MAAP: For Medical Providers: Assessing for COVID-19 in children with symptoms �and NO KNOWN EXPOSURE to COVID-191 (Updated 9/10/21)(Both Vaccinated and Unvaccinated)
Lower risk1 | Higher Risk1 |
New Headache Myalgias Runny nose/congestion Nausea/vomiting/diarrhea Any of above symptoms present beyond typical symptoms (i.e. allergies) | New, uncontrolled cough Shortness of breath or difficulty breathing (not exercise induced asthma) New loss of taste or smell Fever (100.4 or higher), chills, rigors Sore throat |
1 lower risk symptom
Not exposed to COVID-192
Return to school/child care 24 hours after symptom improving. If child is not improving after 24 hours, caregiver should contact their primary care provider.
> 2 lower risk symptoms OR 1 higher risk symptom, not exposed 2 to COVID-19: Recommend testing using one of following options3:
Molecular testing done3 Negative test for COVID-19
Seen by clinician and no molecular testing done3 and alternative diagnosis likely6 Consider antigen test if available to r/o COVID, in addition to other tests, like strep or flu.
Molecular testing done3
Positive test for COVID-19
Return to school/child care7 when afebrile 24 hours without antipyretics, and symptoms improving, and test has resulted negative
Return to school/child care7 after 10 days AND 24 hours afebrile without antipyretics AND symptoms improving AND ME CDC approval
No testing AND no alternative diagnosis (i.e. family declines, unable to obtain test, etc.)
To be determined by PCP evaluation. Ideally PCR and negative test. If unable to obtain PCR return to school/child care7 after 10 days, 24 hours afebrile without antipyretics AND symptoms improving. CDC not notified of these cases.
Consider COVID-19 with >1 higher risk symptom or > 2 lower risk
IF EXPOSED to COVID-19, algorithm does NOT apply, patient will follow CDC guidelines2
If rapid strep or flu is positive and COVID antigen test is negative, no PCR needed. If COVID antigen positive, go to path 1. Return to school/child care7 when afebrile 24 hours without antipyretics, and symptoms improving.
This guidance was adapted from Washington University in St Louis by the Maine Chapter of the American Academy of Pediatrics, school nurses, school physicians, and Pediatric Infectious Disease Experts. It is subject to change based on the evolving science. https://www.maineaap.org/news/2020/school-re-entry-resources (9/10/21)
Antigen testing done and positive: ”Probable” case 4
School instructs family to f/u with primary care provider
Child should quarantine and PCR to be performed within 48 hours if available.5 If PCR positive, follow path 5, if negative follow path 4.
1.
2
3
4
Antigen testing done and negative: “Presumptive negative” 4
School instructs family to f/u with primary care provider
5
PCR should be performed within 48 hours if clinical suspicion for COVID-19.5 If PCR not available, consider repeat antigen test in 2-3 days if still symptomatic. Consider alternative diagnosis, Path 3. If PCR positive follow path 5, if negative follow path 4.
6