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Research into the medical cardiac care and assessment of the pediatric athlete are accumulating, but specific pediatric international guidelines are not available yet and reference data for ECG and echocardiography are incomplete, in particular for the age group &lt;12\u2009years of age. This article is an introduction to the physiological and diagnostics specifics of the pediatric athlete. The focus lies in the differences in presentation and diagnosis between pediatric and adult athletes for the most common pathologies. Reference data for electrical and structural adaptations to intensive exercise are sparse particularly in athletes aged below 12\u2009years old. Training related changes include decrease of resting heart rate, increase of cardiac output, ventricular cavity size, and wall thickness. Cardiac hypertrophy is less pronounced in pediatric athletes, as HR mediated cardiac output increase to endurance exercise is the dominant mechanism in peripubertal children. As in adults, the most pronounced cardiovascular adaptations appear in classical endurance sports like rowing, triathlon, and swimming, but the specifics of pediatric ECG and echocardiographic changes need to be considered.<\/jats:p>","DOI":"10.1002\/clc.23417","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T07:50:26Z","timestamp":1594281026000},"page":"852-862","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["The adolescent athlete's heart; A miniature adult or grown\u2010up child?"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1203-688X","authenticated-orcid":false,"given":"Guido E.","family":"Pieles","sequence":"first","affiliation":[{"name":"National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit Bristol Heart Institute  Bristol UK"},{"name":"Institute of Sport, Exercise and Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Graham","family":"Stuart","sequence":"additional","affiliation":[{"name":"National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit Bristol Heart Institute  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,9]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2013-303826"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098253"},{"key":"e_1_2_6_4_1","volume-title":"Global recommendations on physical activity for health","author":"World Health Organization","year":"2010"},{"key":"e_1_2_6_5_1","unstructured":"UK Chief Medical Officers' Physical Activity Guidelines. 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