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It’s important for parents of student athletes to know the medical ramifications of playing and competing, doctors say. Here, eight key questions and their answers.

How do I know my child is drinking enough fluids?

In the past few years, a spate of deaths among young football players practicing in hot conditions has frightened many parents and even caused the American College of Sports Medicine to call out the dangers of heat illnesses and heat stroke.

Guidelines for hydrating to prevent injury, established by the American Academy of Pediatrics, say that a good starting point is four to six ounces of fluid every 15 minutes for a 90-pound child. The AAP also recommends recording your child’s weight both before and after exercise to determine how much fluid he or she is losing. According to the AAP, athletes should be hydrating often enough that they weigh about the same before and after practice. Despite theories about whether water should be room temperature, the AAP says cold water is fine for rehydration, but kids should stay away from sports drinks, fruit juices, and soda, all of which contain too much sugar.

At practice, watch your child for symptoms of heat illness, including muscle cramps, dizziness, nausea, headaches, or muscle weakness. Most sports programs are willing to reschedule or cancel practice in extreme heat; if you’re concerned, don’t be shy about voicing your opinion.

When should my child start weight training?

The short answer is when they hit puberty, says Dr. Chris Manoue, associate professor of orthopedic surgery at the University of South Carolina Sports Center. Benefits of strength training include building bone density, increasing your child’s muscle strength and endurance, and boosting metabolism. Done properly, say experts at the Mayo Clinic, strength training can put kids on a path to a lifetime of good health. But it’s important to know what your child can (or should) handle. The Mayo Clinic’s guidelines for strength training for teens and tweens can be found here.

Should I have special concerns about my female student athlete?

According to Dr. Menoue, young women — for whom the most common activities include cross country running and ice skating — are most at risk for stress fractures and osteoporosis. Dr. Menoue also suggests keeping an eye on abnormal periods. Athletes who miss consecutive cycles should be evaluated for nutritional problems and hormonal abnormalities. If you’re concerned about your daughter’s weight or eating habits, consider asking your doctor about the so-called “female athlete triad”: eating disorders, menstrual abnormalities, and osteoporosis.

Should my child have an electrocardiogram or echocardiogram before the sports season begins?

Aside from well-publicized heat- and dehydration-related sports deaths, one of the most hot-button topics among the academic sports communities is whether all kids should be evaluated via EKG or echocardiogram before the sports season — even if a routine physical doesn’t reveal any abnormalities. “It’s literally the most debated question,” says Dr. Manoue. “You hear about athletes dying because of heart issues that might have been caught in an echocardiogram.”

But according to Dr. Lyle Mason, who evaluated high school athletes for 25 years before becoming team physician for the Utah Jazz, cardiac problems that would prevent kids from participating in sports are rare. “Irregularities, like heart murmurs, aren’t uncommon,” he says. “If I picked up a problem, I’d have them go through an EKG, but nine times out of ten, it was benign.”

What are the most common injuries for football players?

“In football players, we see a lot of specific kinds of injuries,” says Dr. Manoue, including nerve injury resulting from trauma to the neck and shoulder, called ‘stingers,’ and concussions. “We also see a lot of ligament injuries. If an athlete has a history of multiple concussions or injuries that haven’t been repaired, he should not pass a physical.”
What are the most common injuries for baseball players?

Shoulder injuries, according to Dr. Manoue. “Most of the time, these are overuse injuries,” he says. He suggests parents ask their doctors when kids can handle the forces that advanced pitches put on their bodies; most doctors agree it’s once a child hits puberty. Until then, he says, a baseball player “should be throwing fast balls and change ups.”

What are the most common injuries for basketball players?

Overuse injuries are common in basketball, Dr. Mason says, though adolescent players have a different set of concerns than those in the professional arena. “We see a lot of growth plate issues,” says Dr. Mason, such as Osgood Schlatter’s disease, a kind of inflammation below the knee usually caused by fast adolescent growth and high activity. Often, growth problems resolve themselves, though students at risk should be closely monitored. Some doctors may suggest a brief hiatus from playing.

What conditions could cause my child to fail a sports physical?

Aside from the already-mentioned injuries and conditions, both Dr. Manoue and Dr. Mason say that obesity and being severely underweight can keep kids out of the season. “Obesity often involves social situations and socioeconomic factors, both of which are difficult to address from a sports medicine program,” says Dr. Manoue. “If we see a kid who’s obviously obese, we counsel him or her, or advise following up with a nutritionist.” By the same token, says Dr. Mason, “If you had a boy or girl who is malnourished, the problem could actually be more life-threatening than obesity.” And, he warns, losing weight unhealthily isn’t a problem exclusive to girls, pointing to the epidemic of student wrestlers doing “almost anything to get their weight down, like wearing plastic suits in the sauna to lose water weight,” he says. “That’s one of the reasons we now use body fat to measure healthy weight.”