child next to them who is drinking a juice box, having no problem at all. If videotaping is not possible, make sure you are able to document the character of the event, the severity of it and the context. That information is important to help the doctor make an accurate diagnosis.

Q. When should I seek the advice of a breathing specialist?

A. In general, if the treating physician(s) and parents understand a diagnosis and are compliant with the specific treatment, and a child is still struggling with the symptoms (or in some cases measurements) associated with a disease, I recommend seeking the advice of a breathing specialist or pulmonologist.

One of the benefits to seeing a pulmonologist is that specialists have more time and resources to focus on asthma education and proper use of therapies. We also have a great frame of reference to consider alternative therapies for asthma or other conditions that may be causing the symptoms.

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