Sports And Camp Check-Ups

By: Marc E. Childs, MD, Pediatrics, CareMount Medical

A rite of passage in spring is getting kids ready for warm-weather activities and sports, day camp, and sleepaway camp. As the world is cautiously opening up again, the prospect of getting children out of the house and into the fresh air is looking bright, compared to previous summers when activities were up-ended by the pandemic. For the majority of kids who have not tested positive for the virus that causes COVID-19, all they need is a routine medical check-up before they participate in sports or attend camp.

For the more than 12.8 million children who have tested positive for COVID-19 in the past two years, their situation is more complicated because there are still many unknowns about the disease and its after-effects. Most children infected by the virus have mild symptoms or have no symptoms and, rarely, others can get severely ill requiring hospitalization, intensive care, or a ventilator to help them breathe. Groups such as the American College of Cardiology (ACC) and the American Academy of Pediatrics (AAP) have developed guidelines for physicians to help them evaluate if and when children who have tested positive for COVID-19 should return to physical activity and sports.

Children and adolescents should not return to activities until seven days after testing positive for COVID19 and their symptoms have resolved completely for 72 hours. There is a consensus that children and adolescents who have had a positive COVID-19 test within the prior six months should visit their doctor for a complete physical examination before resuming sports and physical activities. The examination should take place greater than 14 days after symptoms have resolved. Importantly, the examination should include particular emphasis on assessing the child’s cardiac health regardless of the severity of their illness. Many pediatricians use the American Heart Association 14-element screening checklist to evaluate for any cardiac symptoms including chest pain, shortness of breath out of proportion for upper respiratory tract infection, new-onset palpitations, or dizziness.

Every child and every case are unique, but general guidance according to the American Academy of Pediatrics (AAP) is as follows for children 10 years of age and older:

• If the child is asymptomatic or has mild symptoms (less than four days of fever of greater than 100.4 and less than seven days of muscle pain, chills, or lethargy), and the pre-participation screening evaluation and examination are normal, no further cardiac testing is warranted.
• For children with moderate illness (four or more days of fever greater than 100.4, seven or more days of muscle pain, chills or lethargy, a non ICU hospital stay, no evidence of MIS-C, a normal ECG or if a physical exam reveals any new or concerning cardiac issues), the physician may request an echocardiogram (echo). Patients with a normal echo can be cleared for participation as per above. If the echo results are abnormal, a pediatric cardiologist should be consulted, and additional testing may be required.
• Patients with severe illness (ICU admission and/or intubation— MIS-C—associated with COVID19 infection) should not exercise for at least three to six months and should be evaluated by a pediatric cardiologist prior to resuming training or competition. They may require other tests based on signs or symptoms.

The AAP also recommends that doctors educate all patients and families to monitor for “chest pain, shortness of breath out of proportion for upper respiratory tract infection, new-onset palpitations or syncope when returning to exercise.”

Most pediatric patients will be easily cleared for participation without extensive cardiac testing, but parents and caregivers should schedule an appointment with their child’s pediatrician as soon as possible to ensure that these patients have fully recovered and have no evidence of damage to the heart.