Does My Child Have COVID-19? A Quick Guide on Testing
Over the last few months, science has helped us to refine our knowledge about when to test for COVID-19 and what type of test is best. The goal of testing is to quickly find and isolate children who are positive for the virus. Testing guidelines are changing frequently (seems like daily….) based on best practice, available evidence, test availability, and local health department guidance.
TL;DR// If you really want to know if your child is COVID-19 positive, you need to test.
When considering a COVID-19 test, most kids fall into one of 4 categories. Here is a brief look testing recommendations for each of these groups. For additional details, please call your doc. And don’t miss the additional notes at the bottom of this post.
COVID-19 symptoms and known exposure**
Self-quarantine for 14 days should begin immediately after a known exposure. If significant symptoms develop during that time, it can be assumed your child is positive. From the first day the symptoms develop, your child needs to be isolated for at least 10 days. Your child can be treated at home during this time, and testing is not necessary for presumed positive illness. Antibody (blood) testing to confirm infection can be ordered about 4 weeks after becoming ill, if recommended by your child’s doctor.
COVID-19 symptoms and no known exposure
To help us determine which children need to get a test versus those who can stay at home and recover, we are using two groups of symptoms as our guide.
“Major” symptoms of COVID-19 include: New cough, difficulty breathing, and loss of taste or smell.
“Minor” symptoms of COVID-19 include: Fever over 100.4 C, chills, congestion/runny nose, nausea/vomiting/diarrhea, sore throat, headache, muscle aches.
If your child has one major symptom, he needs a viral PCR (nasal swab or saliva) test. For kids with symptoms, testing is reliable as soon as day 1 of illness. Getting tested quickly will allow return to school or play sooner, if the test returns negative. While waiting for the testing results, it’s very important to stay home. (No school. No sports. No playdates.) It has been suggested that loss of taste or smell is so specific to COVID-19 that this symptom would indicate active infection regardless of testing results, but this is not currently standard advice.
If your child has 2 or more minor symptoms, she needs a viral PCR (nasal swab or saliva) test. For kids with symptoms, testing is reliable as soon as day 1 of illness. Getting tested quickly will allow return to school or play sooner, if the test returns negative. While waiting for the testing results, it’s very important to stay home. (No school. No sports. No playdates.).
If your child has 1 minor symptom, call your doc for specific advice. Currently, I would plan on treatment at home, and return to school or play after 24 hours of fever resolution and symptom improvement. If additional symptoms develop, consider testing.
No COVID-19 symptoms and known exposure**
After a known close-contact exposure, your child should self-quarantine for 14 days. Period. Important note here: Even if your child and the positive individual were wearing masks, it’s still an exposure and self-quarantine rules apply. For details on self-quarantine, click on this.
If you were exposed and do not have symptoms, the most accurate time to test seems to be around day 5 after exposure. However, testing is not required since testing results do not change the self-quarantine duration. As an alternative, antibody testing can be drawn 4 weeks after suspected exposure.
No COVID-19 symptoms and no exposure
This group includes kids who are required to have testing prior to having a medical procedure completed, returning to college campus, traveling, or participating in an event. These tests can be arranged through the physician performing the procedure or your pediatrician’s office.
Additional things to consider when thinking about COVID-19 testing:
Children who are immunosuppressed or have significant chronic medical illnesses should be tested at the first sign of significant COVID-19 symptoms.
The decision to test is also dependent upon who lives at home. If an ill or exposed child lives with a elderly grandparents, sibling or parent with a chronic medical illness, or pregnant parent; testing is strongly encouraged.
The symptoms of COVID-19 in kids include symptoms of just about every illness of childhood, so there is no way to know if your child has COVID-19 based on symptoms alone. The only way to know if your child is positive is to test. In turn, there is no way for a physician to know your child does NOT have COVID-19 without a test.
We are increasingly cautious about our student athletes and the risk of COVID-19 related heart complications. If your child is an elite athlete or high school athlete, testing may be valuable because a positive test will change your child’s athletic clearance and return-to-play protocol. For more details and links to current research, click on this post about athletes and COVID-19.
After a child tests positive, no additional COVID-19 testing is needed for 3 months unless new symptoms begin. The CDC has updated this guideline after research has shown individuals infected with SARS-CoV-2 can test positive for infection for as long as 3 months after initial illness. After appropriate isolation and recovery, a negative test should not be required to return to full participation in school or sports.
Prepare your child for the nasopharyngeal swab used for testing. Watch this great video from BC Childrens to help her know what to expect.
Yes, many kids will have to be tested multiple times. This is important because ask any kid and they will tell you a nasal swab is not fun. Especially for schools and daycares that are requiring a negative test to return to school, we are already seeing kids who are getting very agitated and panicky when they figure out the nose stick is coming again. This is unsettling and we don’t like it either. But until we have widely available access to saliva testing or something else, getting repeated nasal swabs is something we all have to prepare ourselves and our kids for.
Rapid antigen tests are coming, but not all of them are great. Believe me, we are all eagerly waiting for reliable testing that can give us a result during an office visit. Early rapid tests had a very high rate of incorrect results, rendering them fairly useless. Newer generations of rapid antigen tests have shown improved accuracy in adults, but this is adult data has not been validated in kids.
Testing turnaround time really depends on your location. In #KC our testing has been anywhere from 24 hours to 7 days, depending upon the lab used and the reason the child was tested. Testing time is changing every day, so please be patient as you wait for results. If your child is tested, he or she must stay home until you are notified of the results.
Testing is not an emergency. As long as your child is generally doing well, keep your child at home and testing can be arranged by your child’s pediatrician as soon as the office opens.
Most importantly, If you are worried, please call us! As fast as these recommendations are changing, your child’s doc is and will be the best source for decision making. Now is the time to be sure you know how to contact your pediatrician’s office, and understand the hours and expectations for office visits.
Continue to make smart choices! Outside is better. Wear masks. Wash hands. Keep your distance. Check on your strong friends. Stay active. Eat well. Connect with your family. Be kind.
** Current CDC guidelines define an exposure as close contact with a person infected with the COVID-19 virus. Close contact is within 6 feet for at least 15 minutes duration. Wearing a mask does NOT exclude a close contact exposure.
