What if my child who is physically active/plays sports tests positive for COVID?
Due to an increased risk of myocarditis (heart inflammation) caused by COVID infection, the American Academy of Pediatrics recommends evaluation of all children/adolescents who are diagnosed with COVID prior to return to physical activity/sports. Children should avoid exercise after COVID infection until they are cleared by a physician.
When should my child be evaluated for sports clearance after COVID?
Children with mild to moderate COVID should be evaluated for return to sports after the isolation period has ended and symptoms have resolved. For most children, this will be 10 days from symptom onset or positive test date if the child had no symptoms. Children with severe COVID (ICU admission, MIS-C) should wait 3 to 6 months prior to return to exercise.
Does my child need to come into the office for evaluation or can the visit be done virtually/by phone?
How your child’s evaluation takes place depends on the severity of your child’s infection. Children with mild symptoms of COVID may have a virtual visit for sports clearance. At the visit, the provider will ask questions from an American Heart Association 14-point screening evaluation that addresses symptoms, family history and other risk factors. Any child or adolescent with a concerning family history or who reports signs/symptoms that place them at increased risk for myocarditis will be scheduled for an in-office visit that includes a complete physical examination, and consideration for an EKG prior to clearance to return to physical activity. Children with moderate symptoms of COVID should be evaluated in the office for a complete physical examination and consideration of an EKG.
Mild or no symptoms
- Less than 4 days of fever >100.4 F
- Less than 1 week of muscle aches, chills, and lethargy
Moderate symptoms
- 4 days or more of fever >100.4°F
- 1 week or more of muscle aches, chills, or lethargy
- a non-ICU hospital stay and no evidence of multisystem inflammatory syndrome in children [MIS-C]
Severe symptoms
ICU stay
Intubation
MIS-C
At what pace should children and adolescents return to play?
- Under age 12: progress according to own tolerance
- Age 12+: should perform the following progression once isolation is completed and physician clearance has been obtained if indicated:
- Asymptomatic/mild symptoms: Minimum 1 day symptom free (excluding loss of taste/smell), 2 days of increase in physical activity (ie, one light practice, one normal practice), no games before day 3. A face mask should be worn for ALL physical activity, including games or scrimmages, until 10 full days from positive test or symptom onset have passed.
- Moderate symptoms: Minimum 1 day symptom free (excluding loss of taste/smell), and a minimum of 4 days of gradual increase in physical activity (one light cardio workout on own, two light practices, one full practice), no games before day 5. A face mask should be worn for ALL physical activity, including games or scrimmages, until 10 full days from positive test or symptom onset have passed.
A graduated return to exercise in a patient recovering from COVID-19 should follow the progression below. This was adapted from Elliott N, et al, infographic, British Journal of Sports Medicine, 2020:
Stage 1: Day 1 and Day 2 – (2 Days Minimum) – 15 minutes or less: Light activity (walking, jogging, stationary bike), intensity no greater than 70% of maximum heart rate. No resistance training.
Stage 2: Day 3 – (1 Day Minimum) – 30 minutes or less: Add simple movement activities (eg. running drills) – intensity no greater than 80% of maximum heart rate.
Stage 3: Day 4 – (1 Day minimum) – 45 minutes or less – progress to more complex training – intensity no greater than 80% maximum heart rate. May add light resistance training.
Stage 4: Day 5 and Day 6 – (2 Days Minimum) – 60 minutes – Normal training activity – intensity no greater than 80% maximum heart rate.
Stage 5: Day 7 – return to full activity/participation (ie, contests/competitions).
When should children and adolescents pause their return to play?
If your child develops chest pain, shortness of breath, palpitations/irregular heart beats, dizziness or faints after returning to exercise, they should stop immediately and you should call for an appointment and/or guidance.
