Health Issues

Youth Sports: A COVID-19 Safety Checklist

Youth Sports Participation During COVID-19: A Safety Checklist

Having COVID-19 vaccines available for ages 5 and up is a game changer for many families. Being fully vaccinated can keep kids healthy for fun activities like youth sports.

Even with the omicron variant spreading and a record number of COVID-19 cases in kids, we have proven tools and strategies to protect youth athletes starting or returning to sports and other activities.

Fortunately, fully vaccinated children and teens mostly have not been severely ill from COVID or multisystem inflammatory syndrome in children (MIS-C). However, any child or teen who recently had COVID-19 should be screened before resuming physical activity, regardless of how minor their symptoms were. This can be through a phone, telemedicine or in-person visit with their pediatrician. During the assessment, your child can be evaluated for any possible effects of COVID-19 on the heart.

Read on for more ways to get your child ready to safely participate in sports and other physical activity.

Before the sports season starts

☐	Understand the safety rules for participation during COVID-19. Talk about what they mean with your child.
☐	Make sure your child has their own face mask, hand sanitizer, towel, water bottle, and tissues labeled with their name.
☐	Call your pediatrician to make an appointment if your child needs a pre-participation physical evaluation. It's also a good time to catch up on recommended vaccinations.
☐	If your child hasn't been active during the pandemic, start easing into exercise. (Read on for how to begin return to activity after COVID.) For sports with a lot of running, for example, consider a beginner running program (such as the "Couch to 5K" or "None to Run" apps) a couple months before the season. This can help prevent injuries that sudden, intense activity can cause in growing children. It can also reduce the risk of heat-related illness in kids affected by obesity.

Prior to practice or games

☐	Keep your child home from practice or games. Kids should isolate and test if they have any symptoms of COVID-19.
☐	Remind your child to wash their hands before arriving or use hand sanitizer if soap and water aren't available.
☐	Bring labeled (with name) personal sports equipment, water bottle, towel, tissues, hand sanitizer, and face mask.
☐	Regardless of vaccination status, kids should wear a mask indoors in areas with high transmission of COVID and shared transportation.

Returning to physical activity after COVID-19 infection If your child has a positive COVID-19 test, notify their pediatrician. The doctor can advise how long they need to wait before returning to exercise or sports. This will be based on how severe their COVID-19 symptoms are, and whether they develop signs of multisystem inflammatory syndrome in children (MIS-C), myocarditis or other post-COVID-19 conditions. Children and teens with no symptoms or mild symptoms of COVID-19, and no symptoms of MIS-C need to have a phone, telemedicine or in-person visit with their pediatrician. The doctor will tell you how long to isolate and advise your child not to exercise during that time. They will also ask about heart symptoms such as chest pain, shortness of breath, fatigue, irregular heartbeat or fainting. A child with a positive heart screening will need to have an in-person visit for a complete physical exam. The doctor will decide if an electrocardiogram (EKG) is needed before clearing your child for physical activity. Those with moderate symptoms of COVID-19 and no signs of MIS-C should have an in-person visit with their doctor. They should not exercise until their symptoms are gone and they are seen by their doctor to be screened for possible effects of COVID-19 on the heart, a complete physical exam and EKG. Moderate symptoms are considered to be 4 or more days of fever over 100.4 F, a week or more of muscle aches, chills or fatigue, or a hospital stay that wasn't in the intensive care unit (ICU). Next steps depend on the cardiac screening and/or EKG findings. If your child's heart screening is normal, they can gradually go back to physical activity once 10 days have passed from a positive test. Their symptoms also have to be gone without using fever-reducing medicine for at least 10 days. If your child's heart screening or EKG is abnormal, you will probably be referred to a cardiologist for more tests. Children and teens who were very sick from COVID-19 or diagnosed with MIS-C must be treated as though they have an inflamed heart muscle (myocarditis). Because they needed to stay in the ICU and/or were intubated, they may need other tests depending on signs and symptoms. Before your child leaves the hospital, have a plan to follow up with a cardiologist. After severe illness or MIS-C, exercise should be restricted for at least 3 to 6 months. A pediatric cardiologist should examine your child before they can return to exercise or competition. The doctor will recommend a schedule of gradually increasing physical activity based on your child's age and how severe the symptoms were. Keep in mind: Even if your child is cleared for activity, they will need to stop immediately if they experience any of these symptoms: Chest pain Increased shortness of breath Sudden heart palpitations Feeling faint or passing out Your child will need to see their pediatrician in-person if they have any of these symptoms to rule out a heart issue.

Returning to physical activity after COVID-19 infection

If your child has a positive COVID-19 test, notify their pediatrician. The doctor can advise how long they need to wait before returning to exercise or sports. This will be based on how severe their COVID-19 symptoms are, and whether they develop signs of multisystem inflammatory syndrome in children (MIS-C), myocarditis or other post-COVID-19 conditions.

Children and teens with no symptoms or mild symptoms of COVID-19, and no symptoms of MIS-C need to have a phone, telemedicine or in-person visit with their pediatrician. The doctor will tell you how long to isolate and advise your child not to exercise during that time. They will also ask about heart symptoms such as chest pain, shortness of breath, fatigue, irregular heartbeat or fainting. A child with a positive heart screening will need to have an in-person visit for a complete physical exam. The doctor will decide if an electrocardiogram (EKG) is needed before clearing your child for physical activity.
Those with moderate symptoms of COVID-19 and no signs of MIS-C should have an in-person visit with their doctor. They should not exercise until their symptoms are gone and they are seen by their doctor to be screened for possible effects of COVID-19 on the heart, a complete physical exam and EKG. Moderate symptoms are considered to be 4 or more days of fever over 100.4 F, a week or more of muscle aches, chills or fatigue, or a hospital stay that wasn't in the intensive care unit (ICU). Next steps depend on the cardiac screening and/or EKG findings.
If your child's heart screening is normal, they can gradually go back to physical activity once 10 days have passed from a positive test. Their symptoms also have to be gone without using fever-reducing medicine for at least 10 days. If your child's heart screening or EKG is abnormal, you will probably be referred to a cardiologist for more tests.

Children and teens who were very sick from COVID-19 or diagnosed with MIS-C must be treated as though they have an inflamed heart muscle (myocarditis). Because they needed to stay in the ICU and/or were intubated, they may need other tests depending on signs and symptoms. Before your child leaves the hospital, have a plan to follow up with a cardiologist.
After severe illness or MIS-C, exercise should be restricted for at least 3 to 6 months. A pediatric cardiologist should examine your child before they can return to exercise or competition. The doctor will recommend a schedule of gradually increasing physical activity based on your child's age and how severe the symptoms were.

Keep in mind: Even if your child is cleared for activity, they will need to stop immediately if they experience any of these symptoms:

Chest pain
Increased shortness of breath
Sudden heart palpitations
Feeling faint or passing out

Your child will need to see their pediatrician in-person if they have any of these symptoms to rule out a heart issue.

During sports practice or games

☐	If the sport is outdoors, athletes who are not fully vaccinated against COVID-19 should be encouraged to wear a face mask on the sidelines and during all group training and competition that involve continually being within 3 feet or less from others.
☐	Anyone not fully vaccinated should wear a face mask for all indoor sports training, competition and on the sidelines. In counties with substantial or high transmission, all athletes should wear a mask for indoor training and competition, whether or not they are vaccinated. Even if they're fully vaccinated, encourage your child to wear a mask in crowded indoor spaces like locker rooms, shared transportation, walking to and from the playing area, between practice drills, and on the sidelines. If your child takes off their mask during a break, they should stay at least 3 feet away from everyone else. However, masks should not be worn during: Water sports such as swimming, diving and water polo since wet masks may be difficult to breathe through. If a mask becomes soaked with sweat, it should be changed right away. Certain exercises in competitive cheerleading and gymnastics. The goal is to avoid the risk of masks getting caught on equipment, creating a choking hazard or blocking vision. Masks should go back on after these exercises, especially if athletes can't stay 3 feet apart from others inside. Face masks are also discouraged while wrestling, unless an adult coach or official is closely monitoring to ensure the masks don't become a choking hazard. In addition, exceptions to mask-wearing might be appropriate when the risk of heat-related illness is increased.
☐	All coaches, officials, spectators and volunteers should wear masks at all times. This helps set a good example for others and protects against transmission.
☐	To help protect everyone, try to avoid: Huddles, high-fives, fist bumps, handshakes, etc. Sharing food or drink with teammates. Cheering, chanting or singing when closer than 6-8 feet from others. Spitting or blowing nose without a tissue.
☐	Minimize sharing sports equipment when possible.
☐	Tell a coach if you are not feeling well and leave the practice or game with a parent or caregiver.

After sports practice or games

☐	Sanitize or wash hands.
☐	Wash or replace face masks, towel, and practice clothes or uniform.
☐	Clean personal sports equipment and water bottle.

Remember

For children too young to get the COVID vaccine, it is especially important to continue steps that reduce the risk of spreading the virus. Talk with your child's pediatrician if you have any questions about your child participating safely in sports, based on vaccination eligibility, COVID-19 rates in your community and your child's health.

More Information

The information was adapted from material developed jointly by the American Academy of Pediatrics and:

Last Updated: 1/27/2022

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.