Some heart health cautions

Some heart health cautions for young athletes who’ve had COVID-19

Written by DR. CHRISTINA JOHNS

Senior Medical Advisor PM Pediatrics

With 35 million to 45 million children ages 6 to 18 playing sports in the United States every year, those who have contracted COVID-19 need specific consideration with regard to their heart prior to restarting their activities. COVID-19 can cause heart damage and myocarditis in some children, which can be a cause of sudden death during exercise. With many children exhibiting fewer, milder or even no symptoms even after being exposed to COVID-19, parents need to make sure to talk with a doctor before they let their children rush onto a field or court.

Three questions doctors and parents need to ask are:

• How recent was your child’s COVID-19 infection? Children should be given a minimum of 10 days to recuperate to prepare their bodies for strenuous exercise. A gradual return to exercise is recommended.

• How severe was the infection? Children need ample time to recover before playing sports. For moderate infection (more than four days of fever greater than 100.4°F, myalgia, chills or lethargy, or those who had a non-ICU hospital stay and no evidence of MIS-C), a screening electrocardiogram (ECG) and possibly other tests might be required before they return to play, and those with severe infection might need to wait three to six months to have clearance by a pediatric cardiologist before returning.

• What is the physical activity or sport being considered? Every sport comes with its own level of intensity. Check with your doctor to see if he or she thinks your child is ready for a particular sport.

Heart attacks in children are rare. Most commonly the cause of chest pain in children is unrelated to the heart muscle itself. Some examples include:

• Medicine – Albuterol, the most common medicine for wheezing given to children via inhaler or nebulizer, can cause your child’s heart to race.

• Costochondritis (kos-tuh-kon-DRY-tis) – This is chest wall pain and is often a result of strenuous activity, such as weightlifting or gymnastics. This also can happen when children have an upper respiratory infection with frequent coughing. The pain is due to inflammation of the cartilage that attaches the sternum to the rib cage. Pain can typically be reproduced with pressing on the inflamed area and it generally goes away within a few days. This is usually not a cause for concern. Heat packs and ibuprofen can be given for pain relief, if necessary.

• Acid reflux/gas – Children are notorious for having trouble pinpointing pain so “chest pain” can actually be heartburn or gas pains. After visiting a doctor, acid reflux Dr. Christina Johns Photo courtesy of PM Pediatrics and gas can be resolved with antacids and diet changes.

If a child faints during exercise, all physical activity must stop immediately, and the child needs to be evaluated by a doctor as soon as possible. This might indicate the need for an ECG, a chest x-ray and/or a physical exam, so even if a child says he or she feels fine after a few minutes of rest, do not allow any physical activity until a physician has completed an evaluation for potential heart conditions.

Dr. Christina Johns is senior medical adviser for PM Pediatrics and a practicing pediatric emergency physician. Follow her at @drcjohns on Twitter, @deardrchristina on Instagram and Dr. Christina Johns on Facebook.