After months of being cooped up at home, many children yearn to play organized sports again with their friends. Parents are also eager for their kids to reap the mental and physical health benefits but worry about the potential risks during the ongoing 2019 coronavirus disease (COVID-19) pandemic.

In areas where school and community sports are being allowed, medical and sports professionals are devising ways to resume play as safely as possible, which includes recommendations to wear masks and face coverings, maintain social distancing, and limit physical contact during sports participation. Parental involvement is a key part of that equation as well.

“This is a great time for parents to be advocates for their kids so that they are able to participate and do so safely,” says Cordelia W. Carter, MD, co-director of the Center for Young Athletes, part of Hassenfeld Children’s Hospital at NYU Langone. “Ask questions of your league. Who is making the decisions about safety, and what information are they using to make those decisions? How often are they updating that? Asking questions from the start will hold coaches and organizations accountable for athletes’ safety.”

As parents weigh whether to allow their kids to play sports, be it at school or in community recreation leagues, here are some important questions to consider. For additional analysis of the issues concerning youth sports during the COVID-19 pandemic, check out our return to sports webinars for parents and sports professionals.

Does Your Child Play a Contact Sport?

Sports that require close contact, such as football, wrestling, and competitive cheerleading, have a higher risk of COVID-19 transmission than others. That’s because COVID-19 is transmitted by inhaling respiratory droplets—particularly from exhalations, sneezes, and coughing—from an infected person.

Sports with brief contact, such as soccer, baseball, and basketball, are considered moderate risk. Swimming, cross country, tennis, and other sports that allow for physical distancing are considered safest. Outdoor sports have a lower risk of infection than indoor sports, and individual sports such as cross country have a lower risk than team sports.

Also consider the age of your child. Young children may not be able to maintain social distancing or keep a mask on. If that’s the case, it may be safer for them to sit out this season.

What Is Your Local COVID-19 Incidence Rate?

The incidence rate in your community is a good indicator of overall risk in sport, as well as other activities. The New York City Health Department posts case rates by zip code, and the New York State Department of Health has data by county. Once you know your local rate, you have a better handle on how risky it is to let your child compete. If your child plays for a team that travels, check the rates in each area to determine whether you are comfortable allowing your child to participate in that game.

Has Your Child Had COVID-19?

“Anyone who had COVID-19, even if they were asymptomatic, needs clearance from their doctor before returning to sports,” says Dennis A. Cardone, MD, co-director of the Center for Young Athletes. “There is growing concern about complications related to the heart and cardiovascular system.”

Because COVID-19 can affect the heart and lungs, your pediatrician may recommend cardiac testing to evaluate heart health, especially in high school and collegiate athletes. A child who had COVID-19 and has lingering pulmonary symptoms also needs to be evaluated before returning to sports.

What Is Your Child’s Risk of COVID-19 Complications?

In general, children and adolescents develop less severe COVID-19 symptoms than adults. These include fever, cough, runny nose, muscle aches, and stomach issues such as nausea and vomiting. Most children recover without needing hospitalization, but a small number develop multisystem inflammatory syndrome (MIS-C), a serious condition that can affect the heart and other organs.

If your child has a history of congenital heart disease or other cardiac conditions that put them at risk for serious illness from COVID-19, that should factor into your decision about whether they should play sports, or which ones. Children who have kidney disease, metabolic syndrome, chronic liver disease, or lung-related conditions such as asthma could also be at high risk for more severe COVID-19 symptoms.

What Is the League Doing to Reduce Transmission Risk?

Every person—coaches, athletic trainers, and athletes—should be screened for fever and common COVID-19 symptoms, such as headache and sore throat, before entering the gym, field, or training facility, says Dr. Carter. Results should be logged for each practice or game, and coaches should communicate these screening requirements to parents.

During some contact sports, such as football and basketball, wearing masks during play is not advised because they can move around and cause injury during play. “But as soon as children are on the sideline, whether they’re on the bench or talking with a coach, the masks should go on, and certainly coaches and spectators should always wear masks,” says Dr. Cardone.

Spaces that encourage crowding, such as locker rooms and concession stands, should be closed and remain unused. For fields that have back-to-back games, start times should be staggered to limit crowding. Outdoor activity is preferred, but for sports played indoors, ventilation systems should be inspected and windows and doors opened where possible. Spectators, including parents, should be required to stay 6 feet apart.

What Is the League Protocol If a Child Tests Positive?

“If an athlete tests positive, whomever has been in contact with that child within the last week to 14 days should also be tested,” says Purvi S. Parikh, MD, pediatric allergy, immunology, and infectious disease specialist. “That includes all teammates as well as everyone in the home because it is a highly contagious virus, and this is all part of contact tracing.”

A league should have a written protocol for what to do if a child tests positive, and it should be shared with parents at the beginning of the season. Each practice location and game site should have an identified isolation area for any child exhibiting COVID-19 symptoms, as well as any athletes who might have been exposed to that child.

Are Rules and Routines Being Adapted to Reduce Risk?

Limiting physical contact can reduce risk. For sports, this can include playing against only a small number of teams or shortening the season so there are fewer games. Instead of crowding players into areas such as dugouts, allow them to space out and sit on nearby bleachers.

Coaches can switch to individualized or paired drills that allow for more space between each player. When balls must be shared, such as during basketball and football, they should be disinfected or switched out during the game. Ways to minimize hand contact should be considered, such as switching throw-ins to kick-ins in soccer. Hand sanitizer should be used before and after starting play, as well as during game breaks.

Celebrations should be reconsidered as well. A child running the bases after a homerun is going to be breathing heavily; huddles to celebrate a victory bring people in very close contact; and high fives require hand contact. Teams should be encouraged to create new ways to honor their accomplishments.

Does Your Child Feel Safe Returning to Sports?

Some children may be apprehensive about returning to sports because of their own fear of contracting COVID-19, says Dr. Carter. Listen to your child and don’t push them back on the field before they are ready.

If they want to play but need to feel safe to do it, suggest other sports that have a lower risk of contact, or ways to play that minimize risk. If they are afraid of injury because they have been inactive, provide ways to ease them back into sport, such as playing for a less competitive league.

How Long Has Your Child Been Sedentary?

If your child has not been physically active, they are at risk of injury, in particular broken bones and knee sprains, strains, and tears, as well as heat stroke.

“It’s much quicker to lose your conditioning than to gain it back,” says Dr. Cardone. “If someone hasn’t been exercising for months, the minimum to get ready to resume play will be two to three weeks of conditioning training.”

When your child begins training, it should be at a lower level of exertion than they used the previous season, says Julia Drattell, program coordinator with NYU Langone’s Concussion Center. For example, Drattell says, if you’d expect a child to sprint the length of a field in 30 seconds, the coach should double that to 60 seconds—a 50 percent reduction in speed—during the first couple of weeks of practice. “Intensity should be increased gradually and be responsive to the child’s level of deconditioning,” Drattell says. “The second a child shows a sign of struggling, you stop.”

What Is Your Role as a Parent?

As the people who juggle schedules, wash uniforms, and keep track of the equipment, parents have a huge role in ensuring their children’s safety on the field.

“Parents can help by making sure kids have their own equipment—their own helmet, their own bat,” says Jacqueline Tierney, athletic trainer at NYU Winthrop Hospital. “If you can’t do that, wipe it down after every use. And for their equipment, bring it home after every practice. Wipe it down. Don’t leave it in the bag, and wash uniforms right away if you can.”

Carpooling should be discouraged to limit the amount of time youth spend together in a closed environment, but if it’s unavoidable, try to space kids out as much as possible, keep windows open, and insist that everyone wear a mask. Team snacks and drinks should all be in individually wrapped single servings.

Parents also need to be responsible spectators. Wear a mask at all times and maintain 6 feet of distance from coaches, players, and other parents. And if you are not feeling well, do not attend a game.