Despite being cautious, enforcing masking and even getting your child vaccinated, unfortunately the COVID-19 omicron variant still managed to infect your child(ren). This story has been quite common over the past two months, so many parents now wonder what they need to watch for and when their child can return to activities. First and foremost, if your child has COVID, they will need to follow current isolation precautions to recover and to keep friends and family safe.
Then, the timing of when they can return to regular physical activity depends on the severity of their symptoms and if they have any post-COVID conditions, with cardiac issues generally being the most worrisome. Myocarditis is inflammation of the heart muscle that can cause chest pain, shortness of breath, irregular heartbeat and fatigue. Thankfully, recent literature indicates lower incidence of myocarditis (inflammation of the heart) than earlier in the pandemic (0.5-3%) and MIS-C has been shown in small studies to be less likely to occur after breakthrough cases (ie in patients that were vaccinated). That said, myocarditis has occurred in people who had mild or asymptomatic COVID-19 infections, so it is important to keep a watchful eye and to talk to your pediatrician if you are worried. The following is a breakdown by disease severity according to the current AAP recommendations:
Individuals with no symptoms or mild symptoms of COVID-19, and no symptoms of MIS-C:
All athletes and their families need to monitor for any signs/symptoms of myocarditis including: onset of chest pain, shortness of breath or difficulty breathing, irregular heartbeat or palpitations, or feeling dizzy or faint. If any of these symptoms should develop, they should stop physical activity and seek immediate medical care.
Individuals with moderate symptoms (≥4 days of fever >100.4°F, ≥1 week of myalgia, chills, or lethargy, or a non-ICU hospital stay) and no signs of MIS-C:
These children and teens should NOT exercise until their symptoms are gone and they have been cleared by their pediatrician after a thorough physical exam, cardiac screening and EKG. If the cardiac workup is negative, gradual return to physical activity may be initiated after 10 days have passed from the date of the positive test result (assuming they have been symptom free). At this point, athletes and families should monitor for signs/symptoms concerning for myocarditis as listed above. If there is anything notable on the cardiac screening, the child will be referred to a cardiologist for further evaluation and monitoring.
Children who were very sick from COVID-19 or diagnosed with MIS-C:
These children should be treated as if they have myocarditis and should not exercise or compete for 3 to 6 months. They will need to have a thorough work-up and athletic clearance from a pediatric cardiologist before they are allowed to return to exercise or competition. The doctor will recommend a schedule of gradually increasing physical activity based on the child’s age and severity of symptoms.
Once children are ready to return to sports, it is safest to gradually get back into play with practices and scrimagges only for 3-5 days and then games after that if they have continued to stay symptom free. All that said, these are of course just guidelines and each case of COVID is unique, so please don’t hesitate to reach out to your pediatrician if you have any questions or concerns.
Jacqueline Phillips, MD, February 8, 2022
