AAP: Kids with COVID-19 may need ECG before returning to sports
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In updated guidance, the AAP said some children with COVID-19 may need an ECG before they return to playing sports, based on growing evidence that SARS-CoV-2 infection can severely damage the heart.
The AAP originally published interim guidance on July 23 that advised pediatricians and parents on the risks and benefits of children returning to sports.
Before returning to play, children who experienced severe presentations of COVID-19 or who had multisystem inflammatory syndrome in children (MIS-C) “must be treated as though they have myocarditis and restricted from exercise and participation for a duration of 3 to 6 months,” and their cardiac testing must have returned to normal before they can return to playing sports, according to the AAP guidance.
“If an athlete gets MIS-C, then we know they have an inflammatory component to the COVID-19 infection and the heart may be affected as a result,” Susannah M. Briskin, MD, FAAP, a sports medicine specialist at Rainbow Babies and Children’s Hospital in Solon, Ohio, told Healio. “So, we assume that an athlete may have viral myocarditis. The recommendations would include a pediatric cardiology consult and restriction of sports for 3 to 6 months. This is not too long. It is the standard for viral myocarditis caused by any virus. Viral myocarditis can cause arrhythmias and can result in sudden death. Restriction from sport until full recovery and normalized testing is obtained — deemed by cardiologist — would be indicated.”
Children who had moderate symptoms — and any child with “current or a history ofpositive cardiacsymptoms, who hasconcerning findings on their examination”— also should receive an ECG, the AAP said.
All patients who had COVID-19 should be cleared for participation by their primary care physician, according to the AAP. The focus of that screening should be for cardiac symptoms, including to chest pain, shortness of breath, fatigue, palpitations, and syncope.
“There is emerging, but limited evidence that COVID-19 can cause myocarditis in individuals, even asymptomatic individuals,” Briskin told Healio.
Briskin said the AAP guidance aligns with analysis released in July by the American College of Cardiology, supporting the recommendation that pediatric patients be cleared by a physicians before returning to sports.
Any youth participating in exercise or sport-related activities who has or has been exposed to someone with COVID-19 should not attend any practice or game for a minimum of 14 days, the AAP said. Parents and guardians should report any symptoms, whether in their child or in the child’s household. This applies to asymptomatic patients, as well.
“The main reason for this is to have them assessed for any signs and symptoms that are concerning for myocarditis — shortness of breath, chest pain, etc.,” Briskin said. “They should also have a gradual return to physical activity to be monitored for development of any of these symptoms as individuals start up exercise.”
The AAP also said that if a child athlete tests positive for COVID-19 while on a sports team, team officials and the health department should be notified to ensure contact testing and appropriate quarantining.
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AAP. COVID-19 interim guidance: Return to sports. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/. Accessed Sept. 18, 2020.
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