Pre-pandemic, rarely would a bout of the sniffles be something to worry about. Kids get colds all the time, especially during fall and winter. But then came the coronavirus.
“It’s honestly very difficult to tell the difference between COVID and another virus that would cause a common cold,” says Dr. Craig Shapiro, pediatric infectious diseases specialist, Nemours/Alfred I. duPont Hospital for Children. “A lot of the symptoms are similar, and so this year in particular, we have to be more cautious and aware.”
The coronavirus appears less severe in children. But kids can spread the deadly virus to others. This has left many parents wondering: What do I do if my kid gets a runny nose or a cough? Do they need to stay home from school? For how long? Does the whole family have to quarantine? How do I know if it’s just a cold or the coronavirus?
“I’m a physician, but I’m a parent, too, and it can be quite difficult to make these decisions,” says Shapiro. “We have to remember, it’s not just you who this is affecting — it could be your entire community.”
Here’s what to do if your child gets sick.
Is it a cold or COVID-19?
Coronavirus symptoms are similar for kids and adults. According to the Centers for Disease Control and Prevention, the most common ones in children are cough and fever, but can include sore throat, stomachache, and others. Without testing, this makes it nearly impossible to know if your child has COVID-19 or something else, says Dr. Susan Coffin, attending physician for the division of infectious diseases at Children’s Hospital of Philadelphia.
“An isolated mild runny nose is not likely to be coronavirus,” says Coffin. “But when we think about kids getting a runny nose, we know that often comes with other symptoms, such as decreased eating, fever, or cough, and coupled with any of those symptoms, a runny nose may be enough to need a test.”
Coronavirus cases in children are on the rise. A report by the American Academy of Pediatrics shows that kids represent more than 10% of the nation’s coronavirus cases. And the actual number is likely higher. Most children who get infected have mild symptoms or no symptoms — and many never get tested.
However, some kids do have more serious reactions. While rare, children infected with coronavirus are at risk for developing multisystem inflammatory syndrome (MIS-C), a condition in which some parts of the body — like the heart, lungs, blood vessels, kidneys, digestive system, brain, skin, or eyes — become severely inflamed. As of Oct. 1, confirmed U.S. cases of MIS-C in children have passed 1,000. Possible signs and symptoms include a fever that lasts longer than 24 hours, stomach pain and/or nausea, and a red rash.
When should I keep my kid at home? Does the whole family need to stay home?
You shouldn’t normally let your kid leave the house with a fever. Yet it’s common to send kids to school with a lingering cold. But now, experts say, always err on the side of caution.
“If your child’s sick and you think they may even just have a cold, you should keep them home and not have them around other people,” says Shapiro.
Get in contact with your doctor early on. It’s not the time to let cold symptoms play out and see how it goes. Your doctor will help decide if you should get your kid tested.
“If your pediatrician is suspicious this might be coronavirus, then families need to consider themselves exposed and should quarantine, too,” says Coffin.
Quarantining means staying home for 14 days, unless your child gets tested and the results are negative. If possible, keep your child in their own room and avoid sharing a bathroom.
Technically, you’re supposed to stay home for 14 days after your last contact with a person who has COVID-19, so if you’re taking care of a little one and social distancing isn’t possible, you may need to extend your quarantine time even after they are better. And the 14-day clock restarts with each new person who develops symptoms.
What if my kid has allergies and their nose is always running?
Here’s where guidance slightly differs. You don’t necessarily need to call your doctor at the first sign of every sniffle.
“Parents know their child best, and parents' intuition is really important,” says Shapiro. “What you need to be aware of is when your child’s having symptoms you wouldn’t expect based on their prior medical history.”
If you notice new or unexplained symptoms, call your doctor immediately. Otherwise, monitor your child’s allergies, and check in from time to time to ask how they’re feeling.
You should, however, also take into account coronavirus risk levels, says Shapiro. If your kid was or may have been exposed to someone infected, then you need to evaluate those allergy symptoms differently. This applies also if numbers are notably rising in your area or if your kid recently attended a large gathering or other high-risk situation.
When should I get my kid tested?
If your child gets sick, notify their doctor and school immediately. Your pediatrician will help determine if your kid should get tested based on their symptoms, likelihood of exposure, and the infection rates and availability of tests in your area. School requirements may play a factor in this decision, too.
The CDC advises that school-aged children be prioritized for testing if:
They have signs or symptoms of COVID-19 and:
Close contact (within six feet of someone for a total of 15 minutes or more) with a person with confirmed or probable infection or
Increased likelihood for exposure, as defined here
No symptoms but have had close contact (within six feet of someone for a total of 15 minutes or more) with a person with confirmed or probable infection
“If there’s any opportunity to test, that would always be better than just isolating the child at home for 10 days,” says Shapiro. “It’s unfortunately just not feasible to test every child every day, but it’s important to test if you’ve had an exposure or if your child’s having symptoms that can’t be attributed to something else.”
When it’s an option, pursue a testing site where you can get the results back in a day or two. If the test is negative, your kid will be able return to school and/or other outside activities more quickly. If it’s positive, contact tracers can get in touch earlier with others who may have been exposed.
How long do I need to keep my kid at home if they get sick?
It depends on whether your child got tested and those results.
If your kid tests negative, they can return to school once their symptoms have improved.
If your child tests positive, follow the CDC’s guidance: If symptoms subside and your child was isolated at home for at least 10 days, they can return to school, without a doctor’s note or negative test results.
If your child wasn’t tested, they need to be evaluated by a doctor. If coronavirus can’t be ruled out, your child should be considered a presumed case of COVID-19 and isolate according to CDC’s recommendations for home isolation.
If your child doesn’t have symptoms but was exposed to someone with the coronavirus, the CDC advises a 14-day quarantine, even if tested and the results are negative.
Dr. Susan Coffin is an attending physician for the division of infectious diseases at Children’s Hospital of Philadelphia.
Dr. Craig Shapiro is a pediatric infectious diseases specialist, Nemours/Alfred I. duPont Hospital for Children.