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What is Myocarditis and are there COVID-19 Risks of Returning to Sports?

Posted on Aug 23, 2021

With fall sports about to start, parents may be concerned about myocarditis as their children return to play. On this week’s On Call for All Kids, Patrick Mularoni, M.D., medical director for Sports Medicine and IMG Academy Health Services for Johns Hopkins All Children’s Hospital, talks about myocarditis and the risks associated with return to playing sports after COVID-19.

Let’s start with myocarditis. What is it?

Myocarditis is an inflammation in the heart muscle. It can be caused by a variety of conditions, but one of the most common causes of myocarditis is a viral infection. Right now, the focus surrounding myocarditis is on COVID-19, but it has been present long before we knew about COVID. The good news is that myocarditis is a very rare occurrence especially considering the number of viral illnesses that most children catch each year, but as a physician, it is something that we need to be on the lookout for because this rare complication has been linked to the viruses that cause anything from hand, foot and mouth to mononucleosis.

You mentioned COVID-19. Have there been cases linked to COVID-19 infection?

The virus that causes COVID-19 is another virus that has been found to be a cause of heart inflammation and physician researchers have been studying this throughout the pandemic. Most children who catch COVID-19 have mild symptoms and are sick for less than one week and will have a lower rate of severe disease when compared with adults. Myocarditis after COVID-19 is rare, and we believe that it is more common after moderate and severe SARS-CoV-2 infections. Those are the infections in individuals who have fever for greater than three days, prolonged symptoms such as muscle aches or chills for more than a week and those children who are hospitalized because of their infection. The other children that would prompt concern for myocarditis are children who complain of chest pain or an abnormal heart beat or feeling in their chest associated with a COVID infection.

So if your child tests positive for COVID-19 and wants to return to sports what should you do?

Parents with athletes should follow back up with their pediatrician after their child has resolved from infection. We suggest that you wait for 10 days after the first symptom or the date of a positive test in a child that is asymptomatic. Your physician will evaluate your child and help to determine if further testing is necessary. When cleared, all children should go through a seven-day return to play protocol where they gradually increase their activity to both return to playing shape but also to make sure that symptoms do not arise while they are attempting to return to sports.

As we are getting back to fall sports in general, do you have any recommendations for athletes as they return this season?

I am in a unique position as I am not only a pediatric sports medicine physician, but I also coach youth lacrosse and football. Unfortunately, many of the kids who are coming back to sports are in worse shape than they have been in the past. This goes for the children who did not get COVID-19 and this could be from multiple factors, including the fact that many children stayed away from organized sports during the pandemic but also because many have been sedentary as their parents attempt to physically distance.

For all parents, even those that are not placing their kids in organized sports this season, it is important to get your child moving. We know that exercise is important for the health and wellbeing of your child and we need to get all kids back up and moving. For those who are returning to organized sports, it is important that they do this gradually but there is not a better time to start than now.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children's Hospital experts. Visit each Monday for the latest report. You also can explore more advice from Patrick Mularoni, M.D.

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