If Your Child Tests Positive for COVID-19
Keep your child at home in one space, away from other family members where possible. When providing care to your child, you should be wearing a mask and washing hands after contact.
Current Centers for Disease Control and Prevention (CDC) guidelines recommend a minimum of 10 days from the start of symptoms without fever (and no Tylenol®/Motrin® for 24 hours) and improvement of symptoms. If they had a severe course — for example they were in the Intensive Care Unit (ICU) in the hospital or are immunocompromised (they have an autoimmune disease or are receiving certain types of cancer care) — recommended isolation may be longer (20 days). Some symptoms can linger (e.g., loss of smell, fatigue, etc.) beyond this period but that does not mean they are contagious.
If they never had symptoms then they should be isolated for 10 days from the last positive test.
Repeated COVID tests in children are not always helpful because they can shed parts of the virus for some time (and have a positive test result) and not necessarily still be contagious.
CDC has guidelines on how to take care of loved ones when they are sick including advice on having a separate trash can, using gloves and masks when handling waste or getting within 6 feet of the patient, disinfecting high surface touch points, etc. Learn More About These Guidelines
We recommend 14 days from the day the child was isolated from them. If the child was unable to be isolated from a family member, then that family member’s quarantine duration would start from the day the child was able to come out of isolation (e.g., 10+14 days = 24 days). Of note, the CDC has recently updated guidelines to allow for shorter duration of quarantine (e.g., 7–10 days) but that should be determined on a case-by-case basis.
For nonhospitalized patients with mild to moderate disease, treatment is supportive (fluids, over-the-counter medications for fever, cough, etc.). Remdesivir, dexamethasone, antibody treatments, etc., are possible considerations for patients who have certain high-risk conditions or are sick enough to be in the hospital. Antibiotics are only helpful if there is concern for bacterial pneumonia. Vitamin D, zinc and other supplements are not routinely recommended for children without known deficiencies. Inhalers may be helpful in patients with known asthma but any patient with new wheezing or difficulty breathing should be assessed by a provider.
There are no studies that clearly show Motrin® is harmful for children with COVID-19, but for now we would prioritize giving Tylenol® first for fever or pain and then Motrin® if necessary.
Without any clinical signs of pneumonia or trouble breathing, a chest X-ray is not helpful — a patient would not be admitted on the basis of a chest X-ray alone and a chest X-ray may not show a pneumonia early in the course. Lab testing may be helpful for looking for signs of Multisystem Inflammatory Syndrome in Children (MIS-C) but only when there is suspicion for the syndrome (e.g., having fever with red eyes, swollen lymph node, rash and looking very sick). If there is concern your child is sick enough to suspect MIS-C they should be assessed by their provider. Otherwise, labs for mild disease do not help predict their course.
- give Tylenol® to keep them comfortable when they have fever or aches
- encourage drinking plenty of fluids to stay hydrated
- allow them to rest when needed but also encourage them to get up and stay active as tolerated
- keep the window shades open during the day so they can keep track of day/nights during isolation and keep them engaged with activities in their room
- closely monitor their temperature, breathing, drinking/urinating and mental status
- chest pain (continuous, not just pain with coughing)
- labored breathing (grunting, breathing too fast to count, working very hard to breathe or blue/pale lips)
- confused or cannot be woken up
Prone positioning is something that may be used in a hospital setting when there is concern for respiratory failure. This is NOT recommended for patients at home.
Hypoxia (low oxygen saturation) has been shown to predict worse outcomes in adults but this is not something that is recommended to check for children at home. Some equipment is not appropriately sized or calibrated for children. If there is any concern for difficult or labored breathing, they should be seen by a provider right away.
COVID-19 is extremely variable in its course depending on the severity. Most cases in children are mild or even asymptomatic, meaning most will not develop pneumonia, hypoxia, respiratory failure or MIS-C. For those with mild symptoms, most recover by 2 weeks but some symptoms (e.g., loss of smell/taste, fatigue, cough, etc.) can linger for another month. There are reports of rare cases of “long COVID” where they have continued lung problems or neurologic issues in which case they should be seen by us and potentially referred to specialists.
Similar to concussion, return to activity may need to be gradual. Some children may be too fatigued to do full-day distance learning and need a modified schedule. Some are ready to go back to full-time school right away. If a child needs modifications for school and has not been seen by us yet, they should be given an appointment to discuss their ongoing symptoms with their provider.
If they were asymptomatic for COVID-19, they should refrain from exercise/sports activity for 2 weeks. If they had significant symptoms and are 12 years or older, they will need a normal EKG at least 2 weeks after symptoms have resolved. If they were hospitalized for COVID-19 or have cardiac symptoms, they must refrain from exercise until cleared by a cardiologist.
No, the currently available antibody testing is not always specific to the type of Coronavirus that causes COVID-19 and we do not know how well children make these specific types of antibodies and for how long. The results will not provide much useful information. Even after having COVID-19 it is possible they could get it again and would need to practice the same precautions similar as those that have not had it.
Testing for COVID-19
Please refer to our COVID-19 testing page for the most up-to-date information on testing options.
COVID-19 testing options for children may vary if your child:
- has symptoms for a COVID-like illness
- doesn’t have symptoms but may have been exposed to someone who does
- needs testing for a procedure/school, etc.
Talk to you child's doctor for some specific recommendations.
Go to your county’s website or talk with your own adult physician.
There are 2 main types — those that look for current infection with SARS-CoV-2 virus and those that look for recent or past infection. They may be called antigen, molecular or antibody tests. Please know that it is possible for your child to receive a false negative result (when they actually do have the virus) with any of them. The timing and method of collection can affect the accuracy of the test — testing too early of a child with very low levels of virus, for instance. Another example would be if a sample collected from a swab at home didn’t collect enough virus. This is why your child may need to be swabbed again for a test to confirm the result.
False positive results are also possible, so a second test may be recommended in certain circumstances to confirm the result. In general, one kind of test (molecular) obtained after the 3rd day of symptoms and at least 5–7 days after exposure tend to be more accurate but great care needs to be taken to follow Centers for Disease Control and Prevention (CDC) guidelines on isolation/quarantine no matter what the test result shows.
This could refer to any of the types of tests that are available. Check to see exactly what kind of test it is — and whether the test is run in a lab or not.
Testing may help for contact tracing purposes (and the County may contact you for that) and help with diagnosing the cause of certain symptoms that develop. If your child does not have symptoms, please remember they are most contagious in the days just before and in the beginning phase of symptoms. A negative test early in the course of exposure may falsely reassure you, only to have symptoms develop later. We recommend quarantining the child for 14 days from last contact. There are certain circumstances where the period of quarantine may be shorter, depending on the timing of testing and symptoms, but this should be determined on an individual basis.
Repeated tests for the SARS-CoV-2 virus in children are not helpful because kids can shed parts of the virus for some time and have a positive result but not necessarily still be contagious. Once they have completed the recommended isolation period and have recovered from symptoms, they do not need a repeat test.