Return to play: Is it safe to let kids play sports following a COVID diagnosis?

Kids who have recovered from a moderate to severe case of COVID-19 may require cardiac testing before being cleared by their physician to return to play.

If your child is itching to return to the soccer field or basketball court following a bout with COVID-19, you may be wondering if it’s safe to let them. A growing body of evidence suggests moderate to severe COVID-19 infections in adults may cause lasting damage to the heart muscle raising concerns about the risks to kids and teens.

According to Dr. Brian Reilly, a sports medicine physician ​at Akron Children’s Hospital, “We stratify an athlete’s need for cardiac clearance based on the likelihood they will develop myocarditis following a known or suspected COVID infection.”

Myocarditis, an inflammation of the heart muscle, is a rare but potentially serious condition that may develop as the result of a viral infection. It can lead to injury and heart dysfunction, and in serious cases, may cause sudden cardiac death in young athletes during exercise or sports.

Dr. Brian Reilly, sports medicine physician

Mild COVID symptoms include fatigue, loss of taste and smell, nausea, vomiting, diarrhea, headache, cough, sore throat, and nasal congestion. Moderate to severe symptoms consist of fever, chills, muscle aches, severe lethargy, shortness of breath, chest pain, pneumonia or any infection that required hospitalization.

“Best evidence suggests that athletes with moderate or severe symptoms, prolonged illness or known history of heart disease would require cardiac clearance before returning to normal activity,” said Dr. Reilly.

An initial cardiac evaluation may involve an electrocardiogram (ECG) to assess the electrical activity of the heart, blood work to evaluate for elevated cardiac enzymes that may indicate inflammation of the heart muscle, and an echocardiogram to look for structural damage to the heart or heart dysfunction.

Cardiac magnetic resonance (CMR) imaging provides additional detail of heart structure and function but is only recommended to help confirm myocarditis if abnormalities are detected in initial cardiovascular tests.

Athletes need to be open with their coaches and athletic trainers regarding any medical conditions. This is especially important ​following a COVID-19 diagnosis.

“Early data developed by the American College of Cardiology suggests the severity of symptoms related to COVID infections are linked to the probability of developing cardiac complications,” said Dr. Reilly. “​Fortunately, athletes with mild symptoms that resolve within 10 days, and those who remain asymptomatic following completion of CDC-guided self-isolation, don’t require cardiac clearance as their risk for myocarditis is extremely low.”

Although certain sports are more aerobic-intensive than others, this should not influence whether an athlete seeks cardiac clearance. Your child’s provider may ​ultimately recommend clearance for a particular sport but not others pending the results of their cardiac evaluation.

Kids should return to their sport slowly, and gradually build up stamina while also being mindful of symptoms like chest pain, dizziness or shortness of breath which may require further medical evaluation.

Dr. Reilly emphasized athletes need to be open with their coaches and athletic trainers regarding any medical conditions, and especially ​following a bout with COVID, since guidelines are constantly updated as we learn more about the infection.

“Transparency is key to ensuring an athlete’s safe return to play,” he said. “It minimizes the chance of an emergent, life-threatening medical situation.”

Once a child or teen has been medically cleared to return to sports, it’s still important to watch for symptoms ​that may indicate the need for more follow up.

Even though certain sports are more aerobic-intensive than others, this should not influence whether an athlete seeks cardiac clearance. Your child’s physician will ultimately decide.

“Any athlete experiencing chest pain, chest tightness, shortness of breath, dizziness with exercise, or passing out during or immediately after exercise warrants further evaluation,” said Dr. Reilly. “A slow and gradual resumption of physical activity is prudent for any athlete following known or suspected COVID-19 infection. This ensures careful monitoring for the development of cardiac symptoms as athletes progress through increasingly strenuous activity.”

Akron Children’s Hospital has athletic trainers at more than 25 local schools to help guide athletes in their return to play and monitor for the evolution of cardiac symptoms.

“It’s important to note this information is constantly evolving as new data and studies are made available,” said Dr. Reilly. “Current recommendations rely on expert opinions, anecdotal studies and limited research. Parents with questions should talk to their health care provider for the latest evidence-based recommendations.”