Getting kids back to sports after COVID - Albuquerque Journal

Getting kids back to sports after COVID

Q: My son was hospitalized with COVID-19 in January. He has been home for six weeks and is now back in school. Is it safe for him to resume sports?

A: Thank you for your question. It is terrific that your son recovered well and is back in school. You are right to be cautious about him returning to sports.

The mental and physical benefits of sports are undeniable; however, the effects of Covid-19 can linger for a while, exactly how long and in which patients is not clearly known. But a cautious approach makes the most sense.

Updated American Academy of Pediatrics guidance recommends not returning to sports/physical activity until the child has completed the 10-day quarantine period, and can perform normal activities of daily living without displaying any concerning signs or symptoms, such as chest pain, shortness of breath, heart palpitations (a feeling of rapid heartbeat) or light-headedness.

Any child with history of a positive COVID-19 test, regardless of whether they had symptoms, should be screened by a pediatrician for chest pain, shortness of breath, palpitations and light-headedness.

A standardized 14-point pre-participation physical exam (PPE), including a thorough personal and family history, should be done prior to return to sports. A history of COVID-19 infection with symptoms should be specifically discussed during this PPE.

Any child with a prior diagnosis of Covid-related MIS-C (multi-inflammatory syndrome) is at increased risk of late onset heart issues, up to six months after the illness in some cases.

Therefore, all kids with a diagnosis of MIS-C should be cleared by a cardiologist prior to resuming sports. It is routine practice now for cardiologists to follow up with outpatient visits for kids admitted to the hospital with MIS-C.

Children who had moderate or severe symptoms of COVID-19, even without the diagnosis of MIS-C, should be referred to a cardiologist prior to resuming any strenuous physical activity or intense sports training.

You can ask your pediatrician if your child’s symptoms would be classified as mild, moderate or severe.

Any child admitted to the hospital for Covid-related illness automatically qualifies as either moderate or severe.

All kids who test positive for Covid-19 should not exercise until a physician clears them. If the child had a positive test, and no symptoms or only a mild illness, that physician can be a general pediatrician or family practice doctor.

If the child had a positive test, and moderate to severe symptoms, or had MIS-C, the physician who clears them for sports should be a pediatric cardiologist. Often kids with severe symptoms or with MIS-C will be advised not to exercise for at least three to six months after illness.

The initial return to sports should focus on skill and movement development before adding the complexity of a scrimmage or competition to account for loss of sport-specific skills.

The timeline for a child’s progression to previous levels should be based on the degree of de-conditioning, and the demands of the sport and level of competition. Children who had longer periods of relative inactivity and are more de-conditioned require slower progression.

The AAP also supports the benefits of wearing masks during most indoor and outdoor sports. Proper use during indoor training and competition is an effective way to decrease transmission to levels equivalent to outdoor sports and activities.

However, some indoor sports, such as ice hockey and wrestling, may have a higher risk of virus transmission.

For kids who have been showing signs of depression or anxiety during the pandemic, the lack of physical activity and organized sports can exacerbate this problem.

Many parents are eagerly awaiting a safe return to sports for this reason, more than any other.

However, it is important to phase the kids back into sports, and to maintain safe practices with masks and social distancing as much as possible. This safe approach will need to be adhered to for the foreseeable future.

During these prolonged breaks in organized sports, child athletes should be encouraged to maintain their fitness with other regular physical activity. Running with a parent may not be as satisfying as practicing with your track team, but it is a very good substitute for the short term – and much better than doing nothing at all.

I hope this guidance has been helpful as you monitor your son’s recovery and return to school and sports.

Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send questions to asubbaswamy@salud.unm.edu.

 


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