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Disclosures: Briskin reports no relevant financial disclosures.
July 23, 2020
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AAP guidance notes risks, benefits of children returning to sports

Disclosures: Briskin reports no relevant financial disclosures.
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The AAP issued interim guidance to advise pediatricians and parents about the risks and benefits of children returning to athletics during the COVID-19 pandemic.

Susannah Briskin, MD, a sports medicine specialist at Rainbow Babies and Children’s Hospital in Solon, Ohio, and colleagues said reengaging in sports can provide physical and psychological health benefits for children, but also comes with risks.

“There are obviously different risks based on different sports,” Briskin told Healio. “The main takeaway is you can't avoid all risks with returning to sport. But there are certainly things that we can do to try and help minimize risk.”

Briskin and colleagues noted that children appear to be at a lower risk for contracting COVID-19 and typically experience less severe disease when they are infected. And while they do not appear to be a common source of outbreaks, “it is possible that children could infect adult coaches, officials, or family members after contracting SARS-CoV-2,” they wrote.

Close contact with a person who is infected is a main driver of transmission, and the authors suggested that certain sports or settings can influence the spread of the virus.

Susannah Briskin

“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,” they wrote.

Briskin said they did not rank sports in terms of risk, “but certainly [in] an indoor environment, there's a greater risk than exercising in an outdoor environment.”

“In the indoor environment, obviously, you have restrictions in the air quality and potentially the air flow, as well as indoor spaces tend to be smaller and so they can affect your ability to space out,” Briskin said. “We do think that indoor spaces are probably at a higher risk than outdoor spaces.”

According to the guidance, parents should review school and sports league policies regarding the spread of the coronavirus to other family members who could be spectating the sporting event. Briskin recommended that if a parent or other family member has a high-risk condition, they should consider not attending the sporting event — especially if the event is indoors.

“Spectators are typically going to be regulated by the local governing bodies,” she said. “A lot of state governments are deciding how many people can be gathered in a certain place. There may be restrictions on how many people can be present. Certainly, when anybody is on the sidelines, social distancing should be followed. You want to keep space from people who you don't live with, and use of a cloth face mask should be encouraged.”

Briskin said the issue of when children can return to playing sports has created controversy because there are no significant data on the subject. She said the AAP currently recommends that if any athlete has a known exposure, whether they are symptomatic or not, they should take 2 weeks off and not exercise or participate in sports, while being closely monitored.

“Certainly, if an individual develops symptoms and is diagnosed with COVID-19, then that restriction time will likely be elongated and follow-up with [a] pediatrician is recommended before return to sport,” Briskin said.

The interim guidance discourages testing children before they return to sports if they are asymptomatic and have not had contact with someone known to be recently infected. It also recommends against antibody testing.