AAP updates guidance on masks, testing and PPE for pediatric COVID-19 care
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The AAP updated its guidance regarding COVID-19-related advice for cloth face coverings, testing protocols and personal protective equipment in the care of children during the pandemic.
The guidance draws from the latest available evidence, the AAP said.
Cloth face coverings
The AAP advised that all children aged 2 years or older can wear cloth face coverings safely, “including the vast majority of children with underlying health conditions.”
“Children are incredibly adaptable and resilient,” AAP President Sally Goza, MD, FAAP, said in a press release about the guidance. “Just like children understand that they must wear bicycle helmets and buckle into their car seats, they will come to learn to wear masks routinely when necessary.”
The use of a cloth face covering significantly reduces the spread of SARS-CoV-2 and other respiratory infections within schools, homes and the community, the guidance said.
Steve Krug, MD, FAAP, chair of AAP’s Council on Children and Disasters, said there are two reasons why children and adults should wear a facial covering at home.
“One is that they may have an elderly or an at-risk person in the household, somebody with a risk factor for severe illness related to a COVID-19 infection,” Krug told Healio. “[Another] way to get your child prepared to go to school and to tolerate the face mask is to practice at home, as opposed to trying the face mask for the first time when your child starts school on a certain day.”
Testing protocols
According to the AAP, a child should be tested for COVID-19 if their symptoms are consistent with the illness, they were near someone with confirmed COVID-19 or they are scheduled to have elective surgery.
Symptoms of COVID-19 are similar to influenza, the AAP noted. Pediatricians should watch for a loss of taste or smell — a prominent symptom of COVID-19, not influenza. Moreover, symptoms of influenza usually occur within 1 to 4 days following exposure, whereas symptoms of COVID-19 typically appear from 2 to 14 days, the AAP said.
It noted the three types of testing available for COVID-19: molecular testing, antigen testing and antibody testing.
“A molecular test that has received U.S. Food and Drug Administration (FDA) approval is the ‘gold standard’ for testing an individual child for SARS-CoV-2 infection,” the AAP wrote. “If unavailable, other FDA-approved tests should be considered.”
Antibody testing is less straightforward, is “not routinely recommended” and “should not be used to make decisions on grouping people in classrooms or other facilities at this time,” the AAP said.
“[Antibody testing is] not proving to be a terribly effective screening mechanism, so it really should be the antigen tests that we are looking for,” Krug said. “There are other tests that actually look at other ways to find the virus, but those are not tests that I think are universally available.”
PPE
The AAP recommended that “all practices have written protocols for [personal protective equipment (PPE)], hand hygiene, disinfection of equipment and physical facilities, and efforts to promote physical distancing” and that “higher levels of PPE are necessary during procedures that could generate smaller respiratory droplets at higher concentrations, and to protect staff who are at increased risk of severe illness.”
“The intended audiences are office space pediatricians because people who work in a hospital, like me, I don't have to come up with my own control rules, because there's somebody there to tell me what to do,” said Krug, who is also an attending physician at Lurie Children’s Hospital of Chicago.
Krug said everyone indoors should be wearing facial coverings, and he emphasized the need for eye protection.
“The reason for the eye protection is because it's been demonstrated that the virus can be transmitted by either aerosol or droplets and that [if] they get into your eye, you will catch the virus, much like you would if you inhaled it.”
Along with these requirements, hand-washing and social distancing would be considered the minimum standard, Krug said.
References:
- AAP. Cloth face coverings. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/cloth-face-coverings/. Accessed August 13, 2020.
- AAP. COVID-19 testing guidance. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-testing-guidance/. Accessed August 13, 2020.
- AAP. Guidance on the use of personal protective equipment (PPE) for pediatric care in ambulatory care settings during the SARS-CoV-2 pandemic. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/guidance-on-the-use-of-personal-protective-equipment-ppe-for-pediatric-care-in-ambulatory-care-settings-during-the-sars-cov-2-pandemic/. Accessed August 13, 2020.
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AAP. Cloth face coverings. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/cloth-face-coverings/. Accessed August 13, 2020.
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