Changing sport restrictions for pediatric congenital heart disease patients

Historically, providers were restrictive in allowing children with congenital heart disease (CHD) to participate in youth sports, or even regular exercise.

More recently, practitioners have come to understand that most forms of exercise are safe and actually advisable for patients with CHD. CHD encompasses a wide variety of heart problems caused by abnormalities in the heart's development and affects approximately 1 in 100 children, according to Timothy Cotts, M.D., a CHD specialist at C.S. Mott Children's Hospital.

Since no heart defect is created equal, athletic limitations can vary from child to child. While many children can grow to lead healthy lives, the majority of CHD patients require life-long monitoring and care, and routine follow-up is important.

For example, patients with CHD involving abnormal function of heart valves may require valve replacement later in life."

Timothy Cotts, M.D., CHD specialist at C.S. Mott Children's Hospital

Although physical activity can be associated with some risk, not all exercise should be off-limits for children with CHD.

"We know that patients with all types of congenital heart disease do better in the long run if they remain active," says Cotts.

In fact, those with CHD could even become pro-athletes, like Olympic gold medalist and professional snowboarder, Shaun White, who has been open about having CHD.

How do specialists make the call?

According to Cotts, almost all children with CHD can walk, hike or swim, which are beneficial to overall health and wellness. However, regular cardiology follow-up is important so each child can have an individualized assessment with a healthcare professional.

These assessments allow physicians to begin discussing health risks early, offering support and guidance based on national guidelines, before a patient begins sports or activities. For example, a patient with certain cardiac defects may be steered to play baseball or volleyball as opposed to a high-impact sport like hockey or football, which could up their risk of serious complications.

A specialist will determine how much dynamic and static exercise a child can safely tolerate based on a low-high table. The table accounts for how much dynamic and static exercise is involved in a certain physical activity and is inspired by a scientific statement from the American Heart Association and American College of Cardiology.

The dynamic component is how much cardio and muscle strength is involved in the activity and the static component is how much muscle strain is involved in the activity. For example, country running is a highly dynamic activity and weight training or gymnastics are highly static activities.

Taking on CHD

If you have a child with CHD participating in physical activity, Cotts says there are additional steps you can take to be vigilant about your child's safety.

"Let your child's coaching staff know about possible limitations and how to recognize signs of distress," says Cotts. "It can be lifesaving to know where the nearest AED is as well."

Life can throw major curve balls, like learning your child has CHD. But with attentive monitoring, routine checkups and a strong support system, no child has to sit on the sidelines.