As a parent, I have gotten used to the nagging concerns about bruises, scratches, and even broken bones that can occur in children participating regularly in organized athletic events. These scary outcomes seem like a reasonable tradeoff for the pleasure, discipline, and health benefits that our kids gain from these activities.

As a cardiologist, I am acutely aware that medical catastrophes can also occur in young athletes. Fortunately, events like sudden death during sporting activities are extremely rare, but they raise enough anxiety that I get asked about them often. So let's talk about this.

First, we should put the magnitude of the problem in perspective. The numbers vary, but best estimates are that about one in 50,000 athletes over age 12 die suddenly each year that they participate in organized sports -- the cumulative risk may be closer to one in 5,000 over a 10-year span of participating in sports.

Sudden death in athletes is almost always due to heart problems. In adult athletes, heart attack due to blockages in arteries around the heart is the usual culprit. Darryl Kile, the all-star pitcher for the St. Louis Cardinals who died suddenly during the 2002 Major League Baseball season, unknowingly suffered from chronic heart disease that led to a heart attack.

In adolescents and young adults, the story is a little bit different. Heart disease is still by far the biggest cause of sudden death in young athletes, but the cause is almost always structural disease of the heart and blood vessels due to genetic causes. These diseases -- with names like hypertrophic cardiomyopathy, coronary anomalies and Long QT syndrome -- are not very common, may be difficult to detect with a routine physical exam, and often do not cause symptoms or limit activities until a catastrophic event occurs. x How can we prevent a tragedy from occurring in our young athletes? At a community level, we will all benefit by raising awareness among parents, teachers, and coaches of the magnitude and causes of sudden death in athletes.

Many schools have requirements for physical examinations prior to enrollment in organized athletic activities. It is critical to be aware that symptoms of chest pain, shortness of breath, or fainting may be an early warning signal in an at-risk athlete.

Many schools are investing in automatic external defibrillators that can be used to resuscitate individuals who collapse during sporting events. Being prepared for a tragedy can be the most effective way to prevent one from happening, so devices like this are only useful if people know how and are prepared to use them.

What about your own kids? The American Heart Association recommends a validated 12-item cardiovascular screening examination for all competitive athletes in middle school, high school or college that includes a careful history and physical examination as well as taking a family history to search for cardiovascular diseases that may run within a family.

If your child is being screened, make sure that your physician is familiar with the guidelines for these examinations and that a complete evaluation is being performed. Any abnormal finding in this screening exam should lead to more thorough examination by a cardiovascular specialist. Participation in competitive activities should be deferred until this more rigorous evaluation, including an electrocardiogram and echocardiogram in most cases, has been performed.

Why not perform more extensive testing on all of our kids? In fact, some people argue that this should be done. I mentioned earlier that the causes of sudden death can sometimes be missed on physical examination. In Italy, electrocardiograms are routinely performed on all students before participation in organized athletics, and this program has been associated with a reduction in sudden death in athletes in Italy.

The major impediment to routine testing using these more sophisticated methods is cost. It would take several billion dollars per year to implement such a program in the United States. Nevertheless, there may be individual circumstances that warrant a more aggressive initial evaluation -- certainly in situations when there is a concerning family history, or if there is significant anxiety within the family about risks due to participation in athletics for other reasons. Most adult or pediatric cardiologists offer these services.

Organized athletics provide substantial benefits to our children, and many of us recall our participation in sports as a highlight of our adolescence. We must be sure that we continue to make these opportunities available to our children, and that we do so in the safest way possible. Being concerned about cardiovascular risks in young athletes is an important part of this safety equation, and a little knowledge within our families and our communities goes a long way toward ensuring that safety.