Coronavirus 2019 disease (COVID-19) is often mild, but can lead to cardiovascular harm. Ensuring the safe return to sports by affected children will be a necessity. The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on our delivery of health care. It has also affected economic systems, global politics, and our quality of life, especially for children and particularly those involved in sports. In the United States alone, over 35 million children and adolescents participate in athletic endeavors, and social distancing requirements and the immediate halting of large gatherings has negatively affected their physical and psychological health. With the return to school, sporting events are resuming under the watchful eyes of local or state governments, which often seek guidance from medical organizations, sporting bodies, and the Centers for Disease Control and Prevention in formulating regulations. We propose the following recommendations for the safe return of children to all athletic participation (including gym class and heavy chores), after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, to assist pediatricians and primary care providers (PCPs) in making the safest decisions for their patients. All children and adolescents who are SARS-CoV-2 positive, once asymptomatic, should seek clearance from their PCP prior to returning to athletic participation. This visit should occur after they are asymptomatic for a minimum of 24 hours off fever-reducing medicine, and have completed their 10-day quarantine period.12 The visit should involve a (re-)evaluation of the local preparticipation questionnaire with a comprehensive physical exam. The PCP should pay specific attention to the parts of the questionnaire that are pertinent to cardiac symptoms, such as episodes of chest pain, shortness of breath, exertional dizziness, excessive fatigue out of proportion for a viral upper respiratory infection, and new onset syncope and palpitations during the patient`s infection or recovery. Gastrointestinal symptoms such as early satiety, abdominal pain, nausea, and anorexia can sometimes warrant an evaluation for heart failure.13 Any new history or physical exam findings at this visit should prompt referrals and further testing.
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