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Mask use, vaccination and guidance for those who are or are not already vaccinated are covered in this update, which aligns with CDC recommendations

The American Academy of Pediatrics has updated its interim sports guidance for safety during COVID-19 to clarify guidance on masks, detail steps to safely return to play and encourage all teens who are eligible to be vaccinated.

 Staying physically active is important for children’s physical and psychological health, whether it’s through organized sports or informal outdoor play. The AAP encourages children and teens to gradually return to physical activity and sports, especially if they were more sedentary over the past year because of the pandemic.

“We know many children were learning remotely and restricted from participating in activities that kept them active before the pandemic,” said Susannah Briskin, MD, FAAP, lead author of the guidance. “Those who have taken a prolonged break from sports are at a higher risk of injury when they return. Families should also be aware of an increased risk for heat-related illness if they are not acclimated.”

The AAP recommendations reflect the most recent research and are consistent with guidance provided by the Centers for Disease Control and Prevention.

Recommendations include:

  • All children should have an annual health supervision visit, which ideally incorporates the preparticipation physical evaluation (sports examination).
  • Children and teens who have not participated in consistent physical activity for more than 1 month should start at 25% of their usual volume and intensity of activity and consider every-other-day exercise. An increase of volume of 10% per week is recommended until the desired volume is achieved. Next, intensity of the desired exercise can be increased by 10% per week until the desired in intensity is reached.
  • The AAP encourages all people who are eligible to receive the COVID-19 vaccine as soon as it is available. Once athletes are fully vaccinated, they should continue to follow transmission mitigation recommendations as described by the CDC for vaccinated people.
  • Athletes should wear a face mask for all indoor sports training, competition, and on the sidelines if they are not fully vaccinated, except in the case where the mask bears a safety risk. Parents and spectators should follow current local regulations for physical distancing and use of face masks. Because indoor areas have higher rates of COVID-19 transmission, all spectators, regardless of vaccine status, should consider wearing a face mask during sporting events with limited spacing.
  • Sports performed outside are lower risk for transmission of COVID-19, and a face mask may not be necessary for all sport-related activities. For outdoor sports, athletes who are not fully vaccinated should be encouraged to wear face masks on the sidelines and during all group training and competition in which there is sustained contact of 3 feet or less.
  • Asymptomatic or mildly symptomatic individuals no longer have to see a doctor for clearance. A phone call or telemedicine visit is appropriate so medical records can be updated and screening for cardiac symptoms over the phone can be performed. This allows for a more expedient return to activities and allows education on importance of gradual return to physical activity post-infection.

The guidance also includes detailed instructions for athletes who show symptoms or test positive for COVID-19 and when they may safely return to physical activities over a progression of time. While rare, some children and teens recovering from COVID-19 have exhibited a heart problem called myocardititis.

Symptoms such as chest pain, shortness of breath, heart palpitations or feeling faint during exercise warrant a trip to the pediatrician for an in-office examination.

“Don’t hesitate to call your pediatrician if you have any questions or concerns,” Dr. Briskin said. “We know it’s good for kids to return to sports, and we can do it safely if everyone follows protocols set by their local health department and organization leaders.”

The guidance is here: COVID-19 Interim Guidance: Return to Sports and Physical Activity (

Information for parents can be found here: Youth Sports: A COVID-19 Safety Checklist

To request an interview, contact AAP Public Affairs.

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. For more information, visit 

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