Young Athletes and COVID-19: When Can My Child Return To Play?

Why does my child need a doctor’s clearance to return to sports after a COVID-19 infection?

Researchers have found that a significant number of young, healthy people who have had a COVID-19 infection have evidence of inflammation in the heart (called myocarditis).  We have not seen this as much with other viruses. While we are not sure exactly what this means in all children, the concern is that this inflammation can lead to a condition which could cause sudden collapse during vigorous exercise.

How long does my child need to rest before being cleared to return to play?

All athletes will need a rest period of 10 days after she/he tested positive.  Also, if your child had symptoms, then he/she should be symptom free before she/he returns to play.  These are the recommendations of the American Academy of Pediatrics.

Does my child need to have tests done to see if they are OK to play?

If your child had significant symptoms of a COVID-19 infection, or needed to be hospitalized, she/he should have an evaluation by a pediatric cardiologist before returning to play.  If your child had the following symptoms, they should also see a pediatric cardiologist before returning to play:

  • Fever of greater than 100.4 for three days, plus at least ONE of the following symptoms:
  • shortness of breath
  • general exhaustion, discomfort, or not feeling well
  • rash
  • deep muscle pain or muscle aches
  • chills/shivering during fever

I thought my child would just need an EKG or a heart ultrasound (ECHO) to return to play.  Is this true?

Actually, the EKG and cardiac ultrasound (ECHO) tests will miss at least 50% of patients with heart inflammation.  If your child had the above symptoms, we will recommend a consult with a pediatric cardiologist first.  Our local pediatric cardiologists MAY recommend a cardiac MRI as the best available test to diagnose myocarditis (heart inflammation).

 

If my child is “cleared” to play sports, does that mean he/she can play in a game right away?

No.  Much like returning to play after a concussion, children will have to work with an athletic trainer or responsible adult to start a gradual progression back to playing her/his sport.  This is a lot like returning to play after a concussion.  If the athlete doesn’t have any symptoms during this progression, then he/she may return to full sports activity, including games.

My child had very mild symptoms, or no symptoms of their COVID-19 infection.  But, I’m still worried about inflammation in the heart.  Can my child get a cardiac MRI or a visit with a cardiologist?

Yes.  If you have concerns about heart inflammation, either based on what you’ve heard in the news, or your child’s symptoms, we will be happy to refer you to the pediatric cardiologists to evaluate your child, who can guide you on the next steps and any testing that may be needed.