Dr. Monique Burton and Dr. Celeste Quitiquit are both sports medicine pediatricians. Dr. Burton is medical director of sports medicine and Dr. Quitiquit is co-medical director of the athletic training program at Seattle Children’s.

What does the sports landscape look like for kids this fall?

headshot of Dr. Monique Burton

Monique Burton

headshot of Dr. Celeste Quitiquit

Celeste Quitiquit

Drs. Burton and Quitiquit: Youth sports definitely looks different this fall. Some sporting teams are in full effect, with fingers crossed. Other teams already cancelled their seasons in advance. Many sporting teams tread carefully, building safety and contingency plans, creating hybrid practice agendas and trying to stay current with COVID-related news. To say there are some modifications is definitely an understatement. For example, the Washington Interscholastic Activities Association (WIAA) has divided the upcoming school year into four sports seasons rather than the usual three, limiting play in fall and moving more play to spring. Almost all of November and December will be a no-play period during which WIAA will reassess plans for 2021 based on what’s happening with COVID-19. It’s very much a fluid, “stay tuned” type of situation.

For now, WIAA has school football and soccer slated to be played in spring rather than fall, and some sports (i.e., tennis, golf, slow pitch softball, cross country) will play “alternate seasons” (i.e., competing in fall but saving tournament play until spring).

Schools are deciding whether to offer sports based on the phase their county is in (1 through 4) and the advice of their local public health experts.

If you’d like to find out more, the WIAA website is a good resource. It offers sports season calendars as well as sport-specific recommendations for coaches and athletic directors.

What are your concerns as children return to school and re-engage in sports?

Drs. Burton and Quitiquit: For kids playing sports during the pandemic, we want them to be safe. Seattle Children’s athletic training team created the blog post Returning to Sports Safely During COVID-19 to help teen athletes and their families know what questions to ask and the answers to look for. Questions it offers include:

  • Will there be a screening process for athletes and staff?
  • What are your plans for physical distancing?
  • Do you have a written return-to-play guideline or policy for COVID-19? If so, can I see it?
  • What are your cleaning plans?
  • What is your cloth face-covering plan?

Feel free to share the blog post with your families.

We all want kids to feel empowered to keep themselves and their teammates safe. That starts with feeling confident that this is an important enough issue to speak up about and also feeling knowledgeable enough to speak up — both of which providers can help with. Providers often have long-standing relationships with the child and family. They are trusted. They have authority to educate on COVID-19 and give advice on a child’s physical and mental health.

Consider initiating conversations during visits with your teen athletes about the importance of following state safety guidelines for their county’s phase. We like the following questions because they allow us to start conversations and hear what is happening in our community:

  • What kinds of things are you doing during practice to stay safe from COVID-19?
  • Do you know what phase your county is in and what the state guidelines are for it?
  • Has your school or club team shared its COVID-19 guidelines with you? If so, what are they?

Families will make their own choices but asking curiosity questions like these will help them be informed and empowered.

Are the families you talk to worried about their kids playing sports?

Drs. Burton and Quitiquit: Some families are sufficiently concerned that they are opting not to have their child participate in sports for now.

However, we have also found that after careful investigation of safety and health protocols, many families have felt comfortable enough to allow their child to participate. Many tell us how happy their child is to be playing sports and say they are relieved their child has this outlet during COVID-19. I think each family needs to take into consideration their personal circumstances and make a decision that feels best as a family about group physical activity or sports participation.

What about kids who are having to miss sports this fall?

Drs. Burton and Quitiquit: Lots of kids will fall into this category this year, either because sports aren’t offered at their school or they and/or their parents don’t feel it’s safe. We recommend two main things for providers to do to support these kids:

  1. Acknowledge the loss. For kids who can’t play their sport, it’s important that during a visit, their provider acknowledges the loss. The child is losing something related to their identity. It is where many have turned to for friendship, consistency, fun and motivation. They may also be losing valuable scholarship opportunities, social ties, their key way of managing anxiety and stress or skills they worked hard to acquire. Their body may start to look and feel different. All these losses can impact their social and emotional well-being.
  2. Ask questions to help them articulate their experience and explore options. For example, ask:
    • How are you feeling about not being able to participate in your sport?
    • Have you found other activities you enjoy?
    • What is something new you always wanted to try?
    • What is something your family can do together?

 

We can use our visits with our teen athletes to talk about injury prevention too. Ironically, we’ve seen athletes getting injured in new ways just from trying new things during COVID-19. As providers we should be mindful of overuse injuries and remind them to warm up before any physical activity and get medical care if they’re experiencing discomfort. With so many kids now trying out new activities that can be done solo (i.e., bikes, paddleboards, etc.) it’s also important to offer reminders about common-sense safety rules such as wearing helmets and lifejackets.

There is still much to learn about the COVID-19 illness. We do know it can present unique health issues in its wake, including to student-athletes, and this should be considered in their return to sports and exercise. While it appears that the great majority of young people infected with coronavirus display mild symptoms or are asymptomatic, cardiopulmonary complications are being reported in the adult population. To help provide guidelines for safe return to play, an expert task force from the National Federation of State High School Associations (NFHS) and the American Medical Society for Sports Medicine (AMSSM) formed and wrote a guidance statement. In this paper, the task force recommends that schools consider a supplemental questionnaire addressing medical issues specific to COVID-19, like:

  • Have you had any of the following symptoms in the past two weeks (lists 12 symptoms associated with COVID-19)?
  • Do you have a family or household member with current or past COVID-19?
  • Do you have moderate asthma, a heart condition, diabetes, chronic kidney or liver disease or take medication or have a medical condition that weakens your immune system?
  • Have you been diagnosed with or tested positive for COVID-19?

Any positive response from the survey should trigger an evaluation by a medical provider prior to sports participation, and the article provides an algorithm for possible evaluation.

What about the loss of PE and playtime for younger kids? What issues should we be aware of?

Drs. Burton and Quitiquit: With COVID-19, elementary school students this fall may have greatly reduced (or no) PE, recess, playground time before and after school and after-school activities. The Washington state requirement for 100 hours of PE instruction has been waived this year. Video game console sales for the first half of 2020 were up 37% over the same period last year.

This makes it all the more important for providers to engage in conversations during their visits with ALL kids about staying active, including teens who don’t normally play sports.

Some things we strongly encourage include:

  • Get outside: Rain or shine, kids should spend time outside if they can do so without heightened risk of COVID-19. The fresh air and sunlight will help their bodies and their mood.
  • Play as a family: Playtime is a stress reliever, parent/child equalizer and bonding activity — all much needed during this time of forced family togetherness.
  • Role modeling the benefits of physical activity: Monique does yoga for 30 minutes several times a week. Her kids don’t love it. They interrupt a lot to ask when she’ll be done. But it helps her unwind and gives her the energy to be a better mom. She knows that seeing their mom make time for exercise teaches her kids how valuable it is. And they see that although this pandemic is hard, there are ways we can cope.
  • Remind families of the fundamentals:
    • Create routines in the home. Kids need routines to feel safe and thrive.
    • Overcommunicate; parents should check in with children regularly.
    • Be honest about what’s going on.
    • Focus on what’s in your control, not on things that are out of your control.

We also always like to remind providers they can connect families with the free Washington Mental Health Referral Service for Children and Teens. The service links families with local outpatient mental health providers who fit their child’s specialty needs and insurance coverage. As this pandemic wears on and financial and other strains mount on families, mental health care should be a priority for all ages, including children.

What resources do you recommend to help kids stay active?

Drs. Burton and Quitiquit: There is an overabundance of resources online to support families. This can actually make things harder for parents, who are overwhelmed with so many decisions right now. Our recommendation to PCPs is to urge families to try a simple approach. Recommend resources you personally know and like. Tell your patients your own real-life situation and give them guidance based on what is working for you. Families trust their PCP, and this will take some stress off them.

If you need resource ideas, click here to see some that we like.

What are the equity issues to consider?

Drs. Burton and Quitiquit: Last fall, State of Play, Seattle-King County found significant inequities in access to play. Children of color, youth who do not speak English at home, youth from lower-income families and those living in South King County have less access to parks, physical activity and play than other children. With many school facilities closed, we are concerned this gap will widen and have a ripple effect on kids’ social and emotional well-being. All the more reason to have those important conversations with families during their visits about what their children are doing to stay active and how to adapt and find new activities during COVID-19 to stay physically active. It can be helpful to find some local and online resources to provide to families at their clinic visits.

What are you personally seeing and hearing in your own visits with patients?

Drs. Burton and Quitiquit: We’re sensing great stress from our patients’ parents because of the isolation they’re experiencing and particularly the unknowns of remote learning this fall. We have found that families often need more time to express and share their frustrations and challenges.

We make time to discuss maintaining some type of routine despite how different it may be from normal. We know routine is helpful but can feel a bit overwhelming right now with so many uncertainties from school to sports participation options and all the other psychosocial factors. Having a PCP reiterate and talk through routine with the family goes a long way. We tuck physical activity into that conversation, knowing all the benefits it has on both physical health but also mental health. Physical activity helps us get back to the basics: get up, get dressed – and it builds momentum to engage in regular physical activity, so we can keep feeling good and keep going.

Resources:

Related reading: “No Fall Sports? How to Keep Your Kid Active.” Right as Rain by UW Medicine. Aug. 31, 2020.

New Seattle Children’s sports videos for families: