Covid cases usually present with a range of flu-like symptoms (such as fever, body aches, sore throat, cough, congestion, vomiting and diarrhea). It’s important to realize that not every person shows the same combination or severity of symptoms. If your child experiences these symptoms, it is reasonable to have them tested for Covid. They can test as soon as they are symptomatic.
We have two testing options available in our office, both of which require a nasal swab: rapid testing (with results in minutes) and send-out laboratory testing (with results usually available in 48 – 72 hours). The send-out testing is what is referred to as a ‘PCR test’ and has a higher likelihood of detecting the virus. You must schedule your child for a sick visit or virtual visit with one of our providers to have a Covid test. We do not have saliva based or cheek swab testing available in our office at this time.
Home rapid antigen tests are reportedly as sensitive as office-based rapid antigen tests when evaluated in lab settings. It has not been confirmed that these tests work as well in real world settings. It is reasonable to assume a positive home test is reliable, but a negative test should be interpreted with some caution, depending on the specific situation.
Please ensure you check with your child’s school on which test is required and accepted for return-to-school policy.
Tests do not specify which variant of Covid is present. This should not matter because once infected, there is not likely to be a significant difference in the outcome of the infection (delta and omicron variants are more easily spread, but there is no evidence that any variants are any more serious than other strains). It is currently safe to assume that a positive test means you have the omicron variant as that is reported to be the vast majority of circulating infections.
We do not perform antibody testing in our office. If appropriate, we can order antibody testing through an outside draw station. In general, there is limited benefit to antibody testing. Antibodies tend to fade after several months, but that does not mean that Covid immunity has faded. A negative antibody test does not rule-out prior infection or ongoing immunity. Asymptomatic patients may test positive for Covid antibodies, but it is unclear whether this provides lasting protection from re-infection. Antibodies generally do not become detectable until 10-14 days after the onset of illness, so immediate testing post-exposure is not helpful in medical decision making.
If your child tests positive to Covid
Fortunately, the vast majority of children who get Covid will have a short lasting flu-like illness. Treatment is based on symptoms and mainly includes fever-reducers, pain relief, hydration and rest.
There are no approved or recommended outpatient prescription medications for Covid for kids and no need to try any popularized off label medications.
Respiratory difficulty (labored breathing, shortness of breath) is the main sign/symptom of worsening illness that you should monitor. You should seek immediate medical attention for your child if this develops.
Everyone, regardless of vaccination status, can now quarantine for only 5 days from the start of their symptoms, they should also be fever free for 24 hours (without fever reducing medication) and have improving respiratory symptoms before returning to school/social activities. It is recommended that they wear a mask for an additional 5 days if they only quarantine for the 5 days.
Children in athletic activities need to be evaluated 10 days after symptoms started, or positive test if no symptoms, in order to start a return to play protocol.
If a child tests positive without having any Covid symptoms, then they should be quarantined for 5 days from the date of the positive test.
There is no need to retest after being diagnosed with Covid. Some people can have positive tests even after they are no longer contagious (the tests can detect non-infective viral particles).
We can only provide return-to-school notes for patients assessed by our office by one of our providers. If your child is diagnosed outside of our office (home test, urgent care, etc.) we cannot give clearance if we have not done our own assessment.
Covid Exposures (Unvaccinated Children)
A Covid exposure is defined by the Centers for Disease Control (CDC) as contact within 6 feet of a known case for a total of 15 minutes over a 24-hour period. If both parties are masked, then this is not considered a close contact.
People are considered to be contagious with Covid starting two days before the onset of their symptoms.
Unfortunately, the Texas Education Agency (TEA) and the Centers for Disease Control (CDC) have differing recommendations/requirements for quarantine after Covid exposure in schools which makes giving advice about handling an exposure for your child difficult. TEA does not require schools to quarantine exposed students and each school may set its own policy. You should check with your child’s school to understand their specific Covid contact and quarantine requirements. When possible, we recommend following the CDC guidelines on post-exposure quarantine, but we understand this may not be an option for some children. If an exposed child does go to school during the recommended quarantine period, we strongly suggest they wear a mask and get tested if they show any possible Covid symptoms.
Completed the primary series of Pfizer or Moderna vaccine over 6 months ago and are not boosted
Completed the primary series of J&J over 2 months ago and are not boosted
Quarantine for a minimum of 5 days from your last exposure to the contagious individual; you may return to activities after 5 days from exposure if you have a negative Covid test after day 5. Continue to wear a mask for an additional 5 days.
Covid Exposures (Vaccinated Children)
Vaccinated individuals may still become infected by Covid and be contagious to other people, but the risk is lessened compared to unvaccinated people.
Have been boosted
Completed the primary series of Pfizer or Moderna vaccine within the last 6 months
Completed the primary series of J&J vaccine within the last 2 months
and were exposed to a contagious person, you do not need to be quarantined, but it is recommended that you wear a mask for 10 days and get tested 5 days after the exposure to make sure you are not spreading the virus.
If a vaccinated child tests positive for Covid, they should follow the quarantine recommendations discussed above.
The Pfizer vaccine is available for children 5 and above.
We currently offer the Pfizer vaccine in our office. Call the clinic to get an appointment should you wish to receive the vaccine. If you have questions about the risks and benefits, please contact us via a portal message and/or call for an appointment to discuss with your provider.
Children who have had Covid should wait at least 6 weeks after their infection before getting vaccinated. The risk of significant illness with a second infection in an otherwise healthy child is extremely low, so we suggest you discuss this with your physician when in the office for more detailed discussion if you have questions about the risks/benefits.
If your school does not require universal masking, your child can still wear a mask if you choose.
Individual masking with a cloth mask probably provides limited protection against acquiring Covid in a school full of unmasked students, especially with the increased contagiousness of the delta variant.
If you want to maximize your child’s protection by masking, then we suggest ordering a properly fitting N-95 or KN-95 mask and instruct your child on proper and consistent use.
We strongly encourage all children to wear a face covering when they have cold/respiratory symptoms such as cough, runny nose or sore throat. We hope this may limit the spread of many infections beyond just Covid. Children with fever should stay home from school and consider being tested for Covid.