Sick child this school year? Planning for the inevitable during a pandemic

Children get sick; it's part of life. They catch colds, they get fevers, they throw up and get diarrhea. Most of the time, it's nothing at all. But this year, as we struggle through the COVID-19 pandemic, every sniffle will be complicated.

The problem is, the symptoms of COVID-19 can be not just mild, but similar to the symptoms of all the common illnesses kids get all the time. Symptoms can include

• fever, even a mild one
• cough (that you don't have another clear reason for)
• breathing difficulty
• sore throat or runny nose (that you don't have another clear reason for)
• loss of taste or smell
• headache (if with other symptoms)
• muscle or body aches
• nausea, vomiting, or diarrhea.

And even if there is another explanation for that sore throat or cough, it doesn't mean that your child couldn't also have COVID-19. People can get two germs at once.

Set the bar low for keeping sick children home

This is not a year when you can send your child to school or daycare with that cough, or that one vomit, or that low-grade temp, and hope for the best. This is a year when we need to do our best to keep every sick person home, whether they have COVID-19 or something else. This is also not a year to skip the flu shot. We need there to be as little influenza as possible this year for everyone's safety and well-being.

Here's what you should do if your child gets any of the symptoms above:

• Keep them home from school or daycare. I understand that this may mean missing work, but there is simply no choice.
• To the extent that it is possible, keep them away from other family members.
• Call your doctor. If they have any trouble breathing, a high fever, severe pain or irritability, or unusual sleepiness, you should go to an emergency room. Otherwise, your doctor will advise you about next steps, including testing for COVID-19.

Theoretically, everybody with any of the above symptoms should be tested. But that may not be possible. And for some children - those with mild symptoms who aren't in daycare or school, whose parents are working remotely and who don't have contact with high-risk individuals - a test may not be crucial as long as everyone can stay home. Make sure you talk with your doctor and understand exactly what you and other family members need to do if your child is not tested.

The difference between quarantine and isolation

Quarantine and isolation are two terms that are used a lot these days, and while they are often used interchangeably, they aren't the same thing.

• Quarantine means staying home: no trips to stores, or anywhere outside of the house or yard.
• Isolating means staying away from other people in the home - in a separate room, preferably with a separate bathroom (or wiping down in between), wearing a mask when they must leave their room, and not sharing utensils, towels, or anything else with anyone.

What to do if a test for COVID-19 is positive or you cannot get a test

The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend these steps:

If your child tests positive for COVID-19:

• Make sure you are in touch with your doctor, follow all recommendations, and call for help if you have any concerns about how your child is acting or feeling.
• Isolate your child at home, to the extent that this is possible.
• Don't send them back to school or daycare until at least 10 days from the start of their symptoms (longer if they are still sick), and until they have not had a fever for at least 24 hours without any fever-reducing medications.

Children who test positive are considered infectious until that 10 day/no fever point. So family members living with the child need to quarantine until 14 days after the 10-day point (if anybody gets sick, call your doctor). They also should wear masks and do their best to isolate from others at home, as you never know which person might get sick.

Getting family members tested doesn't change the quarantine requirement - because the incubation period can be as long as 14 days. Theoretically you could be infected at day nine of your child's infection - and not show symptoms for 14 days after that. It's best to wait four to five days after the 10-day day point to be sure the test will be accurate (although any family member with symptoms should schedule a test right away). Testing family members can pick up asymptomatic cases - and may reset the quarantine clock for everyone else. Your doctor can guide you through.

This is going to be hard, and very disruptive, but it's the only way to contain the virus.

If you can't or don't test your child, all the same instructions apply - because you don't know if they have COVID-19. So you need to act as if they do, to be safe.

What to do if a test for COVID-19 is negative

If your child tests negative for COVID-19, talk to your doctor about what to do and when your child can return to school or daycare. It will depend on your child's symptoms and whether another diagnosis was made.

What to do if your child is exposed to COVID-19 away from home

If your child is exposed to someone with COVID-19 outside of the home (being within six feet of them for 10 to 15 minutes), call your doctor for advice. Most likely, you will be told that your child needs to quarantine for 14 days after their last exposure to that person. As above, if you decide to test you should wait a few days - unless your child develops symptoms, in which case testing right away is a good idea. A negative test won't get your child out of quarantine, but if they test positive then you will know to start isolating them - and start the clock for everyone else's quarantine.

This is complicated, I know. Call your doctor's office if you have questions - and check out the website of the American Academy of Pediatrics.