Dangerous and Safe Sports Choices for Children With Hemophilia

Learning that your child has hemophilia (or another bleeding disorder) can be life-changing, particularly if there is no family history of this condition. Many questions may be swirling through your head. A common question heard in pediatric hemophilia clinic is “can he still play sports?” The short answer is yes, but there are some things to consider.

Although spontaneous bleeding is most common in severe hemophilia, bleeding with injury is increased in all forms of hemophilia. This is the biggest concern when children with hemophilia play sports, particularly in sports with contact (basketball) or collision (football) sports. Although there are concerns in certain sports, physical activity is recommended for all patients with hemophilia. This includes participating in physical education classes in school, with appropriate restrictions. Being in good physical condition can prevent injury and bleeding episodes. However, the risks and benefits of each type of physical activity must be carefully weighed.

There are many factors that go into determining if your child can participate in sports or what sports are safe for your child to play. These include:

• The severity of your child's hemophilia: More severely affected patients are more likely to have bleeding episodes secondary to a sports injury. Families of children with severe hemophilia are likely to recognize a bleed secondary to injury early and treat aggressively. It is important for families with more mildly affected children to be watchful and initiate treatment as soon as possible. 
• Number of bleeding episodes/condition of joints: Joint bleeding causes damage to the joints themselves, increasing the risk of additional bleeds. It is important to consider what joints will be more likely to be injured during the sports. So, if your child's target joint is his dominant elbow, maybe tennis isn't the best choice. 
• Level of activity: As children age, the intensity of sports also increases. Basketball is considered a relatively safe sport for young children but might need re-evaluation if your child is participating on the high school varsity team as the likelihood of injury increases. 
• Recent bleeding: It is important to discuss with your hemophilia treatment team when it is safe to resume sports after a bleeding episode. Increasing physical activity too soon after an event could lead to repeat bleeding and/or joint damage. 

The National Hemophilia Foundation ranks sports/physical activities from 1 to 3 based on risk. These are often also used for other types of bleeding disorders like platelet function disorders. Examples are as follows:

Category 3: Dangerous

These activities are NOT recommended for anyone with hemophilia. These sports have a risk for significant, life-threatening bleeding. 

• BMX biking
• Boxing
• Powerlifting
• Rodeo
• Football
• Hockey

Category 2.5: Moderate to Dangerous

• Baseball
• Basketball
• Cheerleading
• Skateboarding
• Softball

Category 2: Moderate Risk

• Aerobic
• Dance
• Jumping rope
• Rowing/crew
• Tennis

Category 1.5: Safe to Moderate Risk

• Circuit training
• Pilates
• Treadmill
• Weight lifting (resistance training, not powerlifting)

Category 1: Safe

• Elliptical machine
• Golf
• Hiking
• Swimming
• Tai Chi

If your child with hemophilia wants to play sports, it is important to include your hemophilia treatment team in the decision. For some sports, there are modifications that can be made to reduce the risk of bleeding. For example, when playing baseball/softball it is recommended to wear a helmet (all the time, not just with batting) and to avoid sliding into base. Similarly, a helmet should be worn while riding a bicycle/scooter or skating. A potential solution for higher risk sports (not category 3, which is never recommended) for patients with severe hemophilia is timing prophylactic factor treatment just prior to sports activity. Patients with mild to moderate hemophilia may need to start prophylactic factor infusions, particularly during their sporting season.