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With the summer winding down and the school year shifting into gear (although, with a much different look from previous years), pediatricians’ offices are once again seeing patients for well visit appointments and sports physicals for those children/adolescents planning to participate in athletics this year.

As schools reopen, there are additional questions regarding student athletes. Namely, if my child was diagnosed, or is at some point this school year diagnosed, with COVID-19 infection, is he or she safe to return to sports? With most viral infections, the answer is usually yes, once recovered. Certain viral infections such as that from Epstein-Barr virus, which causes “Mono,” may require additional clearance from your Pediatrician following a thorough assessment before sports may be resumed. Due to COVID-19 being such a new virus, there is still much to learn about its potential long-term effects; however, it does seem to be different, from the common cold, in that it can cause more severe systemic inflammation, including inflammation of the heart. For this reason, The American College of Cardiology (ACC) has provided additional recommendations for children following a COVID-19 infection.

If your child/adolescent has mild symptoms or a child under the age of 12 has mild to moderate symptoms, then he or she may be cleared for participation once completely asymptomatic for 14 days. Note that this may mean your child is allowed to return to school before they are cleared to return to sports.

The most notable difference in clearance concerns those athletes 12 years or older, who have moderate symptoms (which the ACC defines as “prolonged fevers and bedrest, no hospitalizations, no abnormal cardiac testing) and participate in high-intensity competitive sports or physical activity. These patients should all receive an electrocardiogram (ECG), which records the electrical signals in your heart, prior to returning to play. If the ECG is abnormal, then further testing and evaluation is needed.  In any adolescent with a severe COVID-19 illness, which requires hospitalization, in-depth testing and evaluation by a Pediatric Cardiologist is required before consideration for returning to play.

The goal of these guidelines is to identify any patient who may have Myocarditis, a condition characterized by inflammation of the heart muscle. While rare, if undiagnosed, a heart that is damaged and then put under the stress of any high-intensity exercise could result in heart failure, abnormal heart rhythms, or even sudden cardiac death.

Though this may seem like a lot of steps to take, as with a safe return to school, a safe return to sports means taking the necessary precautions to ensure that every athlete is and stays healthy for play. If you have any questions or concerns, give your Pediatrician a call!

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