Children who play competitive sport are not simply small adults. That sentence opens a landmark clinical consensus statement published in the European Heart Journal in 2026, and it sets the tone for everything that follows. For the first time, the European Association of Preventive Cardiology and the Association for European Paediatric and Congenital Cardiology have jointly produced guidance dedicated entirely to cardiac screening in paediatric athletes under 16 years old. As a paediatric cardiologist who works with young athletes very often, I think this document changes the conversation in important ways.

Until now, most cardiac screening recommendations for athletes were written with adults in mind. When children were mentioned at all, they were treated as a subset of adult guidance, with a few adjustments at the margins. The new consensus statement makes the case forcefully that this approach is not good enough. The heart of a child or adolescent behaves differently, adapts differently to training, and harbours disease in ways that look nothing like the adult version.

The headline recommendation is clear: cardiac screening of young athletes should begin no later than age 12, should be repeated every two years until age 16, and should include a personal and family medical history, a physical examination, and a 12-lead resting electrocardiogram. That combination earns the highest evidence rating in the document. It is also the minimum. For some children, a single echocardiogram may be appropriate on top of that, particularly to catch structural problems that an ECG simply cannot see, things like abnormal coronary artery origins or aortic disease.

Why age 12? The evidence is compelling. A study of over 22,000 children screened over 11 years found that more than 90% of cardiac conditions associated with sudden cardiac arrest were identified in children aged 12 or older. Younger children can and do have cardiac conditions, but the clinical picture often becomes clearer around puberty, when inherited cardiomyopathies begin to show themselves structurally and when training loads in competitive sport intensify sharply. The risk of sudden cardiac arrest in athletes aged 12 to 15 is roughly twice that seen in the 8 to 11 age group.

That risk, though small in absolute terms, is real. The reported incidence of sudden cardiac arrest or death in young athletes aged 8 to 15 is around 0.7 per 100,000 per year. And crucially, in most cases there are no warning symptoms beforehand. Screening is not about finding every child with a heart murmur. It is about identifying the small number of children with a condition that could kill them during the very activity that is supposed to be good for them.

The consensus statement is also honest about limitations. Screening in younger adolescents yields more ambiguous results than in older athletes. Conditions that will later become obvious may be invisible at age 12. Some findings that look worrying turn out to be normal variations of a developing heart. This is exactly why the guidance recommends serial screening rather than a single once-off assessment, and why it emphasises the need for clinicians with genuine paediatric expertise to perform and interpret the tests.

For parents, the practical message is this. If your child competes in organised sport and is approaching or past their 12th birthday, a cardiac screen is worth having. Not because danger is lurking everywhere, but because the conditions that cause sudden death in young athletes are largely detectable, largely manageable, and largely preventable if we look for them in time.

Author: Dr. Alessandro Giardini, MD, PhD, Consultant Paediatric Cardiologist

Written 03/06/2026