How and When Children Should Return to Sports During COVID-19

• The American Academy of Pediatrics has issued guidelines for children playing sports during the COVID-19 pandemic.
• Experts say parents should consider how a team practices and plays, as well as the spread of the disease within their community.
• They also recommend coaches start the season with individual skill drills and then move on to small group practices.
• Experts say parents should also consider the physical and psychological benefits of children playing sports.

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As the United States struggles to figure out if athletic competition is safe during the COVID-19 pandemic, the American Academy of Pediatrics (AAP) has issued interim guidelines for children returning to the sports field.

The key may depend on what sport the young athletes play, as well as where they play it, according to the recommendations released last week.

“Weighing the risk versus benefit of return to sport is driven by the sport and setting, local disease activity, and individual circumstances, including underlying health conditions that place the athlete or household contacts at high risk of severe disease should they contract SARS-CoV-2 infection,” the academy stated.

The point is to start the conversation with parents and answer some preliminary questions before turning children loose on the playing field.

“As children present for health supervision visits and pre-participation physical evaluations, parents and athletes likely will ask questions about how to best ensure safety when considering a return to sports participation,” the guidelines state.

Caution with children

Opinions vary as to how vulnerable children are to COVID-19.

While the AAP points out children contract SARS-CoV-2 less frequently than adults and typically have a less severe reaction to COVID-19, some states are reporting recent surges in the number of children with the novel coronavirus.

On July 16, the Florida Department of Health reported that 23,170 children had tested positive in that state since the pandemic began. By July 24, that number soared to 31,150 — a 34 percent increase in new cases among children in 8 days.

There’s also the COVID-19 outbreak among the Miami Marlins baseball team to consider.

“When deciding about participation, parents must assess the risk,” Alicia Filley, PT, MS, a physical therapist and the editor of Sports Injury Bulletin, a resource for coaches and sports clinicians, told Healthline. “How prevalent is the virus in their area? Is their child able to maintain appropriate distancing from other children during practices and games? Team and individual sports that are outside, like soccer, baseball, tennis, and golf, will be easier and safer to implement.”

Filley suggests coaches start with individual drills with plenty of physical distancing, followed by pod drills. Pods are small groups of kids who move together through drill stations during every practice

“By forming interactive pods, kids limit their exposure risk,” Filley said. “The next step is to progress to full team practices.”

Dr. Sharon Nachman, the chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital in New York, told Healthline that parents need to look to their municipalities and other adults first when determining whether to let kids play.

“It’s not about the sport nearly as much as it is about the community and county numbers,” Nachman said. “Those numbers tell us much more about the adults and give us a sense of asymptomatic spread and what percentage of kids are getting sick.”

“How many kids are part of the team? How are they training? How are they hanging out together in the dugout, locker (room), or bench? Are they social distancing, masking, handwashing?” she added.

The National Training Centres have recently reopened, observing strict COVID-19 protocols.

Dan Blackburn, the founder and president, told Healthline that parents should start with honest conversations with their child athletes.

“Parents (should) open an ongoing dialogue with their kids about what they enjoy doing and discuss the fears/apprehension/concerns that the kids and parent might have about returning to sports after a 3- to 4-month hiatus,” he said.

Government guidance

Relying on municipalities can be problematic for parents and coaches due to overlapping guidelines coming from cities, counties, and states.

Dr. Jalan Burton, the founder of Healthy Home Pediatrics in Washington, D.C., told Healthline the federal government could make things easier for everyone involved.

“The return to sports and activities during COVID-19 should be national or at least regional,” Burton said. “State by state does not make sense when dealing with an international pandemic.”

“I am licensed in D.C., Maryland, and Virginia, and even though I can venture to all of these jurisdictions in an average day as a house call pediatrician, the responses varied and the policies varied significantly,” Burton said.

“To truly open our country, we must get ahead of the curve, as they say. If this requires us to take our time returning to organized sports, let’s do it,” she added.

The issue of testing

Not only do parents have to worry about their children, but there will also be contact with coaches and parent volunteers.

That can be problematic if someone hasn’t been tested.

The AAP guidelines discourage testing for athletes “unless an athlete is symptomatic or has been exposed to someone known to be infected.”

“As a parent volunteer at my son’s District of Columbia public school, I saw a huge shift in pre-volunteering clearance this school year,” Burton said. “This year, for the first time, a background check and tuberculosis screening was required. I do not think it’s realistic to ask parent volunteers to have COVID-19 testing because it would require multiple tests, maybe even for each volunteer activity. That is costly and time-consuming and may have little return for investment.”

The benefits of sports

There’s a reason why Burton and other doctors are putting lots of thought into how kids can return to sports and other activities.

Athletics can be critical to a child’s development.

The AAP points out that 35 to 45 million children between the ages of 6 and 18 participate in some form of athletics in the United States, and doing so has significant physical and psychological benefits.

“Youth sports are an excellent way to promote and enhance a child’s development,” said John Gallucci Jr., MS, ATC, PT, DPT, the chief executive officer of JAG-ONE Physical Therapy and the former head athletic trainer for the New York Red Bulls of Major League Soccer. “Not only will the child benefit from exercise and learning a new sport, but they will also develop fine and gross motor skills and learn to socialize and interact with their peers. Additionally, the child will learn to set and attain goals, build self-confidence, and work together as a team.”

Looking to the future

Many agree that when scientists finally get a handle on controlling COVID-19, youth sports won’t be the same moving forward.

“We must work together during these stressful times to ensure that our youth has the opportunity to participate in athletics safely,” Gallucci told Healthline. “As we work toward a vaccine, we may have to adapt or adjust length of season, timing of season, practice and game schedules, illness reporting, and a number of other factors. Although this may be difficult or not ideal in the beginning, remember that the ultimate goal is allowing for our youth to have a safe environment and to see and interact with friends, get some exercise, and develop critical milestones along the way.”

Here are some tips from the AAP for families and coaches returning to youth sports from COVID-19 lockdown:

• Families should review and discuss school and league COVID-19 policies as well as CDC recommendations for youth sports.
• Always follow safety protocols.
• Prioritize noncontact activity, including drills maintaining physical or social distancing.
• If physical distancing can’t be maintained, use cloth face coverings or masks.
• Reinforce appropriate hygiene and respiratory etiquette through signage, education, and use of handwashing stations or hand sanitizer.
• Maintain practice pods in small sizes without mixing athletes.
• Minimize travel to other communities and regions.
• Clean and disinfect frequently touched surfaces on the field, court, or play surface, as well as drinking fountains. This should be done at least daily or as much as possible.
• Reduce use of shared equipment and communal spaces, such as locker rooms.
• Avoid poorly ventilated areas and small spaces. Use fans or open doors and windows when possible.
• Don’t allow athletes to share food and drink. Participants should always use their own water bottles.