A Pediatrician’s Guide on When Your Child Should Be Tested for COVID-19 and When They Can Return to School

With kids going back to school, new questions are coming up on when kids should be tested for COVID-19 and when they can return to school.

Keep in mind there are some conflicting and confusing pieces of advice out there and this is only promised to be up to date as of on Sept. 25, 2020 when we are publishing this. But here are some reasonable-evidenced based approaches on testing and returning to school.

Who needs to be tested for COVID?

All patients with high risk symptoms and without another explanation should be tested for COVID before returning to school. These symptoms include:

• Fever
• Cough
• Shortness of breath
• Body aches
• Loss of taste/smell
• Headache
• Sore throat
• Sustained vomiting or diarrhea (and usually a combination of these symptoms)

If high suspicion for COVID still exists after a negative test is obtained, a second test the next day may be recommended by your doctor. If the COVID test or tests are negative, the child may be treated as they normally would for that illness (for example, returning to school after they were fever free for 24 hours).

All patients with low risk symptoms and NO known exposure to COVID can be tested before returning to school based on physician discretion. Low risk symptoms include congestion or runny nose, rash or a single episodes of vomiting or diarrhea.

If COVID is negative, the child can be treated as they normally would for that illness. Patients with low risk symptoms and no known COVID exposure may be tested, but do not necessarily need to be if their medical provider feels comfortable that their symptoms do not require it. The patient should be counseled on the high-risk symptoms to look for and they should be counseled if they do discover a possible exposure or develop high risk symptoms.

All patients with any exposure to COVID, regardless of symptoms, will need to be home on quarantine for 14 days after their last exposure to someone with COVID. They can be tested during that time if they are ill, but even if it is negative, they will need to stay home for the full 14 days. If they test positive during that time, they will need to stay home for 10 days after the onset of their own symptoms instead.

When can my child go back to school?

Children with a known close exposure to COVID must stay isolated for 14 days from exposure. Negative testing does not decrease the time of quarantine and should not be used to allow a child to return to school sooner. If continued contact with the exposed case could not be avoided ( for example you, the primary caregiver), longer duration of quarantine may be required. I recommend talking with your doctor or the health department about a safe return to school dates.

Children with a known case of COVID-19 are able to return to school:

• No sooner than 10 days after their symptoms started
• Have improvement in symptoms
• Are 24 hours without any fever while not using fever reducing medicines.

If symptoms are minimal or they are asymptomatic when they get their initial test, this 10 day period will be started at the time the test was conducted.

Does my child need a negative test to return to school or activities?

The quick answer is, No.

As long as the above guidelines are followed, negative testing should not be required to return to school. Some kids may remain positive (in testing alone but they aren’t contagious) for weeks and a sustained positive test should not prevent them from returning to school or other activities. Therefore, it does not make sense to require follow up testing in most instances.

Summary

It’s never been more important to have a sustained, quality relationship with your pediatrician. As we continue to navigate these complex decisions, having a provider who knows your child and can help you make decisions can go a long way to keeping them in school as much as possible and to ensure that their classmates are safe.