Current Environment:

Overview

As new guidelines arise and restrictions lighten in the coming months, you can expect to see more children and adolescents in your office for health supervision visits and pre-participation physical evaluations. Parents, coaches, and athletes likely will have questions about how best to ensure safety when considering a return to sports.

Fortunately, the majority of children and adolescents have very mild symptoms of COVID-19. However, if a child has tested positive for COVID-19, the AAP recommends that they be screened by their primary care provider (PCP) before returning to play, especially as we learn more about potential long-term effects of the COVID-19 virus.

In December, the AAP also released回到体育COVID——指导方针19 infection.

To learn more about these new recommendations, we spoke with Boston Children’s Health Physicians pediatric cardiologist,Dr. Joseph Giamelli.

SARS-CoV-2–positive children have been divided into three symptomatic categories to determine a systematic and safe return to sports.

Children who have had:

1)No symptomsormild symptoms (< 4 days): Should not exercise until they are cleared by a physician. They should visit their PCP, who will review the 14-point pre-participation screening evaluation with special emphasis on cardiac symptoms includingchest pain, shortness of breath out of proportion for upper respiratory tract infection, new-onset palpitations, or syncopeand perform a complete physical examination.

If the screening and examination are normal, no further testing is warranted and the patient may begin agradual return*to play after 10 days have passed from the date of the positive test result and a minimum of 24 hours symptom free, and off fever reducing medications. If the PCP identifies any new or concerning history or physical examination findings at this visit, referral should be made to a pediatric cardiologist for evaluation and further testing.

*Gradual return to play should be done in these phases:

If any symptoms develop during the return to play progression, the patient should contact their primary care provider.

2)Moderate symptoms (> 4 days) or non-ICU hospital stay: An ECG and cardiology consult is recommended after symptom resolution at a minimum of 10 days past the date of the positive test result.

3)Severe symptoms (ICU Stay or multisystem inflammatory syndrome in children [MIS-C]): Restriction from exercise for a minimum of 3 to 6 months and required cardiology clearance prior to resuming training or competition.

    • Stage 1 (Days 1 - 2): 15 minutes of walking/jogging
    • Stage 2 (Day 3): 30 minutes of simple movement activities/drills
    • Stage 3 (Day 4): 45 minutes of more complex training; can begin resistance exercises
    • Stage 4 (Days 5 - 6): 60 minutes of practice
    • Stage 5 (Day 7): return to full activity

According to Dr. Giamelli, any child with a positive heart screen that is referred to apediatric cardiologistwill undergo cardiac tests that may include an electrocardiogram and echocardiogram. Children who have been referred for moderate or severe symptoms, as described above, may be considered for additional testing such as a Holter monitor, troponin level, basic natriuretic peptide level, exercise stress test, or cardiac magnetic resonance imaging (MRI).

A gradual return exercise can begin once an athlete has been cleared by a cardiologist formoderatetosevereCOVID-19 symptoms and is asymptomatic when performing normal activities of daily living. The progression should be performed over the course of a minimum of 7 days.

If a child is participating in sports during the COVID-19 pandemic, they should continue wearing masks, avoid sharing equipment, and practicing excellent hand hygiene. The American Academy of Pediatrics (AAP) has helpful recommendations:Youth Sports Participation During COVID-19: A Safety Checklist.
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