Boy with soccer ball after returning to sports after COVID-19.

Returning to sports after COVID-19

Even if the school year just ended, it’s not too early to start thinking about getting your child ready for the next school year. This includes scheduling a sports physical now, so you can beat the rush and make sure you can get an appointment with your child’s primary care provider.

If your child recently had COVID-19, there are some additional safety precautions to consider before scheduling that sports physical. Those precautions apply to your child’s return to sports after COVID-19 year round.

If your child tested positive for COVID-19 within the last four weeks, they may need further evaluation that requires them to see their primary care provider.

“From COVID-19, you can get myocarditis, which is an inflammation of the heart. You can have minimal symptoms from that and still have a sudden cardiac event, such as cardiac arrest,” said Marc Knepp, MD, pediatric cardiologist with OSF HealthCare Children’s Hospital of Illinois.

“The evaluation is necessary so we can prevent kids from sudden death or having a cardiac event after going back to playing sports.”

Guidelines for playing after COVID-19

The American Academy of Pediatrics and the American College of Cardiology recommend that any person with a COVID-19 diagnosis not play sports until a doctor has screened them for heart symptoms. Those include:

  • Chest pain
  • Fainting
  • Fatigue
  • Irregular heartbeat
  • Shortness of breath

This screening should happen either before your child returns to playing sports or within two to four weeks of a positive COVID test, according to AAP recommendations.

“It’s all about keeping kids safe,” Dr. Knepp said. “Take COVID-19 out of the picture for a minute. When we do the annual pre-participation screening exams, we’re looking for the exact same things. The number of kids who might have a cardiac event is really, really small, but we can identify a good percentage of them and keep them safe. It’s the exact same thing here. The principles are the same.”

Mild or no symptoms

For children who experienced only mild symptoms, or no symptoms at all, a video visit or phone call with their PCP is sufficient. Mild symptoms include:

  • Fever greater than 100.4 degrees Fahrenheit for less than four days
  • Muscle aches, chills or lethargy for less than one week

Moderate symptoms

If your child experienced moderate symptoms, an in-person screening from the child’s PCP is recommended. Moderate symptoms include:

  • Fever greater than 100.4 degrees Fahrenheit for four or more days
  • Muscle aches, chills or lethargy for one week or longer, or a non-ICU hospital stay with no evidence of multisystem inflammatory syndrome in children (MIS-C)

Severe symptoms

If your child required an ICU stay for treatment, needed to be intubated for help breathing or shows signs of MIS-C, they should not exercise for a minimum of three to six months. They will need to be cleared by a cardiologist before returning to training or competition.

Extra testing if necessary

Other viruses besides the one that causes COVID-19 can cause myocarditis. This includes viruses that cause regular colds or influenza.

But the risk of heart problems after a COVID-19 infection is higher, so these guidelines were put in place.

If irregularities are found, additional tests will be performed to determine the extent and severity of the problem. It’s possible your child will be sidelined from sports participation for a while. How long depends on what the tests reveal.

“We hate doing that. We know how much they want to play, and we want to get them back on the field or the court as quickly as possible. We’re going to do everything we can to make that happen,” Dr. Knepp said.

“Most of these kids will be just fine. They’ll get cleared and go right back to sports. But they need this evaluation to make sure, so they can go back and be safe.”

See your primary care provider

At OSF HealthCare, only primary care providers – your child’s pediatrician or family medicine provider – will perform sports physicals on kids who have had moderate to severe COVID-19 within the past six months.

“Your primary care provider knows your child’s history much better than an urgent care provider,” Dr. Knepp said. “They’ll know if additional testing is needed after moderate to severe COVID-19.”

The goal is to get your child back to the sports they love and to make sure they will not be facing a hidden risk.

If your child is 6 or older and has had moderate to severe COVID-19 within the past six months and needs a sports physical, please schedule an appointment with your primary care provider. OSF OnCall Urgent Care and OSF PromptCare can perform sports physicals on children 6 and older who have not had moderate to severe COVID-19. If you don’t have a PCP, you can find one in your area and schedule an appointment today.

Last Updated: July 21, 2023

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About Author: Ken Harris

Ken Harris is the proudest father and was a writing coordinator for the Marketing & Communications division of OSF HealthCare.

He has a bachelor's in journalism from the University of Wisconsin-Madison and worked as a daily newspaper reporter for four years before leaving the field and eventually finding his way to OSF HealthCare.

In his free time, Ken likes reading, fly fishing, hanging out with his dog and generally pestering his lovely, patient wife.

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Categories: General, Kids & Family