Screening for the coronavirus in children can be done via several tests: the PCR (the most reliable), the antigen test in pharmacies and recently by self-test (especially for contact cases at school). How to do them? When to do a PCR test? Antigenic? Salivary? What to do if the Covid test is positive in a child? Practical Guide
[Mise à jour le 13 janvier 2022 à 17h34] Children can be tested for Covid by test PCR, antigenic, salivary (in laboratory) and even autotest (from 3 years). The tests at home are 100% supported without advance of costs. Guest from France2 on Monday January 10, Jean Castex announced “three simplification and flexibility measures” for the children cases contacts at school. From now on, there is no need to run to the pharmacy or the laboratory for an antigen or PCR test. You just have to go to a pharmacy to get (for free) three self-tests to do it immediately at home (J0) then to D + 2 and D + 4. Outside of school, thechild case contact must do an antigen test or PCR as soon as he learns that he is in contact. How to test your child? When ? What instructions in case of test positive ? The same as in adults? Path to follow.
“Covid tests are used in children when they are sick or when they are case-contact, with differences in indications according to the age of the children “ informs Fabienne Kochert, liberal pediatrician in Orléans and President of the French Association for Ambulatory Pediatrics (AFPA).
- If your child has fever (temperature above 38 ° C) and / or a cough and / or digestive signs (diarrhea and / or vomiting), the first recommendation is to do not put it together.
- If your child has under 6 years old, is not a Covid case-contact and that his condition is not worrying (general condition preserved, no behavioral disorder, fever well tolerated) and that his symptoms last less than 3 days, a Covid test is not for instant not necessary. “A Covid test is carried out only in case of unusual symptoms and this to avoid doing too many tests in young children. One test is done if symptoms persist for more than 3 days“ specifies Dr Fabienne Kochert.
- If your child sick at over 6 years old and not COVID contact, it is advisable to consult a doctor, especially if the signs worsen or persist. This can indicate the performance of a Covid test if it considers it necessary. This is the case if the diagnosis of another infectious disease is not obvious (for example scarlet fever, enterovirus, urinary tract infections…) or if the viral circulation is important.
- In any case, when your child, whatever his age, presents disturbing signs (high fever that is poorly tolerated, breathing difficulties, apathy) it is recommended to see a doctor urgently or call 15 or go to the pediatric emergency room. A screening test for SARS-COV2 will be performed. “In all cases it is important if there is no obvious diagnosis to make a PCR covid and also if the child must be hospitalized it is necessary to know if he is covid or not” specifies the pediatrician.
- If your child is a contact case at school, he must be tested by 3 autotests distributed free of charge in pharmacies carried out on D0, D + 2 and D + 4.
- If your child has contact outside of school, it is recommended to have him do an antigen test in a pharmacy or PCR in a laboratory.
It will be easier to do a Covid test in children over 6 years old because after 6 years, children are less often sick (they have acquired immunity compared to all childhood viruses) and especially since the virus is actively circulating in the territory.
“The reference test is the RT-PCR test but the antigenic tests are very useful in sick children if the indications are well respected” inform the pediatrician. “Antigen tests are relevant when children are sick and symptoms have started less than 4 days ago” she explains. When a child is in contact at school, the government recommends doing three self-tests. “The antigen test can isolate contagious people (adults or children who have a large amount of virus). On the other hand, it is less reliable than the RT-PCR test when the viral load is low” underlines Dr Kochert. This is why it is not not relevant in a non-sick child (as is also the case for adults).
The High Authority of Health validated the use of self-testing for Covid in children under 15 in April 2021. They are authorized from the age of 3. This test can be used, in particular within the framework of a collective screening (school, day center, summer camp, etc.), on site in pharmacies or at home. The self-test is intended for people without symptoms and contact cases (since January 3 2022). “In children only, use is possible in the event of minor symptoms compatible with Covid (for example: runny nose, cough, moderate fever). If in doubt, in the event of symptoms or contact with a person who has tested positive to the Covid “ inform the Ministry of Health. Their efficiency varies between 50 and 60% in asymptomatic patients; and 70-80% in symptomatic.
- One positive self-test must be confirmed by PCR or antigen test within 24 hours. The child must isolate himself while waiting.
- A negative result does not exclude that the person tested is a carrier of the virus. HAS therefore reiterates the need to continue to respect barrier gestures.
The Haute Autorité de Santé has issued a Opinion favorable to deployment of saliva tests in children, in schools, February 11. From this date, a school can thus offer collective screening of children by saliva test. The test is carried out by collecting sputum from the child in a small sterile pot. Saliva tests are analyzed by RT-PCR (the same method of analysis as the nasopharyngeal test). the collection of consent with parents or the legal representative is systematic before the first intervention in an establishment and valid for all screening operations that will be carried out there. Carried out in the laboratory, the saliva test in minors is paid for without advance payment by health insurance. Not all laboratories do, it is better to ask the question directly by calling the laboratory or look on Sante.fr.
When a child is case-contact (contact without respecting the barrier measures with a sick person or PCR +) at school, since January 10, 2022, the government has recommended the completion of three self-tests to be done at home on D0, D + 2 and D + 4. This test must be performed on the day the child learns that he is in contact. In the private sphere, the instructions are the same for children and adults. Children under 12 years old (regardless of their vaccination status) or over 12 years old and having a complete vaccination schedule must perform a TAG or RT-PCR test as soon as he knows there is contact, then perform self-tests on D2 and D4. If the test is positive, the person becomes a case and begins isolation. The unvaccinated child or having an incomplete vaccination schedule must isolate yourself 7 days from the date of the last contact and to come out of quarantine must perform an antigen test or RT-PCR and have a negative result after 7 days (full).
If a test is indicated, the child can be tested directly in the doctor’s office if your doctor or pediatrician does the antigen tests. “This makes it possible not to multiply the interveners with the children which is anxiety-provoking, and to be able to immediately explain to the children and to the parents the result of the test and the measures to be taken. The family leaves with a diagnosis and a course of action to be taken. ” estimates Dr Fabienne Kochert. If your doctor does not do the Covid tests in their doctor’s office, a antigen test can be done in pharmacies who carry them out or in a medical analysis laboratory. If a child has had symptoms for more than 4 days, an RT-PCR test should be performed in a medical laboratory.
RT-PCR and antigen testing work the same in children as they do in adults. “It is in both cases a posterior nasopharyngeal sample, the gesture is a little invasive but perfectly bearable if it is well explained to the child ” specifies Dr Fabienne Kochert. With the self-tests, the sample is nasal and therefore shallower. Finally, laboratories can perform saliva tests then analyzed by the RT-PCR technique, which is therefore almost as reliable as the nasopharyngeal test.
If the screening test is negative, the child is a priori not contaminated by the Covid-19 virus but he must continue to respect barrier gestures (mask, distance, etc.). At school, child under 12 case-contact whose tests are negative may keep going to class. The same goes for those over 12 who have been vaccinated. On the other hand, the over 12 years unvaccinated or having an incomplete vaccination schedule must isolate themselves for 7 days and perform a PCR or antigen test after 7 days. Isolation will be lifted if this test is negative.
For positive children with a complete vaccination schedule (reminder carried out in accordance with the requirements of the health pass): the isolation is for a period of 7 days (full) after the date of the onset of signs or the date of the positive test sample. After 5 days, the child can be released from isolation if he performs an antigen test or RTPCR and it is negative; if he has not had clinical signs of infection for 48 hours. If the test carried out is positive or if the person does not perform a test, their isolation is maintained for 7 days. She does not perform a second test on D7.
For positive children with an incomplete vaccination schedule (booster not performed) or not vaccinated : isolation is 10 days (full) after the date of the onset of signs or the date of the positive test sample. After 7 days, the child can be released from isolation if he performs an antigen or RTPCR test and it is negative and if he has not had clinical signs of infection for 48 hours. If the test is positive or if the child does not perform a test, isolation is 10 days. In case of apositive test: the result should be confirmed by an RT-PCR test.
The tests are not chargeable for minors, whether it is antigenic tests carried out in pharmacies or some PCR lab tests. For the autotests, if they are carried out for a contact case child within the framework of the school protocol, they are also free. On the other hand, if they are purchased for screening in the private sphere, they must be paid (5.20 euros for the self-test as in adults).
Tests can be offered to students from kindergarten after parental authorization as part of the strategy to control the circulation of variants of the coronavirus, informs the Ministry of Education. These tests can be nasal antigens (rapid TDR, TROD and self-test tests) or salivary. They “appear relevant for breaking chains of contamination, especially in schools” indicates the HAS on April 26 by issuing results in 15 to 30 min. Their efficiency analyzed in the general asymptomatic population ranges from 50 to 58%. In children “the few clinical studies are reassuring in terms of their performance”, indicates the HAS. The collection of consent from parents or the legal representative is systematic before the first intervention in an establishment and valid for all screening operations that will be carried out there. The results are only communicated to parents, not at school.
Thanks to Fabienne Kochert, liberal pediatrician in Orléans and President of the French Association for Ambulatory Pediatrics (AFPA).