While most children and adolescents with COVID-19 make a full recovery, the virus can sometimes have lasting effects. One of these effects can be damage to the heart muscle – and if a damaged heart is stressed from exercise, it can lead to arrhythmias, heart failure, or even sudden death.
It seems rare. But given that we literally learn as we go about COVID-19, it’s hard for us to know how rare it is – and how risky exercising after a positive COVID-19 test could be. be. To help physicians, trainers, gym teachers, parents, and caregivers make safe decisions, the American Academy of Pediatrics has published some advice on returning to sport and physical activity after having COVID-19.
This is “interim advice” – our current best guess of what to do, based on what we know so far. Unfortunately, there is a lot we don’t know and can’t know until we have had more time to study the virus and observe what happens to patients as they recover over time. weeks, months and years.
What is important to know about returning to sport and physical activity?
Adolescents and young adults who participate in competitive sports are at the highest risk for heart problems. This is both because young children seem less affected by COVID-19, and because older teens and young adults have more difficult workouts which are more likely to stress the heart muscle. Of course, no one can say for sure that running around an elementary school yard is completely safe for a child who has had COVID-19.
Recommendations for returning to physical activity depend on whether the case of COVID-19 was considered mild (including asymptomatic), moderate, or severe.
- Mild: less than four days of fever greater than 100.4 and less than a week of muscle pain, chills, or fatigue (this includes asymptomatic cases)
- Moderate: four or more days of fever greater than 100.4; a week or more of muscle pain, chills or fatigue; or a stay in the hospital (not in the intensive care unit) without proof of MIS-C. (MIS-C is the multisystem inflammatory syndrome that sometimes occurs with COVID-19.)
- Severe: any stay and / or intubation in an ICU, or proof of MIS-C. During intubation, a tube is placed through the mouth into the airways and connected to a machine to help a child breathe.
What screening can be done after a child recovers from an asymptomatic to mild case of COVID-19?
It’s more difficult to offer counseling to young people who have had mild or asymptomatic cases because we really have limited data on this group when it comes to their heart health.
For these children, experts recommend that parents check with the child’s primary care provider. Wait until the child has recovered from his illness (or at least 10 days after a positive test if the child is asymptomatic). They should be screened for any symptoms of heart problems, the most concerning being
- chest pain
- shortness of breath more than you expected after a bad cold
- palpitations they’ve never had before
- dizziness or fainting
A simple phone call to the doctor’s office may be sufficient following very mild or asymptomatic cases in children who are not serious athletes.
An in-person exam is a good idea for those with more borderline cases, or if there are concerns, or if the child is a serious athlete.
If there are concerns with answering questions or the physical exam, then an EKG and referral to a cardiologist makes sense.
If there are no worries, children can resume recreational physical activity when they feel able. Returning to competitive sports should be gradual, monitoring symptoms along the way. See the AAP tips linked above for suggestions on how to do this.
What screening can be done after a child recovers from a moderate or severe case of COVID-19?
Any child with moderate illness should see their primary care provider for symptom screening and examination. Schedule the visit at least 10 days after the child has tested positive for the virus and has had no symptoms for at least 24 hours without taking acetaminophen or ibuprofen.
If there are any questions or concerns regarding symptoms or a finding on physical examination, it is advisable to see a cardiologist for clearance and advice on returning to physical activity.
Children who have had a serious illness should definitely see a cardiologist and should be banned from activity for at least three to six months, only returning when a cardiologist says everything is fine.
Again, these are interim directions that will evolve as we learn more about COVID-19 and its short- and long-term effects. If you have any questions, talk to your doctor.
Follow me on twitter @drClaire