AAP: Children who had mild or asymptomatic COVID-19 do not need to be cleared for sports

Children who had asymptomatic or mildly symptomatic COVID-19 no longer need to be cleared by a doctor before returning to sports or physical activity, the AAP said in updated guidance.

“We are recommending that children who are asymptomatic with COVID-19 or who have symptoms for less than 4 days contact their physician and have a phone call or a telemedicine visit, at a minimum, so that their medical record can be updated with the diagnosis,” Susannah Briskin, MD, coauthor of the guidance and a sports medicine specialist at Rainbow Babies and Children’s Hospital in Solon, Ohio, told Healio. “Then the individual can at least be screened over the phone for any concerning pulmonary or cardiac symptoms that would warrant an in-person visit.”

Briskin said it is the first time the AAP’s guidance on returning to sports does not include a mandatory physical clearance for children who have had COVID-19 since the guidelines were first published last July.

The updated guidance also recommends that children aged 12 years or older should gradually return to physical exercise, especially those “who have not been active to start off with,” Briskin said. Children who have not been consistently active for more than 1 month “should start at 25% of their usual volume and intensity of activity and consider every-other-day exercise,” the AAP said.

“An increase of volume of 10% per week is recommended until the desired volume is achieved. Next, intensity of the desired exercise can be increased by 10% per week until the desired in intensity is reached,” it said.

Sasannah Briskin

“Kids who have been sitting online for school and individuals who haven't had the opportunity to participate in sports, if they just go join the team and start practicing every day, they are at high risk for suffering overuse injuries, such as a stress fracture, or a problem with growth plate irritation,” Briskin said.

AAP recommendations for vaccination are in line with CDC guidelines. However, the AAP’s masking policy differs slightly because masks can be a hazard for some indoor sports.

“Athletes should wear a face mask for all indoor sports training, competition, and on the sidelines if they are not fully vaccinated, except in the case where the mask bears a safety risk,” the AAP said. “Parents and spectators should follow current local regulations for physical distancing and use of face masks. Because indoor areas have higher rates of COVID-19 transmission, all spectators, regardless of vaccine status, should consider wearing a face mask during sporting events with limited spacing.”

“If you are indoors and not vaccinated, and in close proximity for stretches of time during sport, you should still mask unless the sport would be a hazard with a mask, such as something like swimming, where obviously, we don't want people in a wet mask in a pool,” Briskin said.

The AAP said athletes who are not fully vaccinated “should be encouraged to wear face masks on the sidelines and during all group training and competition in which there is sustained contact of 3 feet or less.”

According to Briskin, the majority of transmission occurs during shared car rides and shared meals among those who are not vaccinated.

“I really try and encourage people if they have to share a car ride to make sure everybody's masked and windows are down whenever the weather allows and try to avoid meal sharing if people are not vaccinated because there is still spread in those contexts,” she said.