Return-to-school requirements for children being evaluated for COVID-19 infection or exposure to someone with COVID-19 may differ from your utilization of testing in your practice. Below are some clinical pearls that will help your pediatric patients and their families better navigate the return-to-school process after an illness or exposure.

• Return to school criteria with COVID-19 testing may not align with your clinical perspective.
  • Antibody testing is currently not a valid option for return-to-school testing. It may help in your clinical decision-making, but it is not a current option for schools or childcare.
  • An unvaccinated child can’t completely test out of quarantine when a household exposure is involved, but testing may be needed for shorter quarantine options. A negative test on day seven would be required for a seven-day quarantine period. Some schools may require a negative test on day nine or 10 when using a 10-day quarantine option. Check with the child’s parents to see what the school requires when using a shorter quarantine option.
• Parents may bring their child in to refute a positive test in another setting.
  • An antigen test can only be ruled out by a negative PCR test done within three days of the positive antigen test.
  • A PCR test can only be ruled out by two negative PCR tests done within three days of the positive PCR test in question.
• A physician’s note documenting an alternate diagnosis is always an acceptable option for a child to return to school or childcare if it explains all the child’s class A/B COVID-like symptoms that led to the evaluation for COVID-19. However, if the child had a close contact exposure to a known positive case, they would still need to follow their school’s quarantine guidance.