Kids and Covid Tests: What You Need to Know

Here’s everything you need to know about when to get it and what to expect.

My 4-year-old daughter is pretty tough when it comes to medical procedures. The flu shot? Not even a flinch. Stitches in her forehead? No big deal. Years earlier, she calmly watched as a nurse pricked her finger and squeezed the blood, drop by drop, into a tiny vial to test it for lead.

But the Covid test was different.

In early September, just before her preschool reopened, she began sneezing and had a sore throat. When her congestion worsened, we knew that she needed to get a coronavirus test. But as the nurse approached her, holding a long stick with a brush on the end resembling a pipe cleaner, she covered her face and backed away. In the end, two people had to hold her down. She screamed as the swab activated her lacrimal reflex, bringing tears to her eyes. It was over quickly, but she cried for half an hour afterward and insisted that she would never visit another doctor again. She now refers to that probe as “the needle.”

In late December she needed another test for her preschool, but this time she wasn’t sick. With the memory of her last experience still fresh in my mind, I immediately started researching. Were there less invasive tests to consider? If so, how would we find one? Would it be accurate enough? And was there an ideal way to prepare a squeamish young child who was averse to getting tested?

As it turned out, none of these questions had simple answers. So I consulted with five doctors and two of the largest urgent care providers in the United States to learn more.

There are four main reasons a child might need to be tested:

  • They have symptoms

  • They have been exposed to someone infected with the virus

  • Their school, day care or a hospital requires it

  • They need it as a precaution before and after traveling

If your child has any symptoms of Covid — even mild ones like a runny nose or a sore throat — it’s a good idea for them to get tested and stay home, said Dr. Stanley Spinner, chief medical officer and vice president of Texas Children’s Pediatrics, the largest pediatric primary care group in the country, and Texas Children’s Urgent Care.

“We have seen, time and time again, kids with very mild symptoms with no known exposures who get tested with our very accurate PCR and sure enough, they come back positive,” Dr. Spinner said.

If your child has been in close contact with someone who tested positive for Covid-19 — even if your child does not have any symptoms — they should get tested, the experts said. The Centers for Disease Control and Prevention define close contact as spending at least 15 minutes within six feet of someone who has the coronavirus, or having any type of direct physical contact with an infected person, including kissing or hugging.

If your child is in school or day care, those institutions may have rules on when they must be tested, and how.

It’s safest to stay home, but if you and your children must travel, the C.D.C. recommends getting tested one to three days before your trip and then again three to five days after your trip.

If you’re still unsure if your child needs a test, call their pediatrician, said Dr. Kristin Moffitt, an infectious disease specialist at Boston Children’s Hospital. You can also take the C.D.C.’s clinical assessment tool, which can be used for any family member, including children.

Virus testing for children is, for the most part, the same as it is for adults. The Food and Drug Administration has authorized the emergency use of two basic categories of diagnostic test. The most sensitive ones are the molecular PCR tests, which detect the genetic material of the virus and can take days to deliver results (some locations offer results in as little as a day). The second type of test, the antigen test, hunts for fragments of proteins that are found on or within the coronavirus. Antigen tests typically yield results quickly, within 15 minutes, but can be less sensitive than the molecular tests.

The way your provider collects your sample can vary. For instance, regardless of whether you get a PCR test or an antigen test, the collection method could be any of the following: nasopharyngeal swab (the long swab with a brush at the end that reaches all the way up the nose toward the throat); a shorter swab that is inserted about an inch into the nostrils; a long swab of the tonsils at the back of the throat; or a short swab swizzled on the gums and cheeks. The new saliva tests, which are still being vetted, require you to drool into a sterilized container, which could be difficult for young children.

FastMed Urgent Care, which has a network of more than 100 clinics in Arizona, North Carolina and Texas, currently uses a long swab to perform the rapid antigen test and a short swab for the PCR test, said Dr. Lane Tassin, one of the company’s chief medical officers. But MedExpress, a different urgent care group with clinics in 16 states, tests all patients with the shorter nasal swab when doing either PCR or antigen tests at its nearly 200 urgent care centers, said Jane Trombetta, the company’s chief clinical officer.

The type of test that your child gets will largely depend on what is available in your area, how long it takes to get the results back and why the child needs it, the experts said.

Some day care centers and schools will only accept PCR results for clearance to return to school, so it is best to double check their rules beforehand.

The long-swab molecular test is considered the “gold standard,” but other less-invasive testing methods are also reliable. For routine testing, Dr. Jay K. Varma, senior advisor for public health at the Office of the Mayor of New York City, said the shorter swab “performs basically as well as the longer, deeper swab does. That’s true in both adults and children.” In fact, he added, New York City’s public hospital testing sites began switching from the long swab to the short swab during the summer.

Dr. Jennifer Lighter, a pediatric infectious disease specialist at NYU Langone Health, said she likes the antigen tests because they can quickly identify Covid-positive kids when they are contagious. Antigen tests are most accurate when the amount of virus in the sample is highest — typically around the day that symptoms start.

If you have a preference on which test you’d like your child to get, call your pediatrician’s office first and ask what kinds of tests they perform and how they collect the samples. Clarify whether they use the shallow (anterior) swab or the long (nasopharyngeal) swab. If you want the more comfortable, shallow PCR test but your pediatrician’s office does not offer it, try other testing centers in your area, including pediatric urgent care centers.

Some tests are now available for home use. But if you’re using a home test, check the label. Some aren’t indicated for children.

Many testing sites offer drive-through services where you don’t need to leave your car. But if you must walk into a clinic, the experts I spoke with said that the risk of getting Covid while you’re there is low.

“In my experience, everyone that is delivering health care now is being incredibly careful with infection control,” said Dr. Sean O’Leary, the vice chairman of the American Academy of Pediatrics’ committee on infectious diseases. “The risk of going into a health care facility is probably pretty low relative to a lot of the other things people are currently engaging in in the U.S.”

Testing facilities require people to wear masks and to maintain physical distancing, he added.

The experts also said that the tests themselves are not harmful for young children, including infants, even if done repeatedly. The long swab may produce discomfort for a brief period — Dr. O’Leary jokingly calls it the “brain biopsy” — but he is not aware of any long-term risk to the nose or throat.

To avoid any surprises, ask your provider about which types of tests they offer and how they collect the samples ahead of time.

It’s usually best to be straightforward with your kid about what to expect. For short nasal swabs, explain that a doctor will tickle the inside of their nose with a cotton swab to collect their boogers, and that it won’t hurt.

For the long swab, you may want to prepare your child by explaining that the swab might feel a little uncomfortable, but that it will be over quickly. You can also share that kids of all ages are getting the test, even babies.

Over all, convey that it’s no big deal and it’s something that simply needs to get done, Dr. Lighter said.

“Kids are only as anxious as the information that’s coming to them,” she added.

If your child might be intimidated by the protective gowns, masks and face shields that health providers wear, explain that they wear that clothing to stay safe — kind of like how people wear cloth masks when they go outside.

Some hospitals have created videos like this one from the Children’s Hospital Colorado that show how the Covid test works and what families can expect. If your child is old enough to understand, it might be helpful to watch a video like this together and then talk about it afterward.

Try to find out how long you might need to wait. Many areas have long lines at testing sites, so consider bringing water, snacks and entertainment (crayons, storybooks) for your kids.

If your child’s pediatrician is administering Covid tests, it might be reassuring for your child to have the test performed by someone they are already familiar with. But if not, “try and go somewhere that has experience working with children,” Dr. O’Leary said. Doctors and nurses who test children regularly will most likely know what to do if your child is nervous or scared.

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