Returning to youth sports & COVID-19

Returning to youth sports & COVID-19

Playing sports has many benefits. The socialization our young athletes engage in provides them with benefits both physiologically and psychologically. Participating in athletics helps control obesity, improves body composition, increases cardiovascular benefits and helps build immunity.

Unfortunately, the coronavirus has impacted youth sports in a dramatic way. As the State of West Virginia starts to allow a return to youth sports, athletes and parents should take some important measures as we begin the reopening phase.

COVID-19 transmits during social gatherings, and even though we do not have adequate information on how COVID-19 affects children, there is a potential risk of contracting this deadly virus at athletic events. Compliance with social distancing and mask usage must be a priority at these events.

Frequently Asked Questions

When returning to sports, many parents ask:

  • Should I have my child tested before returning to sports? At this time, the American Academy of Pediatrics does not recommend testing youth to return to sports.
  • What if my child or someone in my family starts to display symptoms of COVID-19? Contact your primary care physician or local health department. Follow the CDC guidelines for testing, quarantining and isolation. Information is available at
  • My child had COVID-19: can they return to sport? According to the American Academy of Pediatrics, individuals who test positive for COVID-19 should not exercise until they are cleared by a physician. Athletes should visit their primary care physician with an emphasis on cardiac symptoms. If the physician’s exam is normal, no other tests are warranted, and the athlete may begin a gradual return to athletics (see below). If the physician is concerned about the patient’s history or finds an abnormal finding in the exam, an ECG should be performed and the child referred to a pediatric cardiologist.

For those who have moderate symptoms of COVID-19 for more than 4 days plus a fever over 100.4°F or those who had a non-ICU stay and no evidence of multisystem inflammatory syndrome in children (MIS-C), an ECG and cardiology consult are currently recommended after symptom resolution, and at a minimum of 10 days past the date of the positive test result. The cardiologist may consider a full cardiac workup. If all tests are negative, the child may begin a gradual return to activity after a minimum of 10 days of symptom resolution.

For patients with severe COVID-19 symptoms including ICU stay, intubation and/or (MIS-C), it is recommended they be restricted from exercise for a minimum of 3 to 6 months and require cardiology clearance prior to resuming training or competition. Coordination of follow-up cardiology care should be arranged prior to hospital discharge. Extensive cardiac testing should include but is not limited to: troponin tests, echocardiogram and cardiac MRI.

Gradual return-to-play protocol

A graduated return-to-play protocol* can begin once an athlete has been cleared by a physician and is asymptomatic when performing normal activities of daily living. The progression should be performed over the course of a minimum seven days in conjunction with supervision of a health care provider. Throughout each phase, you should monitor your child for the following symptoms:

  • Dizziness
  • Difficulty breathing
  • Chest pain/pressure
  • Decreased exercise tolerance,
  • Fainting

If your child experiences any of these symptoms, all activity should be discontinued and a health care provider should evaluate further.

Stage Day Activity Intensity Resistance training

1 and 2
(2 days min.)

15 or less: Light activity (walking, jogging, stationary bike) <70% of maximum heart rate None
2 3
(1 day min.)
30 minutes or less: Add simple movement activities (e.g. running drills) <80% of maximum heart rate None
3 4
(1 day min.)
45 minutes or less: Progress to more complex training <80% of maximum heart rate Light
4 5 and 6
(2 days min.)
60 minutes: Normal training activity <80% of maximum heart rate Light
5 7 Return to full activity/participation (i.e. contests/competitions)

 *Adapted from Elliott N, et al, infographic, British Journal of Sports Medicine, 2020


If you have additional questions, talk with your primary care provider or call the Marshall Sports Medicine Institute at 304-691-1880.


Tom Belmaggio, MS, ATC, CSCS

Tom is the coordinator of sports medicine at the Marshall Sports Medicine Institute. Career highlights include serving as head athletic trainer for Marshall University, an intern for the Dallas Cowboys Football Club, a game day EMS crew for the Tennessee Titans and an athletic trainer for the New England Patriots.