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2/3/14blog post

when athletes get sick

In 2009 the swine flu hit our community. At the time, I was working as a team physician at the University of Cincinnati and saw the outbreak firsthand in our athletes. It always started as one athlete having aches, fever, and a cough. Before you could blink, their roommates had it. And by the next day, half the team was sick. When an illness was affecting a team, we often struggled with deciding who could play, and who could travel. We didn’t want to send someone on the road who could potentially infect the entire team, but we didn’t want to hold people out who were fit to compete. We also didn’t want to return them too soon after an illness, when they were no longer contagious, but unable to perform at the required level. This could prolong the recovery phase.

This is an extreme example of how an illness can spread through a team, but it happens every year during cold and flu season. Parents may be concerned when their child athlete gets sick and this brings about the same questions every year:

  • What precautions can I take to minimize the chances of my child athlete getting sick?
  • When is my child too sick to exercise or play sports?
  • When is my child ready to return to play?

Unfortunately there are very few clear-cut answers. Every illness, every individual, and every circumstance is unique. The guidelines below are agreed-upon by most sports medicine specialists and are safe to follow. If you have a unique situation, please see your child’s physician to discuss the specifics.

What precautions can I take to minimize the chances of my child athlete getting sick?

  • Make sure your child is up to date with childhood vaccines and gets a flu shot annually. Although the flu shot is not 100 percent effective, it greatly reduces your chance of getting sick. If they still get sick after a flu shot, the illness is usually less severe than it would be without the vaccine.
  • Remind your child to wash their hands frequently.
  • Your child should not share personal sports equipment, including towels, water bottles and protective gear
  • Help your child go to bed early and get eight hours of sleep per night or more. (This prevents infection better than vitamins or supplements, plus it is free!)
  • Provide avenues for your child to get regular exercise, but they should not over-exercise.

When is my child too sick to exercise or play sports?

  • Anyone with a fever of 100.4 degrees or higher should stay out of sports until they have a normal temperature for 24 hours. Exercising with a fever can increase your risk for heat illness and myocarditis, a rare heart infection.
  • They should not exercise if they are having any symptoms below the neck – cough, vomiting, diarrhea, etc. These symptoms could indicate a more serious illness, such as pneumonia. Or it could be a mild stomach illness which is causing significant dehydration.
  • Your child should not exercise, or attend practice, if they are still considered contagious by their physician. They may feel better, but you do not want their teammates to get sick! Their team may struggle with them sitting out this game, but they will struggle more if four or five are sick for the next game.
  • Your child should not exercise if they have mononucleosis (mono). It is a viral illness which initially mimics strep, but also causes organ enlargement and fatigue for 6-12 weeks after the initial illness is gone. Damage to enlarged organs, such as taking an elbow to the abdomen during a game, can cause organ rupture requiring emergency surgery.

When is my child ready to return to play?

  • No fevers for 24 hours
  • Well-hydrated (colorless or light yellow urine)
  • When their doctor says you are no longer contagious. If antibiotics were prescribed, ask your child’s doctor how long they need to be on them before they are no longer contagious. This is usually 24 hours, but it is longer for some illnesses.
  • If they are able to tolerate light exercise without fatigue. Expect it to take about a week until they are able to exercise at their pre-illness level.

What are the risks of my child returning too soon?

  • Your child may put their body through too much physical stress – between exercise and fighting an illness – to heal appropriately. This puts them at risk of secondary infections. What started as a regular cold could turn into pneumonia, bronchitis, or a sinus infection and have them out longer.

The goal is to have your child performing their best every single day. Sometimes that means sitting out longer than they may want to now, so that they feel better (and their team isn’t sick) later.


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Lora Scott, MD

program director sports medicine
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