Editor’s note: The sports guidance has been updated since this story was published. Please see the guidance on returning to sports. For the latest news on COVID-19, visit http://bit.ly/AAPNewsCOVID19.
The AAP has updated its interim guidance for schools and returning to sports during the COVID-19 pandemic in light of new quarantine and isolation guidance from the Centers for Disease Control and Prevention (CDC).
The AAP has consistently prioritized in-person learning not only for students’ educational attainment but also to protect their mental health and reduce disparities. While the omicron variant has led to a surge in pediatric COVID-19 cases, transmission in schools is low when they use layers of protection.
“We have a vaccine that helps protect us from the virus and lessens the severity of illness for those who do get sick,” AAP President Moira A. Szilagyi, M.D., Ph.D., FAAP, said in a statement. “We know that masks are an extremely effective layer of protection. We urge everyone to have patience and not let down their guard.”
The AAP supports the CDC’s recommendation on isolation and quarantine periods of at least five days. It also laid out steps intended to ease the burden on schools and families while keeping them safe. These include:
- vaccination for everyone 5 years and older without contraindications,
- universal masking for everyone over 2 years,
- modified spaces for eating to reduce the risk of spreading COVID-19 and mask removal only while eating,
- quick identification of COVID-like symptoms and isolation for five days followed by proper and consistent use of face masks for an additional five days, and
- adherence to CDC guidance on practical use of tests in school.
The AAP and CDC also call for physical distancing, contact tracing, improving ventilation and cleaning and disinfecting.
Dr. Szilagyi noted that in areas where the virus is widespread, staffing shortages have led to school closures.
“Those closures should be as brief as possible, and we encourage schools to offer virtual learning when in-person classes are not possible,” she said.
Vaccination and masks also are crucial to keep student-athletes safe. The AAP has updated preparticipation physical examination forms to include booster doses of COVID vaccine. It also recommends athletes wear face masks during most indoor sports activities if they are living in an area with substantial or high transmission or if they are not fully vaccinated.
The AAP has updated the interim sports guidance to clarify CDC guidance on quarantine and isolation as it relates to physical activity and provide new guidelines for returning to physical activity after having COVID-19.
Before returning to physical activity, children and adolescents diagnosed with COVID-19 should complete CDC-recommended isolation and a minimum amount of symptom-free time. Those who are asymptomatic or have a mild case should be assessed by their primary care physician by phone, telemedicine or in-person visit. Those with moderate symptoms should have an in-person evaluation. The guidance details the screenings and exams these appointments should include.
Children should not return to play until all of these criteria have been met:
- Completed isolation and minimum amount of symptom-free time has passed.
- Can perform all activities of daily life
- No concerning signs/symptoms
- Physician clearance has been given, if indicated
Once cleared by a physician, children under 12 can return to sports and physical education classes as their own tolerance allows. More specific steps are laid out for those who are 12 and older.
Adolescents whose disease was asymptomatic or mild should be free from symptoms for at least one day and then can spend two days increasing their physical activity. They should not participate in games before day three.
Adolescents who had a moderate case of COVID should be symptom-free for at least one day and then spend a minimum of four days gradually increasing physical activity. They should not participate in games before day five.
Both groups should continue to wear a face mask for all physical activity until 10 full days after their positive test or symptom onset. All children and their parents should monitor for chest pain, shortness of breath out of proportion for upper respiratory tract infection, new palpitations or syncope. Anyone with these symptoms should stop physical activity and see a pediatrician for an in-person assessment and possibly a pediatric cardiology consultation.
- CDC guidance for schools during the pandemic and clinical considerations for administering COVID-19 vaccines
- AAP interim guidance on school safety during the pandemic, returning to sports and physical activity and vaccination
- Information for parents from HealthyChildren.org on in-person education during the COVID-19 pandemic, youth sports safety and preparing children for a COVID-19 vaccine
- Interim preparticipation physical exam (PPE) history form
- Interim PPE exam form