Many families are asking if their children should be tested for
COVID-19. Your pediatrician can help determine when testing may be a good idea, and which type of test would be best. They can also help you follow up on your child's test results.
When to test
Generally, children and teens who have
symptoms of COVID-19 should be tested without delay to find out if they have an active infection. This is especially important if they have in-person
sports, or jobs, so that anyone who may have been exposed can be alerted. Many hospitals also recommend testing before a child is scheduled for medical procedures such as surgery, and when they're admitted to the hospital for any reason. The United States requires testing for SARS-CoV-2, the virus that causes COVID-19, for unvaccinated people who are traveling internationally.
COVID-19 has similar symptoms to other illnesses such as
influenza and respiratory syncytial virus (RSV). It's also possible to have two of these illnesses at the same time. Because of this, children and teens with COVID-19 symptoms may be tested for all three of these viruses. Your pediatrician will decide what tests need to be done based on your child's symptoms and which illnesses are currently going around.
It's recommended that children and teens who had close contact with someone who has COVID-19 be tested within 3 to 5 days afterward, whether or not they've been vaccinated. Close contact means having been less than 6 feet away for a total of at least 15 minutes over a 24-hour period from a person with a confirmed or probable case of COVID-19. This exposure time would have taken place 2 days before the contact person became ill (or, if the person doesn't have symptoms, 2 days before they were tested) until the time they are isolated.
Testing usually isn't recommended for indirect exposure—close contact with someone exposed to another child with COVID-19, but not the infected child themselves—unless the child contact later tests positive for COVID-19 or develops symptoms.
What if my child was diagnosed with COVID-19 previously or got a COVID-19 vaccine?
COVID-19 vaccines now available are safe, highly effective, and children should get them as soon as they are eligible. However, no vaccine provides 100% protection against SARS-CoV-2. In addition, some SARS-CoV-2 variant strains are more contagious and may still infect people who have been vaccinated or who have already had COVID-19. Typically, infection after vaccination results in mild or even no symptoms, but your child can still spread the virus. Children who have received the vaccine or who already had COVID-19 within the past 3 months and have symptoms of COVID-19 after being in close contact with someone who has it still should be tested for active infection.
Types of COVID-19 tests
There are currently three main types of COVID-19 tests available: Nucleic acid amplification tests, antigen tests, and antibody tests. Your pediatrician can help describe what each test can and cannot do, and when tests can be most useful for your child's situation.
Nucleic acid amplification test (NAAT)
NAATs, also called molecular tests, look for pieces of SARS-CoV-2 virus in the respiratory tract. They generally use a nasal or throat swab or sometimes saliva for the test sample. You might get results the same day or up to a week later.
As diagnostic tests, NAATs are used to check if your child has an active infection. These tests will not tell if your child had COVID-19 in the past. Getting a SARS-CoV-2 vaccine does not cause a positive NAAT or antigen test results. Types of molecular tests include:
Polymerase chain reaction (PCR) tests. These are highly accurate. A PCR test authorized or approved by the U.S. Food and Drug Administration (FDA) is considered the "gold standard" to determine if a child has an active COVID-19 infection.
Loop-mediated isothermal amplification (LAMP) and
nicking enzyme amplification reaction (NEAR) tests. Some of these newer tests have received FDA emergency-use authorization. Until more information is available on how well they work for children, these tests are not a replacement for PCR testing.
Another kind of diagnostic test is an antigen test. It uses a nasal or throat swab. Some antigen tests are approved to give rapid results, available in an hour or less. Positive antigen test results are generally reliable. If the test result is negative, a PCR test might be needed so you know for sure that your child does not have COVID-19. This is because negative antigen tests tend to be less accurate.
Antibody (serology) tests can check a sample of blood for special proteins called antibodies. The body makes these to fight off viruses like SARS-CoV-2, the virus that causes COVID-19. An antibody test can tell someone has had COVID-19 at some point in the past, even if there were no symptoms.
However, antibody tests are not useful to diagnose a current infection. This is because it may take up to two weeks after your child first shows symptoms of being sick before the test can find antibodies in the blood sample. Many test locations can provide results the same day or within one to three days.
Does a positive antibody test mean my child is immune to COVID-19?
Scientists don't know yet if people who had COVID-19 can catch it again, especially with new variant strains now circulating. So, based on what we know today, a positive antibody test does not confirm protection against the COVID-19 virus. Also, because COVID-19 vaccination may cause positive SARS-CoV-2 antibody test results, antibody tests are not recommended to confirm immunity to COVID-19 following vaccination, or to check the need for a vaccine.
Antibody tests should not be used to make decisions about safe entering or returning to group settings like
child care, or dorms. Anyone with a positive antibody test should continue to take COVID-19 prevention steps such as wearing
hand washing , and
getting a vaccine once one is available to them.
After your child has a diagnostic or antibody test, it is important to talk with your pediatrician about positive or negative test results and what to do next. If you have any concerns about your child's health, call your pediatrician.