CHICAGO -- As the omicron variant spread in Chicago, area hospitals saw more children testing positive for COVID-19 and hospitalized. Some were there because of illness and some for other reasons but happened to also test positive.
For many children who caught COVID-19 and remained asymptomatic or with mild illness, this was the first time their families faced a scenario where the child tested positive — but the rest of the family remained negative.
These families enter a gray area of guidance because isolation and quarantine tips tend to be geared toward adults who can be left alone if needed. It’s a different story when an infant or toddler needs to be isolated from other family members, especially if the family members are at higher risk.
Oak Park resident Shannon Craig Straw experienced this recently when her 2-year-old daughter tested positive for COVID-19 but the rest of the family initially remained negative.
Her husband initially stayed with their daughter, wearing a mask. They decided he would be the one to isolate with the toddler because he was vaccinated, boosted and also had COVID-19 in August.
“We had no idea which parent goes in with her, and how to make that decision and that calculus,” she said. Eventually, she also tested positive for COVID-19 and she stayed with her daughter instead; the family has now finished its quarantine and isolation and her daughter was thrilled to go outside.
Families may soon have another vaccine option as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to the president, recently estimated that vaccines for children under age 5 could be available within months.
In the meantime, for advice, we talked to experts about navigating this scenario.
What should parents do if a child tests positive but they are negative?
According to the Centers for Disease Control and Prevention, if someone tests positive they should isolate alone for five full days, followed by five days still wearing a mask around others. This guidance is typically geared toward adults.
For children, the Children’s Hospital of Philadelphia offers recommendations, including to begin the five days one day after symptoms start, or without symptoms one day after the child was tested. CHOP says breastfeeding moms can continue to nurse, but should mask while interacting with the baby.
Parents of children with immune system issues should contact a health care team, according to CHOP; those children may need a longer isolation time.
Dr. Allison Bartlett, a pediatric infectious disease specialist at University of Chicago Medicine’s Comer Children’s Hospital, acknowledges the complexity of such a situation. She says how you handle it will depend on many factors: the age of the child, whether everyone else is vaccinated, whether anyone in the household is at higher risk for illness, and whether the child is experiencing symptoms and needs more hands-on care or is asymptomatic.
“This is a really tricky situation,” she said. “There’s so many potential variables. It all comes down to, there’s no way that we can eliminate all risk of transmission, but we can do our best to decrease the risk.”
Ideally, a child age 2 or older should wear a mask around others if feasible.
Should families choose one parent to stay in the room and isolate with the child?
For an older child who might be vaccinated, and also able to walk around the house and wear a mask, they may need less hands-on care. “If it’s an older child who wants to leave their room and go grab food in the kitchen and go back to their room,” Bartlett said, “they can wear a mask to decrease the risk for everybody else.”
Younger children can’t fend for themselves. So it may make sense to designate one person as the caregiver.
At the same time, “Parenting a sick child solo is not easy either,” Bartlett said. “If you’re lucky enough to have two parents and share the load, that doesn’t have COVID-related benefits, but it has sanity-related benefits.”
Again, families should consider any unique and individual risks they carry.
Should parents wear masks around the child?
Yes, said Dr. Benjamin Levinson, a primary care physician at Nationwide Children’s Hospital. “Besides decreasing the risk of virus transmission, if the parents do catch the virus from the child, this may decrease the viral load they are exposed to,” he said.
How should parents explain the situation to the child?
This depends on how old the child is and their anxiety level, Levinson said. He advises a positive approach, saying that staying in their room can help keep everyone safe. But be careful not to phrase things in a way where the child must do everything right. Should others in the family get sick, you don’t want a child feeling guilty.
“This should not be portrayed as any sort of punishment,” Levinson added. “Parents can also talk to their child about planning fun things to do all together or think of a new toy or game to find once the isolation period is over.”
For a younger child, or a sibling who might be separated temporarily, explain you will be doing things differently for a few days. It may help to say something such as, “We’re going to have things be a little different, and we’ll try and have you hang out in this room more,” he said.