It's inevitable that when kids mix — returning from camp or heading back to school — germs spread. And in a pandemic year fueled by the delta variant, some of those germs may cause COVID-19. The Centers for Disease Control and Prevention has advice for keeping your child protected from this highly contagious version of the coronavirus now and this fall: Mask up in schools and other crowded venues, and make sure everyone age 12 and older in the family gets a COVID-19 shot.
But what if your kids are younger than that? What if they develop symptoms or come into contact with someone who tests positive for the coronavirus?
Rules for testing and quarantining vary from place to place, so we asked several public health experts — all parents — about their personal strategies for keeping their kids and families safe these days.
What do I do if my kid wakes up with the sniffles?
Keep your child at home and consult the pediatrician.
"This happened to us [recently], for camp," says Seema Lakdawala, a virologist who studies flu transmission at the University of Pittsburgh. She has two daughters, ages 5 and 8. "My [8-year-old] daughter woke up and was sneezing and had a runny nose."
She kept her daughter home and then called the pediatrician to talk through her symptoms. The likely culprit was allergies, the doctor told her; the child has known allergies to grass pollen, and it's already hay fever season where she lives. Sure enough, when Lakdawala gave her daughter allergy medication, her symptoms resolved.
The key, says Lakdawala, is that her daughter had no known exposures to COVID-19. "If we had been on a plane recently, or otherwise traveling, then I would definitely want to get her tested for COVID," the mom says.
Test for the coronavirus when warranted.
Ahead of those sniffles, while everyone's healthy, figure out where your child and others in your home can get PCR-tested for the coronavirus on short notice with quick results. "Our pediatrician's office, like many pediatric clinics, has walk-in hours for children who are sick," says Dr. Cassandra Pierre, medical director of public health programs at Boston Medical Center and a parent of 3-year-old twins. "Those hours are in the morning, which means my child could get tested and, hopefully, get the results in the same day."
Keep your child at home until those test results come back.
Another option is to purchase some over-the-counter, rapid antigen tests from the pharmacy now and keep them in your medicine cabinet for a time when you might need them, says Gigi Gronvall, an immunologist and researcher at the Johns Hopkins Center for Health Security. She has two kids, ages 11 and 14. These swab tests are less sensitive than PCR tests (so they might miss very minor infections). But they're quick, easy to use, and considered to be fairly accurate in people who are actively sick. "They certainly provide peace of mind, especially if they're symptomatic," Gronvall says.
Even if those symptoms turn out to be "just a cold," try not to spread it.
Whatever your child's COVID-19 status, please don't send them back to school if they're still coughing and sneezing, Pierre says.
Her 3-year-old was home sick from day care with a cold the day we spoke with her. "If my son is still sick tomorrow, still stuffy and having nasal secretions, I wouldn't necessarily put him right back and expose other children to another respiratory virus," Pierre says. As difficult as it is to arrange for child care, the pandemic has driven home to her that "we really rely on the decisions that other people make," she says. "I want to make sure that I'm making good decisions to prevent other children and parents potentially from getting sick."
If kids must return to camp or school or day care with mild cold symptoms, they should wear masks consistently, says Dr. Monica Gandhi, an infectious disease doctor at the University of California, San Francisco.
What if my child tests positive for the coronavirus?
"Don't panic," says Pierre. "The first thing to remember is that children are incredibly resilient." Most cases of COVID-19 in children are mild. Keep a close eye on your child and check in with the pediatrician, particularly if your child has underlying health conditions that may need monitoring.
Think ahead of time about who will take care of whom — and how — if somebody gets sick.
Households are complicated, but think right now about how you could limit the sick child's contact with others in your home. Consider how you and other members could best divvy up care. Lakdawala and her husband have walked through this scenario. They are both fully vaccinated, but their two children are not yet eligible. If one child tests positive for the coronavirus, she says, they will split the household into parent-child pairs in different parts of the house. They might then take turns in the kitchen and minimize the amount of time they're in enclosed spaces with each other.
If your situation requires more backup, Lakdawala suggests reaching out to fully vaccinated family members, friends or neighbors who may be able to step in and offer help.
Layer protections to reduce the risk of household transmission
The key is to rely on multiple types of protection.
The first defense is vaccines, Pierre says. "We really should be thinking about getting as many people in the household vaccinated as possible to protect themselves, but also to protect the child." Vaccinated people can provide care without needing to quarantine, so long as they remain healthy, without COVID-19 symptoms.
An older child who is sick with COVID-19 may be able to isolate in a bedroom, maybe with a bathroom to themselves, says Pierre. This limits the presence of the virus to a specific part of the home.
But even if space and bathrooms are limited, there are proven ways to reduce the risks of transmission.
COVID-19 is primarily transmitted through the air, so Pierre notes that "respiratory hygiene is your No. 1 priority."
If indoor space is shared with a sick person, everyone in the house should wear masks as much as possible, says Gandhi. This means at all times, except when eating, drinking and sleeping. For the sick person, this reduces the amount of virus they exhale into the air, and for others in the household, it limits the amount of virus they breathe in.
Get fresh air into the house to disperse any clouds of virus that may be lingering in the air, Lakdawala advises: "Open the windows, turn on the fans, get some air circulating." Air purifiers could help filter virus out of the air in a closed room, Pierre adds.
Another possible route of transmission is picking up the live virus on your hands and touching your eyes, nose or mouth. So periodically clean and disinfect shared surfaces such as the bathroom counter or kitchen table, particularly if a sick person has been coughing or sneezing nearby, Pierre says. After a few days (the CDC recommends 3-5 days after a known exposure), it's a good idea to get the rest of the household tested for the coronavirus.
Keep your child home until they're no longer contagious.
Though asymptomatic infections can spread disease, too, people with COVID-19 are most likely to spread the infection to others when symptoms first appear. So 10 days later, if those symptoms have resolved without the continued use of fever-reducing medicine, the illness is no longer considered contagious, Gronvall says. Sometimes, children develop symptoms such as loss of taste and smell that can last longer, "but as far as there being a danger to others, these symptoms don't need to interfere with them going back to school," she says.
What kind of mask should a child wear?
Wear any mask that fits well — with no gaps around the mouth, nose or chin — and is comfortable. While adults these days are being encouraged to step up our mask game beyond cloth versions, the advice for children may be a little different. "The best mask is one that they can wear for long periods of time, even in school," Pierre says. "A cotton mask is the most comfortable, lightweight and breathable."
Bonus points if the kids like the design. "My kids have the cutest masks," Lakdawala says. "They have the ones that look like little cat faces and smiley faces or dogs or bears or whatever." Gronvall's 11-year-old prefers a mask that is "silky and has pictures of cats in outer space that have lasers coming out of their eyes," so she has ordered several of those masks to send with him to school. A child is more likely to wear a mask they find appealing, and to wear it consistently and correctly.
If you want to add more protection, Gandhi suggests wearing two masks, which creates a tighter mask fit on the face, or adding a filter layer to a child's mask. "You can buy a cloth mask with a pocket, and use vacuum bag material as a filter. It's thin and it blocks virus very effectively," she says. Still, she agrees that the bottom line with kids is comfort. So if these interventions make them less likely to wear the mask, she says you can skip them.
Is it OK to hug our kids when they're sick with COVID-19?
The reassurance of physical contact — hugs and cuddles — can be important, especially for little ones, Lakdawala says. "I'm not going to deny or deprive my child of that comfort when they're not feeling well." And you may feel that way, too. But Pierre says that if the kids are older, "I would recommend physical distancing."
Studies suggest that a person with COVID-19 is most infectious in the first five days, so Gandhi says she'd aim to limit close contact in that period. "For the first five days, I'd let them watch TV and I would try to not be as cuddly," she says.
"At night, if a child has a fever and needs comfort, that can be difficult," says Pierre. Nobody recommends wearing a protective mask while sleeping, but if you're sharing a bed with a sick child, you might consider facing in the same direction from behind them, or away — so they're not breathing directly into your face — and opening up the windows or using air purifiers to help clear the air.
Lakdawala says wearing masks when someone is sick with COVID-19, and, again, divvying up care responsibilities between the parents (including hugs), can help reduce the risk that everyone in the household gets sick.
What do I do if my child is sent home from school after a COVID-19 exposure?
If your child is unvaccinated, quarantine your child, wear masks, watch for symptoms and test.
If the school district provides specific instructions for quarantining, follow that guidance, Pierre says. The CDC has a specific definition for "close contact" between kids in schools, and it is more lenient than in other settings: "If your child is physically distancing 3 feet from another child who's sick and both of them are wearing masks consistently, we would not actually consider that to be an exposure," says Pierre. "But if that is not what has happened, then the child needs to be quarantined."
In the house, take reasonable precautions, says Pierre, "but it's not necessarily with the rigor of having to go to your room and stay there," unless your child develops symptoms or tests positive for the coronavirus. Instead, try to keep some physical distance between the quarantining child and other household members, and have the child and/or those other family members wear a mask, especially those who are the most vulnerable and unvaccinated.
In Lakdawala's home, her two children — both too young to be vaccinated — typically share a room. If one were in quarantine, "I would separate them in terms of where they would sleep, but I would probably still send the other one to school if it was just an exposure," she says.
She would wait a few days and then get the quarantining child tested for the coronavirus with a PCR test. In the interim, she'd watch for symptoms. If no symptoms develop or the test comes back negative, it's fine to resume all the usual activities after seven to 14 days, depending on your school's policy.
And while the child in quarantine is staying home, Lakdawala says, the rest of the household can keep on with essential business — school, work, grocery shopping and the like — with some precautions. The whole family should refrain from playdates or dinners out and wear masks in public, indoor settings.
AILSA CHANG, HOST:
To mask or not to mask - that is the question at the heart of the controversy swirling around students returning to school across the country. While the CDC has recommended that everyone wear masks in school, there's been fierce debate and even court fights, all while cases of delta tick up among children. Many schools have ramped up their efforts to combat the spread. California today issued a new public health order that requires all school staff to either show proof of full vaccination or be tested at least once a week. For some practical tips on how to keep your child healthy, our co-host Audie Cornish spoke with NPR health reporter Pien Huang.
AUDIE CORNISH, BYLINE: Masks or not, no matter how many little gold arrows and footprints you paint on the hallway floors, we know that germs spread when young children get together. So what do people think is the right approach if a child does wake up, say, with the sniffles?
PIEN HUANG, BYLINE: Well, Seema Lakdawala - she's a flu researcher at the University of Pittsburgh, and she went through this recently. Her 8-year-old woke up sneezing with a runny nose. Step one, she said, was to keep her home. And step two...
SEEMA LAKDAWALA: I will call the pediatrician and just talk through where we've been. If we were traveling, I think I would be more concerned. If we'd been on a plane recently, then I would, you know, definitely want to try to go get her tested.
HUANG: In this case, she and the doctor thought that it was allergies. And sure enough, the kid took some allergy meds, and she stopped sneezing.
CORNISH: What would prompt a doctor to say, yes, it's time to get your child tested?
HUANG: It could be a number of things. It could be the symptoms - if your child has a fever or loss of taste or smell. It might be the situation - if your kid is exposed. And if there's just a lot of virus transmission going on in the community, they may say, let's just test for it. And experts say it helps to do some research now to know where you can get that test with a fast turnaround time. Maybe your pediatrician has walk-in hours. Maybe your health department runs a test site nearby. And when you know you need to get a test, it might help to call ahead to confirm protocols.
Some of these places can actually give results these days in 12 to 24 hours. And that's for a PCR test, which is still considered the gold standard. But another option is to keep some antigen tests at home. You can now get these 15-minute rapid tests from many pharmacies, and they can add up. They generally cost about $25 for a box of two, but they're considered fairly reliable for people with symptoms. So if someone has the sniffles, it could give you a pretty good read.
CORNISH: Next scenario - the child in your care tests positive - right? - for the coronavirus. What should parents be thinking about then?
HUANG: Well, for starters, don't panic. Dr. Cassandra Pierre - she's an epidemiologist at Boston Medical Center, and she has young twins - she says that kids are very resilient.
CASSANDRA PIERRE: Yes, with the delta variant, we are hearing about more cases of infection - significant infection in children, hospitalization in children. But still, we know that children are less likely to get those severe complications.
HUANG: Now, before it happens, come up with a household plan. Is there a room and bathroom they can have to themselves? Lakdawala and her husband have two young kids, so their plan is to split into parent-child pairs. One would care for the sick kid, the other for the not sick. They'd stay in different parts of the house, take turns in the kitchen.
But if space is tight, there are other things you can do. Everyone should wear masks except when eating or sleeping. Open windows. Run some fans. Use an air filter because - remember - the coronavirus travels through the air. And after a few days, test to see if anyone else is sick. And if you think you might need backup, come up with a list of family, friends, neighbors that are fully vaccinated so they might be able to step in and help.
CORNISH: All right. Another scenario...
CORNISH: What if a student tests positive - right? - in a child's class? So your child isn't sick, but maybe they've been in close contact. I mean, would a household need to quarantine then?
HUANG: So the CDC definition of a close contact at school is actually pretty limited. If your kid was at least three feet away from someone who tests positive and they were both fully masked, your kid is not exposed. But if one of them wasn't masked, then your child would probably need to quarantine, assuming that they're not vaccinated. That doesn't mean that they have to go to the room and stay there. The experts that I talked with said be reasonable. Keep some distance, especially from vulnerable or unvaccinated people. But if the rest of the family remains healthy, one expert said that she would feel comfortable sending everyone to school and work and the grocery store with masks. But she would cancel nonessential business-like playdates and dinners out.
CORNISH: It's funny. We're at this point in the pandemic where it feels like each of us is relying on the decisions that other people make.
HUANG: We know that vaccines do reduce transmission a lot, but they're not perfect. And we're hearing about breakthrough infections right now. So it is going to be possible in school settings for even vaccinated adults - you know, teachers, bus drivers, cafeteria staff - to infect children and for children to transmit the virus to others. And that's why masks are an important tool right now. You know, if you're thinking about what kind of mask, the experts I spoke with said the best one is something that your child will wear consistently and correctly.
CORNISH: That's NPR's Pien Huang. Pien, thanks so much for explaining all this.
HUANG: Thanks for having me.
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