PCR tests on children

An Indian girl cries as a medical worker collects her swab sample for a COVID-19 test at a rural health center in Bagli, outskirts of Dharmsala, India.(AFP)

PCR testing is not a pleasant experience. This is because PCR tests typically test the fluids in the nasopharyngeal area where the highest volumes of the virus are present. But could this invasive test damage the delicate nasal interiors in infants and children?

“PCR testing in children is not different to tests conducted on adults,” opined Dr. B J C Perera, Specialist Consultant Paediatrician and Founder President of the Sri Lanka College of Paediatricians. “But it may be a bit more difficult in children as they would react during the test. Another option is to test saliva, but the accepted test is the nasopharyngeal test.” said Dr. Perera. 

He said that the positivity rate is also not different in children because, other than for the sensitivity and specificity of the test, the result also may depend on the real presence of the virus. “Therefore, due to the absence of sufficient numbers of virus particles and other circumstances one could get false negative PCR results. Therefore, the reliability is between 60-90%.” the doctor added. 

But one of the challenges he observes in children is that around 90% of them with COVID-19 appear to be normal. “Therefore even if they have the infection, they will not show symptoms and will therefore have a risk of being a reservoir of infection. It may therefore spread from these asymptomatic children among other children and adults,” he explained. However, at present, the tests are done only on children who are suspected to be first or even second tier contacts of positive cases and also in those with symptoms suggestive of the disease . 

But one of the challenges he observes in children is that around 90% of them with COVID-19 appear to be normal

When asked if PCR tests are done on infants, Dr. Perera replied in the affirmative while adding that it may cause a certain amount of distress to the child. “To get a nasopharyngeal swab specimen, it has to reach the back wall of the nose. Children might react to it, but there is no risk of damaging the nasal interiors as it is done by trained healthcare workers. But if a child struggles and starts to sneeze or cough, that may pose a risk of spreading the virus to the healthcare workers.” the doctor explained. He emphasised that appropriate precautions should be taken by all healthcare workers dealing with children suspected to have COVID-19.

“A little bit of reassurance helps in this case,” he advised. “You have to prepare the child for the test, explain why you’re doing it, why they shouldn’t struggle and develop a sort of confidence in him or her to face it. Saying encouraging words such as “you got to be brave” or “you will get a reward at the end of the test” also helps,” he added while commending children for abiding by the health guidelines such as wearing masks which have been taken for granted by adults. 

Responding to a query asked about children who show flu-like symptoms, Dr. Perera said that around 10% of children with COVID-19 will show symptoms which are often a mild illness. “It could be an ordinary cold-like and flu-like symptoms. If they have a cold they should not be going out of the house anyway and definitely not to school. Self- isolation is difficult with children, but adults should ensure they maintain social distancing at home and also wear protective masks,”  added Dr. Perera. 

“But one positive observation is that less children are falling ill these days,” he added. “This is because parents have been more careful with their children without taking them out and conforming to other health directives . But they will be vulnerable if they come into contact with other children with coughs and colds. Thankfully, they are now a lot healthier these days but this situation may change if schools open,” he said. 

The doctor further said that a child with a cough or cold should be kept at home for a minimum of 10 days. “It has been proven that patients who have contracted COVID-19 are infectious, just a day before they develop symptoms and then up to about 10-14 days. There is solid evidence that after 10 days they do not spread the virus. So the best thing is to keep the child at home and he or she maybe give some paracetamol for fever. Give some simple bland remedies for a cough,” he advised. However, he further added that if the parents are worried about the child or if the child develops a severe cough or some difficulty in breathing, the child should be seen by a qualified doctor as soon as possible.