Having COVID vaccines for everyone age 6 months and up is a game changer for many families. Being fully vaccinated can keep kids healthy for fun activities like youth sports.
Kids who are vaccinated and boosted mostly have not been severely ill from COVID or multisystem inflammatory syndrome in children (MIS-C). However, all children and teens who test positive for COVID should have at least one follow-up conversation or visit with their pediatrician. (See, "Returning to physical activity after COVID," below.)
Read on for strategies to protect kids starting or returning to sports and other physical activity.
Before the sports season starts
Understand the safety rules for participation during COVID. Talk about what they mean with your child.
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 has not been very
active, it's a good idea to ease into exercise. 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 if they have any signs or
symptoms of COVID, and consult your pediatrician for testing guidance. Anyone who is exposed to someone with COVID should follow Centers for Disease Control and Prevention recommendations for a
known exposure.
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 if use is indicated by COVID community levels.
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:
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
When there is a "high" COVID community level, it is strongly recommended that athletes, coaches, officials and spectators wear a face mask indoors, even if vaccinated and boosted.
This includes wearing 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 indoors, they should stay at least 3 feet away from everyone else.
When there is a "medium" COVID community level, wearing a face mask indoors also is recommended if an athlete or someone on the team or within their home is immunocompromised or considered
high risk.
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.
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.
Exceptions to mask-wearing may be appropriate when the risk of heat-related illness is increased.
Be a good sport when individuals choose to wear a face mask. Some must wear masks when they go out so they can protect themselves or their family members. Remind one another that people who wear masks should not be targeted or bullied for their decision.
To help protect everyone:
Avoid huddles, high-fives, fist bumps, handshakes, etc.
Do not share food or drink with teammates.
Avoid cheering, chanting or singing when closer than 6-8 feet from others.
Don't spit or blow your 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
Talk with your pediatrician if you have any questions about your child's sports participation and health.
More Information
The information was adapted from material developed jointly by the American Academy of Pediatrics and: