When you get sick, doctors usually advise you to rest, stay hydrated, and take it easy until you feel better. For children who play sports, stopping activity when they are sick can be a challenge. Athletes feel left out when they miss practices and games and worry about falling behind in their conditioning.
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Rest after contracting COVID-19 is especially important for children who play sports. Pediatric cardiologist Akash Patel, MD, explains why not everyone who has had COVID-19 can return to sports right away—and how athletes can safely return to competition.
How do you know it’s safe to return to sports?
Dr. Patel says most children who recover from COVID-19 can return to sports. However, when they return to the court or field depends on the severity of their symptoms and how they are affected by the infection.
“The majority of children can come back after their symptoms resolve,” says Dr. Patel. “But if symptoms are more significant, it’s worth seeing a primary care provider before engaging in sports or exercise.”
Fatigue is a common symptom of COVID-19. But the virus can cause a variety of breathing-related symptoms, including sinus congestion, chest discomfort and shortness of breath. In more serious cases, COVID-19 can also affect internal organs, such as your heart.
“When your child has the flu or a cold, they may have some of these respiratory symptoms. And you might say to yourself, “Well, these aren’t heart symptoms. These are just flu symptoms,” notes Dr. Patel. “But COVID is new and we’re still learning about it.”
Dr. Patel explains how to know when your child can return to sports divided by the severity of the COVID-19 infection.
Mild symptoms of COVID-19
This group includes children who have had mild symptoms of COVID-19. “This is the typical upper respiratory tract infection,” says Dr. Patel. “Viral symptoms last less than seven days and do not include a high fever for more than four days.”
Kids can return to sports “relatively soon,” he adds. In a case like this, the athlete should avoid the sport until the quarantine or isolation is over, which is usually five to 10 days, and wait to play until their symptoms subside. Dr. Patel advises also following up with their primary care provider to make sure they’re healthy and on the mend.
Moderate symptoms of COVID-19
The second group are children who have had more severe or moderate COVID-19 and are taking longer to recover. “These are children who have had symptoms for more than seven days and have had a high fever for more than four days,” says Dr. Patel. “These are also children who had to be hospitalized because they developed pneumonia.”
Dr. Patel says it’s best for this group to also let all symptoms subside before returning to exercise. “This could take a week to two weeks. You’ll also likely contact your primary care provider to make sure things look good before returning to sports.
He adds that it’s important to tell doctors if your child has had heart symptoms as part of COVID-19. “If they’ve had chest pain or discomfort, they may get an EKG as part of that evaluation to rule it out,” says Dr. Patel. “If that EKG looks normal, then obviously they can go back to sport. If it doesn’t, then they will be referred to a cardiologist.
Severe symptoms of COVID-19
In rare and serious cases, viral infections such as the flu or COVID-19 can be severe. They can affect multiple organ systems. With COVID-19, children may need to be in the intensive care unit.
As with the flu, COVID-19 can cause myocarditis, or inflammation of the heart. This is a serious condition that requires medical attention and caution before returning to sports.
“Even if these symptoms go away fairly quickly, we usually recommend that children stay out of sports for three to six months,” says Dr. Patel. “Even though their symptoms are gone, there may be small changes in the heart that we don’t see on an exam, EKG or even an ultrasound of the heart.”
The concern is that these changes could put someone at risk for a life-threatening arrhythmia, or irregular heart rhythm, Dr. Patel explains. “We really want to allow the heart to fully recover from this type of viral heart infection before returning to full sport.”
Signs of myocarditis
Myocarditis can come on quickly. Dr. Patel says a child can become “quite sick” within 12 to 24 hours of the onset of infection.
But not every disease a child gets is myocarditis. The difference is that someone has the symptoms of a viral infection — for example, maybe a stomach ailment with vomiting, diarrhea, and constipation — and heart-specific symptoms affecting their heart.
“Generally, when you think of myocarditis, it’s usually in the context of having some kind of viral symptoms — like a fever, a runny nose, something that suggests a virus affecting them. And you layer the heart symptoms on top of that.
Symptoms of myocarditis may include:
- Chest pain. Dr. Patel describes this as “constant chest pain.”
- Increased heart rate. If you are at rest and have a fast heart rate, this is a problem. “For example, if you have a typical 15- or 16-year-old sitting around and you notice that their heart is beating 140 times a minute, that would raise concerns,” says Dr. Patel.
- Irregular, rapid heartbeat.
- I pass out.
- Difficulty in breathing.
A doctor is key to determining what a child is going through, says Dr. Patel. “Usually when you’re evaluated, there are tests that can be done to determine if there’s myocarditis — or if it’s just a viral infection that’s making you feel gross.”
Other heart-related symptoms caused by a viral infection
When the heart is infected with a virus, the child may develop additional symptoms that resemble signs of heart failure. “When you have a viral infection of the heart, the heart doesn’t contract well,” explains Dr. Patel. “And that’s why it’s hard for the heart to pump blood.”
These signs include:
- Difficulty breathing due to fluid in the lungs.
- Chronic fatigue.
- Lack of energy.
- Changes in your child’s mental state. “If the heart isn’t pumping enough blood, you may have changes in your mental status, such as confusion,” adds Dr. Patel.
Monitor for viral symptoms
For children who have COVID-19 or any viral infection, it’s important to keep an eye on them and make sure their illness follows the typical course of a cough or cold. “Are they starting to get better?” Dr. Patel says. “Or do they not follow the typical course of progression and look worse? This should always require some kind of evaluation. Worsening symptoms – or symptoms that do not improve – may be a sign of a serious illness, such as pneumonia.
As for athletes, it’s more important than ever to rest if they’re feeling a little off and not play through any symptoms of illness. COVID-19 is still circulating, and it’s not necessarily easy to tell at first if that tickle in your throat is a cold or something more serious.
“You have to use your best judgment with anything,” notes Dr. Patel. “But at the end of the day, you want to play sports safely. And the best way to exercise is if you are 100% healthy. And if you’re not 100% healthy, you won’t be able to perform at your peak ability.
Take any symptoms of illness seriously and rest and rehydrate. If you have questions, contact your primary care provider. And make sure your child is improving before re-engaging.
“The fall season is starting soon and kids are starting to practice fall sports,” says Dr. Patel. “It’s good to enjoy the summer, make sure the kids are healthy – and then make sure they’re seen before the fall starts so they can have a successful school sports year.”