The American Academy of Pediatrics recently updated its guidelines, originally issued in July, regarding return to youth sports after covid infection. This revised position was strongly influenced by input from the American College of Cardiology as more data has become available thanks to ongoing research.
The recommendations basically divide these patients into 3 groups. Those with no or mild symptoms (such as those associated with any typical viral upper respiratory infection)–low grade fever (<102), of short duration (3-5 days), mild cough and typical only mild aches/pains may return to sports within 3-5 days of resolution of those problems when the child feels well. In particular this applies to children < 12 years of age, who’s sport activity level is mostly in line with the energy expenditures of everyday outdoor play.
Skipping ahead for a moment to “group 3,” this mostly includes those unusual children with severe symptoms requiring hospitalization for such problems as severe chest pains, shortness of breath requiring oxygen supplementation, signs/symptoms of pneumonia and other more dangerous problems. All of these children require thorough evaluation by a pediatric cardiologist prior to resumption of vigorous physical activity. Fortunately, most children DO NOT fall into this group.
It’s the middle group that presents more of a challenge. This includes children who have moderate symptoms of prolonged fever (> 5 days), more pronounced weakness/malaise, and in particular those children with more disruptive coughing (night time awakening, shortness of breath), and chest pain. This classification of post-infected children should refrain from all sports for at least 2 weeks after resolution of symptoms and have a baseline EKG prior to return. Depending on those findings, cardiology evaluation may be indicated.
Covid infection has been shown to cause injury to the heart muscle (“myocarditis”) which can lead to severe weakness and, in rare instances, serious heart rhythm disturbances, so these more significant symptoms must be assessed to evaluate for that problem. At this time, it is simply unknown if post-covid myocarditis is permanent or not; more time and study will be necessary to answer this important question.
I will re-emphasize that the large majority of covid infected children fall into category 1–no or mild symptoms-and have NO RISK for myocarditis. If you have any questions or concerns for your child after covid infection please be sure to bring them to my attention.
The AAP recognizes the physical and mental health advantages of youth sports–particularly in the midst of a pandemic–and strongly encourages participation wherever possible. Here are CDC guidelines to consider when deciding if sports participation during the pandemic is appropriate for your child.
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