Covid Testing For Kids: How to Know When to Go

Little kids get sick with maddening frequency. It is not unusual to suffer through multiple rounds of strep throat, two strains of flu, the Coxsackie virus and assorted ear and eye infections, all in one elementary school year.  Enter the novel coronavirus, and symptoms that would typically make parents groan, ‘Ugh, not again’ instead inspire insomnia. That’s because the indicators of Covid-19 are wide-ranging and overlap with those of many common childhood illnesses. (Sore throat? Low grade fever? Upset stomach? Headache? Fatigue? Show us a kid who doesn’t experience some of the above on a semi-regular basis.) So how do you know when you should watch your kid and wait, quarantining all the while, and when you should have them tested for Covid-19?

Complicating matters is the fact that tests may be hard to come by in certain areas, if they’re even offered to small children at all. There’s also no question that nasopharyngeal swabs are uncomfortable for kids. But none of this should stop you from pursuing a test for your child if you have reason to believe she or he may have the Coronavirus—especially if cases are prevalent in your area. We spoke with Emily Miller, M.D., an Internal Medicine doctor and Infectious Disease Fellow at Columbia University Medical Center  for clear advice in confusing times.

If cases are rising or high in your area and it’s possible your child has been exposed to the virus, then there’s no question you should pursue a test—even if they are totally asymptomatic. If that is the case, you would ideally quarantine for five days after exposure and then get tested, Meg Fisher, M.D., a pediatric infectious disease specialist at Monmouth Medical Center in Long Branch, N.J. told the New York Times. If you test too soon, you may get a false negative result, when in reality the virus is still incubating in the body. It bears repeating: Wear a mask anytime you leave the house. 

The bottom line is this: When in doubt, test. “Generally, I would err on the side of testing rather than not testing,” says Dr. Miller.  “Testing can provide parents with peace of mind and also provides valuable public health information about the rates of COVID-19 in your area and possible clusters of infections.” Now is not the time to doubt your parental instincts. You know your kid. If you sense they are at all unwell, go with your gut. And bear in mind that fatigue manifests as a general ‘I don’t feel good’ feeling in kids. “Studies have also shown that kids can have more GI symptoms like nausea, vomiting and diarrhea compared to adults,” adds Dr. Miller. If your child has any symptoms of illness, your first call should be to your pediatrician.

There are three types of COVID-19 tests available.  The molecular test is the gold standard as it is the most sensitive and accurate, says Dr. Miller. It’s also the most widely available. This one involves the ‘tickle your brain’ deep swab inside the nose. Having been through it with kids several times, we can tell you it is uncomfortable. But it’s also over in seconds. Kids are troopers. More often than not, they will tolerate it. “As a parent and a doctor, I would prefer to get the molecular test for my child,” Dr. Miller says. 

The second type of test is a rapid antigen test, also achieved with a nasal swab. “These are generally somewhat less accurate,” says Dr. Miller. “The antigen rapid test is nice because you get results very quickly, but if you live in an area with a high amount of COVID-19 and your child has symptoms of COVID-19, a negative rapid test may not be sufficient to say for certain that your child does not have COVID-19, and a confirmatory molecular test may still be necessary.” 

The third and final type of test is the antibody test, but the pediatricians we consulted do not rush to give them to kids. Why? “It is not currently known if a positive antibody test means you are now immune from COVID-19, so even if you have antibodies you should follow CDC guidelines to social distance and wear a mask,” says Dr. Miller.  For parents dreading any of the above, there’s good news on the horizon: A non-invasive saliva test developed at Yale “showed similar accuracy to the deep nasal swab,” says Miller. It received FDA emergency use authorization and will likely become available to the public in the future. At the moment, for those able to shell out $150 per test, Vault Health offers an at-home Saliva test, self-administered with the guidance of a telehealth visit, that claims 99% accuracy. 

Anything you can do to put your child in the driver’s seat and give them a sense of control may help. Ask them if they want to count to ten while the swab is inserted into their nose or if they would prefer you or the healthcare provider do so for them. Ask them to decide which special treat (a movie night, ice cream at home, asking Alexa to play their favorite song for a late-night dance party) they would like to get as a reward for being so brave during the test. As the parent, you set the tone. Remain calm. Prepare your child but keep the details age appropriate. It may help to explain that the swab feels sort of like getting chlorine up your nose in the pool. Emphasize the positive: The test will be done so quickly. The nurse or doctor administering the test is wearing cool protective gear to keep everyone safe. Be honest, but also feel free to tap into their imagination. The Children’s Hospital of Philadelphia suggests telling kids, “Let’s pretend we’ve been frozen like Elsa,” to encourage them to remain still during the test. Offer your hand. Hold them in your lap if possible. It really will be over before you (both) know it.

Although it is very rare, a child who has tested positive for Covid-19 must be carefully monitored for the related multisystem inflammatory syndrome, MIS-C. The symptoms to look out for, according to the Times: a lasting fever of 101 or higher, a red rash, and abdominal pain accompanied by diarrhea and vomiting. If symptoms remain mild, hydration and rest are best. Carefully disinfect all surfaces and high touch areas. Keep the child separate from the rest of the family if possible. Everyone should wear masks indoors. Alert their school or daycare immediately. If your city or state does not initiate contact tracing, do your best to inform anyone who has been in close contact with your child in the past two weeks and suggest they get tested. According to C.D.C. guidelines, everyone in the child’s household should quarantine for 14 days since the symptoms first appeared. It is important to note that any time a new household member gets sick with COVID-19, you will all need to restart your 14-day quarantine.

If the child tests positive but is asymptomatic, the child and those caring for him or her can be around others 10 days after the date of the positive test result. Retesting two weeks after the initial diagnosis may not be necessary or even useful because people can continue to test positive for Covid-19 months after they contract the virus, even when they are no longer contagious.