When is it safe to return to sports after COVID-19?

If your child has had COVID-19, you (and they!) may be wondering when it’s safe for them to participate in their favorite sports again. We’ve heard a lot of questions from parents and pediatricians, so we asked Dr. John R. Phillips, cardiologist and director of pediatric electrophysiology, for some guidance.

“In addition to impacting the respiratory system, COVID-19 has been linked to cardiac injury and inflammation of the heart muscle, or myocarditis,” said Dr. Phillips. “But, the degree of COVID’s effects on the heart based on the severity of symptoms, particularly in children, isn’t yet fully known. For this reason, we recommend a cautious approach to return to play based on the recommendations of the American Academy of Pediatrics and American Medical Association.”

Note: While many sports have returned to play across Central Virginia, it’s up to every family to decide their comfort level with activities during this time. If you have questions about the safety of participating in sports during the pandemic, please reach out to your pediatrician or health care provider.

What does this cautious approach to returning to sports after COVID-19 entail?

If your child tested positive for COVID-19

• ALL children who test positive for COVID-19 should wait until at least 14 days AFTER their symptoms have resolved before returning to sports participation – for their safety and the safety of those around them.

If your child was asymptomatic

• They should not return to play until at least 14 days AFTER testing positive – for their safety and the safety of those around them.

• Cardiac testing is not necessary prior to returning to sports.

If your child had a mild illness (i.e. no fever and their illness lasted less than three days)

• They should not return to play until at least 14 days AFTER their COVID-19 symptoms resolve – for their safety and the safety of those around them.

• Cardiac testing is not necessary prior to returning to sports.

If your child had a moderate illness (i.e. fever or their illness lasted more than three days, but they were not sick enough to be hospitalized)

• They should not return to play until at least 14 days AFTER their COVID-19 symptoms resolve – for their safety and the safety of those around them.

• If your child is 12 years or older, cardiac testing should be performed before they return to play.
• If your child is under 12 years of age, consult their doctor to discuss the severity of their illness and the need for cardiac testing.

If your child was hospitalized for COVID-19

• They should not return to play until cardiac testing has been performed and they are cleared to return to play by a pediatric cardiologist or another physician trained to diagnose and treat myocarditis.

Returning to play after COVID

When your child is ready to return to play, they should do it gradually, slowly increasing the intensity of exercise and paying close attention to any symptoms that may occur or reoccur. Monitor your child for complaints of heart palpitations, chest tightness, shortness of breath, difficulty exercising, dizziness or syncope (passing out). If they develop any of these symptoms as they return to play, stop the activity and consult their doctor immediately.

Practicing caution and vigilance, we expect that the vast majority of kids and teens who have been infected with COVID-19 will be able to safely get back to doing what they love on the court, floor, track or field.

Of course, everyone – whether participating in sports or not – should continue following safety precautions to help prevent the spread of the coronavirus.

Look for more COVID-19 health and safety information for your family.

References:

1. Kim JH, Levine BD, Phelan D, et al. Coronavirus Disease 2019 and the Athletic Heart: Emerging Perspectives on Pathology, Risks, and Return to Play. JAMA Cardiol. Published online October 26, 2020. doi:10.1001/jamacardio.2020.5890
2. AAP COVID-19 Interim Guidance: Return to Sports. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/