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Published on February 15, 2021

Child with face mask sitting in soccer uniform with soccer ball

Returning to sports and activity after COVID-19 infection

Children are returning to gymnasiums and fields as schools resume in-person learning. Those who recovered from COVID-19 should exercise special precautions before returning to regular exercise or sports, says Christen Chamberland, MD, pediatric cardiology specialist.

How can COVID-19 impact children’s hearts?

First, the virus can cause inflammation or injury to the heart muscle, which can lead to heart function and heart rhythm issues. Sometimes, the risk of heart rhythm issues can last up to six months after the child feels better. Children may have signs of chest pain, shortness of breath or fatigue with activity. We evaluate children for this concern by looking at an EKG, blood work and possibly an echocardiogram. We may have to restrict exercise for three to six months if the child has inflammation of the heart, known as myocarditis.

The second concern occurs two to four weeks after infection. The infection can cause a chain reaction of immune response, which causes inflammation in multiple organ systems, including the kidney, heart, lungs, skin and nervous system. This is called Multisystem Inflammatory Syndrome in Children (MIS-C). Kids can be very ill, requiring hospitalization for breathing help, or issues with heart or kidney function. MIS-C can occur in young children and teens.

When can children safely resume activity after COVID-19?

Children can gradually increase activity no sooner than 10 days after symptoms resolve. After that, watch for chest pain and shortness of breath. If children show these symptoms, parents should speak with their primary care provider before returning to exercise.

Should children see a provider before returning to sports?

Children should see their primary care provider if they had a fever of at least 100.4 degrees, significant fatigue, shortness of breath or a bad cough for three or more days or if their child has symptoms with routine activities.

Do certain sports or activities pose a higher risk for children after a COVID-19 diagnosis?

If a child is at risk, they should be evaluated by their provider. If the provider determines there is no concern, they can return to exercise gradually.

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