A pediatrician’s tips for promoting a safe return to sports during COVID-19

With some kids and teens returning to team sports after an extended break amid the COVID-19 pandemic, parents and pediatricians alike have safety top of mind.

Taking care of your physical and mental well-being will lead to more achievement and fun on the field, says Dr. Matthew Kornswiet, a sports medicine pediatrician in CHOC Children’s Primary Care Network.

How can you keep your kids safe on the field after so much time off?

Coaches and parents should continue to follow safe return to sports guidelines from the Centers for Disease Control & Prevention and locally, the California Interscholastic Federation.

Remembering the acronym SPORTS can also help support a safe and healthy return to play and participation in athletic activities during the COVID-19 pandemic.

With support from Dr. Chris Koutures, a CHOC pediatrician and sports medicine specialist, Dr. Kornswiet offers these tips for parents, guardians and coaches:

  • Start slowly. It’s been a while since your child has played sports, so do not expect them to start where they left off. It may take several weeks to get back into shape. Start with a review of basic skills and techniques and build up to more advanced skills. Plan shorter workouts to give them time to build up endurance. And limit repetitive movements such as throwing, swinging and jumping.
  • Pay attention to your body. Quickly returning to athletic activities after time off increases the risk of overuse injuries. Follow your instincts – if you are hesitant to return to your activity, then wait or slow down. Also, maintain adequate sleep of eight hours or more per night, and stay hydrated to help your body perform at its best. Early in conditioning, especially during hot days, watch for signs of overheating. If you feel more tired than everyone else, or experience dizziness or confusion, seek medical care immediately.
  • Open mind. Reset expectations and short-term goals. You may not be able to practice like you usually do. Be mindful of your mental health and well-being during this extraordinary time. Think of ways to cross train or do alternative workouts.
  • Red flags. See your pediatrician, sports medicine physician, athletic trainer or physical therapist if you experience pain in a small, confined area; if you are limping or not able to move normally; if you feel pain/soreness greater than four on a scale of one to 10; if you experience pain or soreness when you are not playing sports; or if you feel pain or soreness that lasts two to three days after activity.
  • Take steps to limit the spread of COVID-19. Never practice or play when you are feeling sick. When possible, train outside to limit the risk of transmitting/catching infections. Wear a mask or face covering when possible (i.e. in team meetings and when on the sideline). Bring hand sanitizer and use on your hands often. Try not to share equipment. If that’s not possible, then limit the number of people using that equipment and plan how to clean between uses. Bring your own water and snacks. And avoid high-fives, fist/chest bumps, and hugs – create your own hands-free celebration. 
  • Stay positive. Sports are fun, social and make us stronger physically and mentally. Playing sports can help us through challenging times.
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Return to Learn Concussion Guidelines Every Parent Should Know

When a child has a concussion, the rules for getting back to sports are laid out by state Return to Play laws. But when it comes to getting back to the classroom, the rules aren’t as clear.

A recent study in the journal Pediatrics found that only a few states have Return to Learn concussion laws, and these varied in terms of responsibility. Some of the laws were restricted to student athletes, excluding students who sustained non-sport related concussions.

“When returning a student to the classroom after a concussion, we try to balance stimulation levels and worsening of symptoms,” explains Dr. Chris Koutures, a board certified pediatrician and sports medicine specialist at CHOC Children’s. “While too much cognitive exertion can lead to headaches, problems concentrating, fatigue and trouble with emotional control, over restriction from classroom and academic activities can result in social isolation and anxiety about falling behind or lower grades that can also slow the recovery process.

return to learn
Dr. Chris Koutures, a board certified pediatrician and sports medicine specialist at CHOC Children’s.

“Returning to the classroom after a concussion optimally takes a team approach including the student, family, medical and education teams,” Dr. Koutures says. “Flexibility and creativity in paying attention to individual student needs and concerns can make this process more rewarding for all parties.”

Dr. Koutures advises the patient’s care team, including parents, to follow CHOC’s recommended six stages for returning a student to school after a concussion, including the following added guidelines:

Step-wise Return to Learn Progression

Step 1: No formal academic activity

  • Recent studies suggest that full or prolonged limitations in cognitive activity may actually delay recovery
  • In first few days after concussion, allow 15-20 minute intervals of single-task activities that do not provoke symptoms and are not excessively taxing
    • Listen to light music
    • Draw or color
    • Journal writing
    • Audiobooks
    • Passive television or movies (at home), larger screen preferred, lower volume
    • Some texting, smartphone use; want to balance maintaining key social contacts with not having symptom-flare
    • Conversations with 1-2 other people
  • Separate the 15-20 minute bursts of activity by 30-40 minutes minimum of non-cognitive activity
  • If symptoms flare before 15-20 minute limit, stop activity and try again later
  • If patient can handle 2-3 periods of 15-20 minute activity over the course of day, can consider advancing toward partial return to school

Step 2: Light academic activity

  • Attend 1-2 periods or 1-2 hours of school
  • Select consecutive classes; have child help make decision
  • No physical education or other activity classes
    • Caution with more noisy classes such as woodshop, music/band, chorus
  • Tend to avoid first class in morning to allow more sleep and arrival at school without busy parking lot and hallways
  • Main goal: be in class; no responsibility for note-taking, participating in class /responding to teacher, in-class work, homework or testing
    • Audible learning (most kids handle this better than visual learning after a concussion)
    • Should have pre-printed notes for reference or have others take notes and share
  • Sit away from louder students, windows, projectors, or other light/noise stimulation
  • Sit close to teacher
  • Allow to wear earplugs and sunglasses as needed
  • May allow brief 1-2 minute periods of putting head on desk for rest
  • May leave class early to avoid the noise and commotion of hallways during passing periods

Step 3: Increased academic activity

  • Expand day to 3-4 periods or hours per day
  • Incorporate break periods (nutrition break, lunch)
    • Have quiet place to rest
  • Recommend against assemblies or rallies due to noise stimulation
  • Continue to avoid physical education or activity classes
  • Main goal is to be in class and handle longer day; still not responsible for note-taking, participating in class/responding to teacher, in-class work or homework

Step 4: Full-time attendance

  • Full-day attendance without activity or other higher-stimulation classes
  • May expect some increased fatigue at end of school day
    • If student wants to nap after school, limit to no more than one hour
  • May start to take own notes, though helpful to have pre-printed teacher’s notes or other student notes
  • Incorporate “to do” lists with short-block (10-15 minute) work periods followed by short (5 minute) breaks
  • Break period and breaks in class (especially if block schedule) may still be needed
  • If possible, move most challenging courses to time of day when student feels the best

Step 5: Return to Majority of Academic Activities

  • Once handling full day attendance, can resume taking notes in class, verbal responses to teacher, and in-class work
  • May begin homework starting with limits to 30-60 minutes a night and priority on essential concepts that are needed for eventual testing or continuity of learning
    • Waive any projects, papers, essays or other assignments that are not required for future learning needs
    • Try to limit burden of make-up work; focus should be on those assignments that are necessary for future learning
      • Sequential classes (math, foreign languages, science) tend to be the most challenging for make-up work
    • No tests or quizzes at this stage
    • Audible learning – listen/speak responses vs. writing, dictating work, audiobooks may be more favorable at this point

Step 6: Return to Full Academic Activity

  • Full-day attendance without symptoms, fulfilling all in-class duties and completing usual homework assignments
  • Can resume tests and quizzes
    • Strongly consider waiving missed tests or quizzes
    • Combine missed tests or quizzes to allow more quick completion of make-up work
    • Allow student to take missed tests/quizzes to gain exposure/mastery of material without being graded, or only receive grade if results are in usual level of achievement
    • Assign grades at end of grading period based on level of work prior to concussion
  • May need more time for test completion
  • May need individual room placement for testing
  • May limit testing/make-up testing to one test per day
  • May allow open book, use of notes, word banks or home-based testing
  • Consider alternate forms of testing such as spoken test, or multiple choice vs. longer essay responses that might be more taxing for the student
  • Students may still benefit from more audio learning
  • Can resume physical education (with physician release) and activity courses
Learn about the CHOC Children’s Concussion Program now.

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