Sports Physicals and AAP Guidance on Return to Play

As we enter the season of sports physicals for student athletes, a reminder that the current American Academy of Pediatrics (AAP) guidance encourages that a sports physical be conducted by the patient’s primary care provider in conjunction with a well-visit. Munson Healthcare endorses this approach.

In addition, the AAP has provided some minor updates to its guidelines on sports clearance or return to play for student athletes with a history of COVID-19 infection. Included in those recommendations:

• For all patients with a history of COVID-19 infection, a thorough investigation of any cardiac symptoms associated with the infection should be conducted including questions about
  • chest pain
  • shortness of breath that is out of proportion for upper respiratory infection
  • any palpitations or syncope
• Recent literature has reported a much lower incidence of myocarditis, 0.5% to 3%, than earlier in the pandemic; however, children and adolescents who were found to have myocarditis were in the asymptomatic or mildly symptomatic category so this screening is imperative for any child with a history of COVID-19 infection, regardless of active infection symptom severity.
  • For any child who exhibited or reports any associated or lingering cardiac symptoms, additional cardiac testing and workup, including EKG, should be considered prior to sports clearance and a gradual return to play approach should be recommended with a 7-10 day increase in duration and intensity of physical activity.
• For any patient who had a severe case of COVID-19 with or without Multisystem Inflammatory Syndrome (MIS-C):
  • Exercise should be restricted for a minimum of 3-6 months
  • Cardiology consultation and clearance should be obtained
  • Gradual return to activity plans should be recommended
• If a child with a history of COVID-19 infection has already advanced back to physical activity and sports on their own and does not have any abnormal sign/symptoms, no further workup is necessary.

Current AAP recommendations, algorithms, and return to activity plans are available on our For Providers website.