Your teen may appear to be fully recovered from COVID-19, and is probably very eager to return to the activities they love. But before you allow them to get back into the gym or out on the field, there are some precautions you should take to ensure they are physically and mentally ready to return to sports.

Why? We now know this virus can be linked to health problems that may last well beyond the initial wave of symptoms. Kids may also experience depression or anxiety when they’re out of the game for an extended period of time, and their bodies may be deconditioned, putting them at greater risk for injury.

“These all tend to get worse the longer an athlete is out of a sport, but they could happen even over a relatively short isolation or quarantine period,” says Children's Healthcare of Atlanta pediatric sports medicine physician Armand Scurfield, MD.

This is why it’s so important to be sure you’re up to speed on the most recent return-to-sport recommendations for teen athletes who have tested positive for COVID-19.

Once symptoms have subsided, your teen can slowly reintroduce light physical activity into their routine. How quickly this can happen depends on the severity of the illness. Here are some general guidelines to help you determine how soon your athlete can be up and running:

• Asymptomatic or mild symptoms (fewer than four days of fever and less than one week of body aches, chills, fatigue)
• The athlete should be at least five days from a positive test and fever-free for at least 24 hours without the use of fever- or symptom-reducing medications before they gradually returns to sports.
• Monitor for any signs of exercise intolerance, including shortness of breath, heart palpitations, chest pain with exercise, or fainting. Stop exercise and seek further evaluation if these occur.
• Moderate symptoms (four days or more of fever greater than 100.4°F or one week or longer of symptoms)
• The athlete needs to be at least 10 days out from a positive test or from symptom onset, fever-free and symptom-free for at least one day without the use of fever- or symptom-reducing medication. They also needs to be screened by their pediatrician with a physical exam and an ECG test for their heart prior to returning to sports.
• Severe symptoms (hospitalized for treatment)
• The athlete will be required to obtain clearance by their pediatrician and may need an evaluation by a cardiologist as well. Children who experience severe symptoms may have to wait three to six months before returning to athletic activities.

Why is it important for teen athletes to see a doctor after a COVID-19 infection?

Before your teen is officially back on the roster and running in step with their teammates, they need to be evaluated by a pediatrician or a primary care provider. Getting the all-clear by a physician is one easy step for safety and can give you peace of mind.

When your child visits a pediatrician, the doctor will assess readiness to return to sports, both mentally and physically.

Being away from teammates and activities may have taken more of an emotional toll than your teen realizes, so it’s important to screen for signs of depression and anxiety, such as:

• Irritability or anger
• Feelings of worthlessness
• Decrease in energy and motivation
• Social withdrawal
• Sadness

"Parents and athletes should look out for these issues if they have been away from organized sport for any length of time due to COVID-19 concerns," says Dr. Scurfield.

If your teen experiences any new heart-related symptoms while sick with COVID-19, during their recovery period from the virus or when they return to their regular activities, a checkup with a pediatric cardiologist is highly recommended. Concerning heart symptoms may include:

• Chest pain
• Shortness of breath
• Fatigue
• Fainting
• Heart palpitations

“Fortunately, heart problems after COVID-19 are rare in children and adolescents,” says Matthew Oster, MD, MPH, Director of the Cardiac Outcomes Research Program at the Children’s Heart Center. “However, it is important to seek cardiac evaluation if a child has any concerning heart symptoms during their COVID-19 illness or after they return to play.”

During an exam with a cardiologist, your teen will share their medical history as well as their family medical history in case anyone has a heart condition. They may also undergo an electrocardiogram, or ECG, which measures the electrical signals that control the heart and can help doctors see if there is evidence of heart disease.

• If cardiac symptoms/screening are negative and the ECG is normal, the pediatrician could clear them to begin a gradual, four-day minimum progression back to sports
• If cardiac symptoms/screening are positive or the ECG test is abnormal, a referral to a cardiologist is recommended before returning to sports or activities.

“Based on the results of this initial exam, we may have to schedule additional tests like an echocardiogram, ambulatory rhythm monitoring, exercise test or cardiac MRI,” Dr. Oster says. “This will also give us a chance to figure out whether your teen athlete may need to be restricted from activities like sports practices and games for any specific amount of time.”

In most cases, as long as the athlete closely follows their physician’s recommendations and reaches out to their doctor if any concerning symptoms begin or continue, they should be able to return to sports gradually without worry, Dr. Oster adds.

If your teen athlete has had MIS-C, they will be restricted from all sports for about three to six months, or until they are cleared by a pediatric cardiologist.

“What we’ve learned through our research is that heart-related issues are common in children who are diagnosed with MIS-C, but these problems tend to resolve after a few weeks to months,” says Dr. Oster.

In addition to heart complications, kids with this condition also may experience inflammation throughout the body, shock or low blood pressure.

Your child may return to sports when their isolation or quarantine is completed and they are fully recovered, but doctors advise that they do so gradually to limit their risk for injury. When an athlete is away from sports or activities for any extended amount of time—from a couple of weeks to a month or longer—their body isn’t prepared to just jump right back into activity.

“An athlete’s bones, tendons, ligaments, muscles and organs, including the heart and lungs, undergo deconditioning, all of which put the athlete at high risk of injury if returning to sports too quickly,” says Dr. Scurfield. “Athletes are at high risk for stress fractures, ligament tears, muscle strains, and all kinds of injuries if they try to do too much too soon. Their bodies need to gradually build up to the physical demands of their sport.”

This is why Dr. Scurfield recommends athletes follow the American Academy of Pediatrics recommended guidelines for returning to sports after being quarantined or isolated due to COVID-19. “You don’t want to try to rush back into your sport too quickly just to get injured and have to sit out for another lengthy period of time,” he says.

Can my teen athlete compete as usual after they've been cleared by their doctor?

After an athlete has been cleared by their doctor to return to play, it’s important to encourage them to still proceed with caution and listen to their body. It may take seven to 10 days to get back to their baseline activity level. If they had a more moderate or serious COVID-19 illness, this period may be longer. Encourage them to talk with their coach about the doctor’s recommendations for a gradual return to practices and competition, and to speak up if they are experiencing any symptoms or has any concerns.

“Talk to your teammates, parents, athletic trainers, coaches, pediatrician and/or a sports medicine physician if you have any concerns at all,” says Dr. Scurfield. “We all want you back playing sports and doing what you love. Just make sure that you gradually return to activities to help avoid serious injury.”