Healthy Habits: Kids' Heart Health and Covid

 With 35 to 45 million kids ages 6 to 18 playing sports in the United States every year, kids 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 kids 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 kids rush onto the field. 

 

Three questions doctors and parents need to ask are: 

• How recent was your child’s COVID-19 infection? Kids should be given a minimum of 10 days to recuperate and get their bodies capable of strenuous exercise. A gradual return to play program is recommended.

• How severe was the infection? Similar to how recent; kids need ample time to recover before stressing their heart when playing sports. For moderate infection (more than 4 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 ECG and possibly other tests may be required prior to return to play, and those with severe infection may need to wait 3-6 months and 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 they think your child is ready for the sport they want to play.

Additionally, heart attacks in children are rare and most commonly the cause of chest pain in children is unrelated to the heart muscle itself. Some examples include: 

• Medicine – Albuterol, 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. Often a result of strenuous activity (like weightlifting or gymnastics), this can also happen when children have an upper respiratory infection with frequent coughing.  The pain is due to inflammation of the cartilage that attaches your sternum to your rib cage. Pain can typically be reproduced with pressing on the inflamed area and it generally goes away within a few days. 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 and gas can be resolved with antacids and changes to diet. 

If a child passes out during exercise, all physical activity must stop immediately, and the child needs to be evaluated by a doctor as soon as possible.  This may just mean getting an ECG, a chest x-ray and/or a physical exam, so even if your child says they feel fine after a few minutes of rest, do not allow any physical activity until a physician has evaluated them for potential heart conditions. 

 

Dr. Christina Johns is Sr. Medical Advisor for PM Pediatrics and a practicing pediatric emergency physician. Follow her at @drcjohns on twitter, @deardrchristina on Instagram, and Dr. Christina Johns on Facebook.