Return to Play After COVID-19 Infection in Children | Infectious Diseases | JAMA Pediatrics | JAMA Network
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JAMA Pediatrics Patient Page
June 28, 2021

Return to Play After COVID-19 Infection in Children

Author Affiliations
  • 1Department of Pediatrics, University of Florida College of Medicine, Gainesville
  • 2Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
JAMA Pediatr. Published online June 28, 2021. doi:10.1001/jamapediatrics.2021.1485

As the pandemic continues, children may experience long-term effects from COVID-19 infections.

Because children may become “long haulers” or develop multisystem inflammatory syndrome in children (MIS-C), close monitoring after a COVID-19 diagnosis is important. In addition, children who are athletes require a separate return-to-play evaluation before they return to competitive sports or physical activities.

Children Who Test Positive for COVID-19 Infection

More than 3 million children have been diagnosed with COVID-19 since the pandemic began. Children have been tested after close exposures, during times of illness, or because they needed clearance for travel or procedures. During a COVID-19 infection, children can experience fever, cough, difficulty breathing, muscle aches, headache, or diarrhea, but many others have no symptoms. Unfortunately, as children get older and/or if they are Hispanic, Black, or American Indian or Alaska Native, they are at a higher risk for severe disease and death from a COVID-19 infection. In addition, any of these children can develop long-term effects.

What Are the Long-term Problems?

Children who have had a COVID-19 infection are at risk for developing MIS-C or becoming long haulers. Following their initial infection, long haulers can develop inflammation of the heart and lung tissues, among other issues. Children with MIS-C, which is an abnormal immune response after a COVID-19 infection, develop symptoms 2 to 4 weeks following their initial COVID-19 infection. These children may require intensive medical evaluations or even hospitalization to treat this condition.

Return to Play or Activity After COVID-19 Infection

We are still learning how to best treat children after a COVID-19 infection. This is especially true for children with long-term complications who need a safe return to sports. Some school systems are requiring that all middle and high school student athletes who tested positive for COVID-19 obtain medical clearance before they return to sports. In addition, many pediatricians feel all teens should be evaluated after a COVID-19 infection before returning to sports. These evaluations should include a review of symptoms (fevers, chest pain, palpitations, difficulty breathing) and a physical examination. Children with worrisome findings may require additional testing before they can safely return. While most children will be able to safely return to normal activities, some will require a slower, gradual return before they can safety resume their pre–COVID-19 activity levels. Any unexpected difficulties with a child’s a return to play require prompt medical attention.

What Can Parents Do?

Parents need to be aware of long-term consequences of COVID-19 infections and closely monitor their children for any concerning symptoms. They should contact their child’s clinician if their children experience any persistent fevers, difficulty breathing, chest pain, palpitations, dizziness, swelling of hands or feet, or fatigue following a COVID-19 infection. In addition, if their child participates in sports or physical activities, it is important that they ask their child’s clinician for recommendations on their safe return to physical activities. Now that COVID-19 vaccines are available for children 12 years and older, get them vaccinated so they are not at risk of infection or long-term COVID-19 problems.

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Article Information

Published Online: June 28, 2021. doi:10.1001/jamapediatrics.2021.1485

Conflict of Interest Disclosures: None reported.

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