A: It depends on how sick the child was and what symptoms they had.
All children and adolescents should have a visit with their primary care clinician (PCP) after COVID-19 infection to see if they are ready to get back to sports, and some kids will need additional tests of their heart to make sure it is safe to play.
Sports are a great way to keep kids physically active, build teamwork, socialize, and burn up some of that excess energy! As more and more kids are diagnosed with COVID-19 (there were 631,822 cases from 1/27-2/3/22 and children account for about 25% of new cases ☹️), we need to make sure that they are healthy enough to return to physical activity. COVID-19 infections in kids can result in medical issues that need to be considered before playing sports. Myocarditis, or inflammation of the heart muscle, is the most concerning issue.
To be eligible to go back to sports, all kids should have finished their isolation period and be feeling better. They should also be able to do their normal stuff without feeling crappy (like clean their room or take a shower). After that, when your kiddo can go back to sports all depends on the severity of their symptoms. Let’s walk through some common scenarios:
➡️ No symptoms or mild symptoms: This is a child who had less than 4 days of fever and less than 1 week of achy muscles, chills, or lethargy. They should be seen by their PCP either in the office or through telehealth. During this visit, the PCP will ask about symptoms that could point to a heart problem. This includes shortness of breath, irregular heartbeat, fainting, chest pain, or fatigue. If the questions are all reassuring, they can return to play! If there are any concerns, the PCP will get an EKG (electrocardiogram). An EKG is an easy, painless test that measures the electrical signals in the heart and can show abnormal heart beats or other heart problems. Children with abnormal EKGs will need to be further evaluated by their PCP and possibly a cardiologist (a heart specialist).
➡️ Moderate symptoms: This kid had 4 or more days of fever, and more than 1 week of achy muscles, lethargy, or chills. This child may have been hospitalized but never required a stay in the intensive care unit (ICU) or had symptoms of Multisystem Inflammatory Syndrome in Children (MIS-C). All of these children should be seen for an in-person appointment with their PCP for a physical examination and EKG. If everything looks good and it has been at least 10 days after symptoms started, they can start to return to play! If there are any concerns, they are not cleared to go back to sports and may need to see a specialist for more tests or treatment.
➡️ Severe symptoms: These kids had to stay in the ICU, had known myocarditis, or developed MIS-C. Children who had severe symptoms cannot return to sports for at least 3-6 months.
Once they are given the “Ok” by their PCP, what does “return to play” look like?
For kids under the age of 12, they can return to sports at their own pace. For older kids, it is a more gradual and guided return to exercise. Your kiddo’s PCP and coaches can help guide this. It typically involves at least one day of feeling well and then at least 2 days of light activity that increases in strenuousness from there. The number of days of light activity and how quickly that ramps up depends on the symptom severity. If the child begins to have any chest pain, unusual shortness of breath, palpitations, or fainting, they should immediately stop playing and get evaluated by their PCP again.
Stay safe. Stay sane. Go Sportsball!
Those Nerdy Girls
Links:
AAP Tracking of COVID-19 Cases in Kids
Healthy Children Youth Sports COVID-19 Safety Checklist
