When Should My Child Return to Sports After COVID-19?

If your child plays sports, you may be worried about the long-term effects of COVID-19. Growing information in the medical community shows that concern may be warranted.

“We're learning more and more about coronavirus and how it affects the body in general, and particularly how it affects the heart,” said Deborah Schutte, M.D., medical director of Cardiology at Cook Children’s. “We're now learning that the virus can attack the heart much like many other viruses and kids can get what's called myocarditis, which is inflammation or swelling of the heart.”

With increasing research in this area, the American Academy of Pediatrics (AAP) recently released its recommendations for safe return to sports and activity. They suggest all children and adolescents with exposure to COVID-19 rest for a minimum of 14 days, regardless of whether or not they had any symptoms. If a child had mild symptoms (fever, cough or runny nose for less than three days), they should rest for at least 14 days after illness.

“They should talk to their pediatrician and they need to stay out of vigorous activity or sports for 14 days after they're asymptomatic or after exposure,” said Dr. Schutte.

For kids with moderate symptoms (those that last longer than three days), further examination, such as an electrocardiogram (EKG), may be required. The AAP also recommends waiting at least 14 days after the symptoms subside and obtaining clearance from a primary care physician before returning to exercise.

If a child had severe illness due to COVID-19 and/or multisystem inflammatory syndrome in children (MIS-C), restriction from activity is recommended for three to six months.

“It's very important for us to be able to assess the patients before they return to sports,” Dr. Schutte explained. “We know from other viruses that cause myocarditis that patients who decided to participate in sports, and perhaps have had a viral infection in their heart, there can be serious consequences, even death, related to sports activities or vigorous exercise.”

While this may sound scary, Dr. Schutte says parents shouldn’t be afraid to let their kids exercise. She says physical activity is important for children and teens, especially now.

“As a parent of two boy athletes, I totally get that you're potentially scared to send your child back out on the field,” she said. “I think exercise is so important for everybody, but kids in particular. It helps combat the isolation they might be feeling right now from having to either quarantine or be socially distanced all the time. And it can also help with anxiety and depression, in addition to the physical benefits of just maintaining a healthy weight and staying fit.”

She says in most cases, the benefits of getting back out onto the field outweigh the risks. But, she adds, it’s an individual decision for each young athlete and their family.

“Parents need to take into consideration what sport it is because there are sports that are considered high-risk like football and wrestling,” she said. “You can imagine you're face-to-face with your opponents as opposed to something like soccer or volleyball, which are considered medium risk, as opposed to golf where they can safely distance themselves.”

Parents also need to consider who the athlete interacts with and whether there’s a high-risk individual in the home, like an elderly grandparent who may be more susceptible to seriousness illness if exposed to COVID-19.

“Unfortunately, it's not easy. It's a very complex decision that needs to be made within the family,” Dr. Schutte said. “But I certainly would not discourage it.”