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Returning to Sports After a COVID-19 Infection: What Are the Risks?

School is back in session, which means fall sports are just around the corner, but some parents may wonder how their child’s COVID-19 infection might have lingering effects on the field or court. The biggest worry is myocarditis, so Patrick Mularoni, M.D., medical director for Sports Medicine and IMG Academy Health Services for Johns Hopkins All Children’s Hospital, explains what this is and the risks associated with returning to playing sports after COVID-19.

What is myocarditis?

This is an inflammation in the heart muscle, which can be caused by a variety of conditions, but one of the most common causes is a viral infection, from hand, foot and mouth to mononucleosis. 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.

What’s the link between COVID-19 infection and myocarditis?

COVID-19 is a virus and researchers are studying its link to heart inflammation throughout the pandemic. Most children who catch COVID-19 have mild symptoms, are sick for less than one week and will have a lower rate of severe disease when compared to adults. Myocarditis after COVID-19 is rare, and appears to be more common after moderate and severe SARS-CoV-2 infections. This typically means they have a fever for greater than three days, prolonged symptoms such as muscle aches or chills for more than a week and are hospitalized because of their infection. Myocarditis should also be looked at in children who complain of chest pain or an abnormal heartbeat or feeling in their chest associated with a COVID infection.

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

Parents of athletes should follow up with their pediatrician after their child has recovered from infection. A good timeframe is 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 return to playing shape and also make sure that symptoms do not arise during this time. 

What are your recommendations for athletes this season?

Many are in worse shape than ever because they have stayed away from organized sports or been sedentary as their parents attempt to physically distance their families during the pandemic. Exercise is important for the health and well being of your child, so 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 now is a great time to start.

For more relevant pediatric healthcare information, visit HopkinsAllChildrens.org/Newsroom. You also can download our free Pocket Doc app, which features a symptom checker, parenting advice and other tools for staying in touch with us.


About the Author: Dr. Mularoni specializes in sports medicine at Johns Hopkins All Children’s Hospital. He graduated from Michigan State University with an undergraduate degree in Biology from the Lyman Briggs College of Science. He completed Medical school at the American University of the Caribbean where he achieved honors in his third and fourth year clinical rotations at Ascension Health Hospitals in Detroit, Michigan. Dr. Mularoni completed his Pediatric Residency at St. John Hospital and Medical Center in Detroit, Michigan. His Fellowship in Pediatric Emergency Medicine was completed in Atlanta, Georgia through Emory University.

While at Emory University, Dr. Mularoni completed research on procedural pain reduction in the emergency setting and was awarded the American Academy of Pediatrics Willis Wingert award for best fellow research. He has continued conducting research at Johns Hopkins All Children’s Hopsital looking at best practice for procedural sedation in reduction of Pediatric forearm fractures. His current research interests include concussion management and prognosis in patients with mild traumatic brain injuries. He is the chairman of the Medical Emergency Committee.

Dr. Mularoni is married to Kim Mularoni who is a Pediatrician in St. Petersburg and together they have three children. During free time, Dr. Mularoni competes in Running, Triathlon and stand up paddle boarding races.


*Presented by Johns Hopkins All Children’s Hospital

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