Editor's note: This guidance has been updated since the article was published. Please visit https://bit.ly/357KU3Z. AAP interim guidance is based on current evidence and best data at the time of publication. Updates are provided to reflect changes in knowledge about the impact of the disease on children and adolescents. For the latest news on COVID-19, visit https://www.aappublications.org/news/2020/01/28/coronavirus.
Children may need to be tested for SARS-CoV-2 if they are symptomatic, in close contact with someone who has the virus or are scheduled for elective surgery, according to new AAP interim guidance.
The COVID-19 testing guidance also addresses types of tests, testing in pediatric offices, personal protective equipment and interpreting results.
Whom to test
The three scenarios listed above are the most common. When patients are symptomatic, clinicians should use their clinical judgment and consider local epidemiology. For patients with respiratory symptoms, pediatricians may consider testing for SARS-CoV-2, influenza and/or other diseases. Some studies have found high levels of co-infection.
Given current testing limitations, the AAP does not recommend “on demand” testing such as prior to travel, particularly if patients are asymptomatic. For AAP guidance on testing related to school entry, visit https://bit.ly/2BMPtW5.
Types of tests
The AAP recommends using molecular tests such as reverse transcription polymerase chain reaction tests that have been approved by the Food and Drug Administration (FDA). Other FDA-approved tests may be considered if necessary.
Most antigen (rapid) tests that have received a Clinical Laboratory Improvement Amendment waiver have limited specificity and sensitivity and should not be used for routine clinical care.
Until experts learn more about SARS-CoV-2 antibodies, antibody testing is not routinely recommended and should not be used to make decisions about grouping people in classrooms or other facilities.
Testing in pediatric offices
Pediatricians who would like to test in their practice should consider the local availability of test kits, access to supplies, space constraints, ability to sanitize the office, capacity of practice staff and ability to follow up on results.
When preparing the office, pediatricians should register patients in advance and separate them either through scheduling or using entrances and exam rooms that are not used for well patients.
Exam rooms should be cleaned using disinfectants known to be effective against SARS-CoV-2. Rooms should be aerated after testing for up to an hour depending on whether the patient was sneezing or coughing and whether an aerosolizing procedure, was done, which does not include testing.
Personal protective equipment (PPE)
N95 masks or equivalent, eye protection, gowns and gloves should be used when collecting respiratory specimens, especially in areas of moderate or high transmission. If N95 masks and/or gowns are not available, clinicians should at least use gloves, a facemask and eye protection during testing.
Test results
Patients and other members of their household should stay in isolation while awaiting test results. Children who are symptomatic and positive should stay isolated until they have been afebrile for 24 hours without the use of antipyretics, at least 10 days have passed since symptom onset and symptoms have improved.
Children who are symptomatic and negative should stay isolated until symptoms resolve. Families should be counseled that the test result shows only a moment in time and the child still can contract the virus.
Children who are asymptomatic and positive should be isolated for 10 to 14 days depending on local public health recommendations.
When a child tests positive, his or her family members should be tested if they become symptomatic. If the child has an upcoming elective surgery, it should be postponed.
Pediatricians should follow state and local guidelines on reporting positive tests to public health officials.
