The following recommendations are based on a collaborative effort by experts in childhood sports medicine from representative regions around the United States. Keep in mind that some recommendations may vary by geographic region, and are subject to change on a regular basis. As our understanding of the disease evolves, our recommendations may evolve as well - so check back periodically.
All athletes should confirm the absence of any of the following COVID-19 related symptoms before sports participation: fever, cough, shortness of breath, shaking chills, loss of taste or smell, sore throat, nausea, vomiting, diarrhea, fatigue, discoloration of the fingers or toes, pain in the extremities.
Individuals who have tested positive for COVID-19 should rest for at least 10 days and be symptom free for at least 7 days. Written medical clearance is recommended with a documented negative repeat COVID-19 test whenever possible prior to a graduated return to play protocol.
A medical evaluation should be considered for those with close contacts who have tested positive for COVID-19, as well as for those with risk factors such as asthma, diabetes, cardiac disease, or a compromised immune system.
Cardiopulmonary complications of COVID-19 may present up to 6-8 weeks or more post-infection and can be associated with the following symptoms:
Shortness of breath or difficulty breathing; chest pain, pressure or tightness; palpitations, racing heart; dizziness, passing out or seizure.
The presence of any of these symptoms and a previous history of known or potential COVID-19 illness warrants a thorough cardiopulmonary evaluation prior to return to sport.
We recommend symptom screening at least weekly via a convenient phone app or online platform accessible by coaches and parents, acknowledging symptom screening alone is not sufficient to mitigate infection and must be combined with other risk reduction strategies.
It is important to acknowledge the potential effect of peer pressure and negative social implications for children who report symptoms or have COVID-19, and we emphasize the need to develop and reinforce a culture that prioritizes the health of teammates and family members above sport.
Risk stratification and risk reduction
Different sports have different levels of risk of transmission that must be taken into account when planning for returning.
High Risk Sports
Involve close, sustained contact between participants and lack of significant
Examples: wrestling, football, rugby, basketball, lacrosse, competitive
cheer, water polo
Moderate Risk Sports
Involve close, sustained contact but also can take advantage of protective
equipment and separation among players
Examples: volleyball, baseball, softball, soccer, tennis, gymnastics,
ice hockey, field hockey
Risk reduction tactics should include:
parent decision making
Ultimately, parents should be empowered to make decisions that are right for their children and their family. Considerations for parents enrolling their children in youth sports should include: