Health Issues

Youth Sports: A COVID-19 Safety Checklist

Youth Sports Participation During COVID-19: A Safety Checklist

Having COVID-19 vaccines for kids age 5 and up is a game changer for many families. Being fully vaccinated can mean a safer return to fun and healthy activities like youth sports.

For children still too young to get the vaccine yet, though, it is especially important to continue steps that reduce the risk of spreading the virus. Also keep in mind that many kids have been less active during the pandemic, raising their risk of certain injuries. Plus, any child or teen who has recently had COVID-19 needs to be screened by their pediatrician for possible effects of the virus on the heart before resuming physical activity.

Read on for more ways to keep your child safe and healthy as they return to sports and other physical activity.

Before the sports season starts

☐	Understand the safety rules and expectations for participation during COVID-19 and talk about them with your child.
☐	Make sure your child has their own face mask, hand sanitizer, towel, water bottle, and tissues labeled with their names.
☐	Call your pediatrician to make an appointment if your child needs a pre-participation physical exam.
☐	If your child hasn't been active during COVID-19, start easing into exercise. For sports with a lot of running, for example, consider a beginner conditioning program (such as the "Couch to 5K" or "None to Run" apps) a couple of 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 during the pandemic.

Prior to practice or games

☐	Keep your child home from practice or games if they're feeling sick or have any symptoms of COVID-19, and get a test if the doctor recommends.
☐	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.
☐	For children who are not fully vaccinated, wear face masks when arriving or leaving the playing facility and off the playing field. Regardless of vaccination status, encourage your child to wear a mask in crowded indoor spaces such as locker rooms 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 conditions.

Children and teens with no symptoms or mild symptoms of COVID-19, and no symptoms of MIS-C, need to have a phone or telemedicine visit with their pediatrician. The doctor will tell you how long to quarantine 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 clearning your child for physical activity.
Kids with moderate symptoms 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). This includes those who needed to stay in the ICU and/or were intubated. Depending on your child's signs and symptoms, other tests may need to be done. Before your child leaves the hospital, there should be a plan to follow-up with a cardiologist.

Children and teens who had severe illness or MIS-C should not exercise or compete in athletics for at least 3 to 6 months. A pediatric cardiologist your child before they are allowed to return to exercise or competition. The doctor will recommend a schedule of gradually increasing physical activity based on your child's age and severity of symptoms.

Keep in mind that even if your child has been cleared for activity, they will need to stop immediately if they experience chest pain, increased shortness of breath, sudden heart palpitations, feeling faint, or passing out. They will need to see their pediatrician in-person if they have these symptoms, which could signal heart problems.

During sports practice or games

☐	If the sport is outdoors and your child is not fully vaccinated against COVID-19, encourage them to wear a face mask when on the sidelines and during group training and competitions that involve continually being within 3 feet or less from others.
☐	Anyone not fully vaccinated should wear a face mask for all indoors 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 and diving, since wet masks may be difficult to breathe through. Gymnastics, cheer stunts, and tumbling to avoid masks getting caught on equipment, creating a choking hazard, or accidentally covering eyes. Face masks are also discouraged while wrestling, unless an adult coach or official is closely monitoring to ensure the masks to become a choking hazard. Exceptions to mask-wearing might be a appropriate when the risk of heat-related illness is increased.
☐	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 unvaccinated children, 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.
☐	Store personal equipment 6-8 feet away from other teammates' equipment.
☐	Minimize sharing sports equipment when possible.
☐	Sanitize hands before and after using shared equipment such as balls, bats and sticks.
☐	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 child's pediatrician if you have any questions about your child participating safely in sports, based on vaccination status, COVID-19 rates in your community and your child's individual health.

More Information

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

Last Updated: 9/30/2021

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.