American Academy of Pediatrics Updates Guidance on Returning to Sports Activities

Pediatricians advise when athletes should return to sports if they have shown signs of illness or have tested positive for COVID-19

The American Academy of Pediatrics has updated its guidance for children and teens who participate in sports activities, clarifying the recommended amount of time that athletes should be held out of practices and games if they or close contacts show symptoms or test positive for the coronavirus.

 Much remains unknown about COVID-19 and its transmission, but new research continues to inform experts. The AAP, in the first update to guidance since July 23, factors in growing evidence that the virus can cause severe damage to the heart. The AAP recommends that athletes who show moderate symptoms of COVID-19 should be asymptomatic for at least 14 days and obtain clearance from their primary care physician before returning to exercise and competition.  The guidance also recommends an electrocardiogram (EKG) be obtained in athletes who have a history of moderate symptoms.

“Exercise and sports offer so many health benefits to youth, and we know that many are eager to return to play,” said Susannah M Briskin, MD FAAP, an author of the guidance and member of the executive committee for the AAP Council on Sports Medicine and Fitness. “We have many suggestions on how to reduce the risks, and they require being candid and forthcoming about anyone who is feeling unwell. Parents, children and coaches need to make safety protocols a priority.”

AAP recommendations include:

• All children and adolescents who have been exposed to the coronavirus, regardless of whether they have symptoms, should sit out from ALL practices and games for a minimum of 14 days. Parents and guardians must report if an athlete or any household contact is exhibiting any signs or symptoms of COVID-19 or tests positive for the virus, even if they have no symptoms.

• Children and adolescents who are diagnosed with COVID-19 or test positive for SARS-CoV-2 should not participate in sports and should be asymptomatic for 14 days total before beginning the gradual return to physical activity.

• Before returning to play, all patients with COVID-19 should be cleared for participation by their primary care physician. The focus of their return to participation screening should be for cardiac symptoms, including but not limited to chest pain, shortness of breath, fatigue, palpitations, or syncope. 
• If an athlete tests positive for coronavirus, team officials and the health department should be notified so contact tracing and appropriate quarantining can be performed.
• Those who experience severe sickness from COVID-19, such as multisystem inflammatory syndrome in children (MIS-C), should be restricted from exercise and participation for 3 to 6 months. These athletes should be cleared to resume participation by their primary care physician and appropriate pediatric medical subspecialist, preferably in consultation with a pediatric cardiologist. Cardiac testing must have returned to normal before return to activity.

Current evidence suggests that children infected with the COVID-19 virus typically experience less severe disease. Although children have generally not been the source of disease outbreaks, it is possible that children could infect adult coaches, officials, or family members after contracting the virus.

The AAP guidance includes other safety protocols, including physical distancing, hand hygiene and cloth face masks.  Athletes, officials, spectators and volunteers should wear a cloth face covering when arriving to or departing from an athletic facility. All athletes should wear a cloth face mask when on the sidelines and should practice physical distancing. Cloth face coverings should not be worn during vigorous activities or in water activities where they could pose an injury risk due to catching on equipment or accidently impairing vision.

“Team members know the importance of working together to win games and achieve goals,” said Christopher Snyder, MD, FAAP, an author of the guidance who chairs the AAP Section on Cardiology and Cardiac Surgery. “Dealing with the coronavirus safely is no different. We are in this together, and we can rise to the challenge with a goal of keeping everyone safe so that we can return to sports and play.”

The interim guidance: COVID-19 Interim Guidance: Return to Sports

More information is available for parents at HealthyChildren.org, include sports safety checklists.

• Youth Sports Participation During COVID-19: A Safety Checklist
• Youth Sports & COVID-19: Understanding the Risks
• Kids and Masks: Why Cloth Face Coverings are Needed in Youth Sports During COVID-19

To request an interview, contact AAP Public Affairs.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.