Cynthia Jaeger was packing up the family minivan for the two-hour trip from her house in Richmond, Va., to Washington, D.C., when her 8-year-old daughter began having an anxiety attack. Zoey, Jaeger’s middle child, has a rare neurological condition, and she needed to go to Children’s National Hospital for chemotherapy and intensive cognitive testing.
A visit to the hospital didn’t freak Zoey out — she was a sturdy patient who was accustomed to medical procedures. But after Jaeger told her daughter she had to get a Covid-19 nasal test when they got to the hospital, Zoey refused to get in the minivan. Jaeger coaxed her into going, and ultimately had to restrain her daughter in her lap while a nurse reached into the van and swabbed Zoey’s nose.
“It was such a nightmare. I was crying, Zoey was crying. It was just a mess, there’s got to be a better way,” Jaeger said. “She was traumatized.”
Testing children for Covid-19 is becoming more prevalent as states reopen, posing challenges for parents, caregivers and medical providers in administering the test. Most hospitals now require patients to get a Covid-19 nasal swab before any surgeries and procedures. Some summer camps and athletic programs are mandating children get tested. And day care centers and schools are considering imposing testing requirements for the fall.
“With more availability of testing, with schools looking at different models for opening, these tests are going to be a very common experience for children, like getting a vaccination,” said Kim Stephens, president of the Association of Child Life Professionals, an organization that represents workers who help kids handle the anxiety associated with hospital visits.
While many medical procedures — like dental work, X-rays and annual vaccinations — often cause kids distress, experts say the Covid-19 nasal swab test is a perfect tripwire for inducing anxiety in children. That is partly because of the novel coronavirus itself. Many kids recognize that the virus is formidable; it has upended the world around them for the past several months and unleashed a steady drumbeat of scary news.
And the test is very uncomfortable. Nurses take a cotton swab and capture cells far inside the nose, which lasts a few seconds and often hurts. When children wiggle their bodies or shake their heads, they will likely experience more significant pain. Some facilities require the test to be done in a drive-up setting to minimize person-to-person contact. In those scenarios, the test is often done while a child is sitting in the back seat of a car, and conducted by a nurse who is not only cocooned in protective gear but also reaching through a half-open rear window.
“Nurses are rightly concerned with physical safety during tests and procedures, but we also have to worry about emotional safety,” Stephens said. “A lot of little minor insults can add up to long-term emotional harm that makes people afraid to go to the doctor, and affects overall medical compliance.”
Research shows that nerve-racking medical tests and interventions can affect children psychologically. For example, a study found that 10 percent of adults abstain from medical procedures involving needles, such as vaccinations, because of poor experiences they had as a child.
Even though the nasal exam is new — and scary — for some kids, parents and caregivers can help by telling kids exactly what to expect, and leveling with them that the test is unpleasant.
“It’s important to be open and honest and share the truth about the test,” Stephens said. “It’s normal for a child to feel anxious and worried. But in the end, it’s an opportunity to build trust.”
“We talk to them about a soft cotton Q-tip that is going to grab some of their boogers,” she said. She also recommended using play time to act out the procedure.
The Coronavirus Outbreak ›
Frequently Asked Questions
Updated July 15, 2020
Is the coronavirus airborne?
- The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
What are the symptoms of coronavirus?
What’s the best material for a mask?
Is it harder to exercise while wearing a mask?
- A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
I’ve heard about a treatment called dexamethasone. Does it work?
- The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
What is pandemic paid leave?
- The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
Does asymptomatic transmission of Covid-19 happen?
- So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
What’s the risk of catching coronavirus from a surface?
- Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
How does blood type influence coronavirus?
- A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How can I protect myself while flying?
- If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
What should I do if I feel sick?
Because keeping your body motionless makes the test more bearable, the Children’s Hospital of Philadelphia instructs parents to tell kids to “try to hold your head still like a soldier” or “let’s pretend we’ve been frozen like Elsa.” It also recommends validating a child’s feelings by saying, “It’s OK to feel upset about this.” And it endorses bringing a favorite comfort item to the testing site like a blanket or a stuffed animal.
“Even for kids who have excellent coping skills, they are having a very hard time with this test,” said Jennifer Rodemeyer, a child life specialist at the Mayo Clinic in Rochester, Minn. “We have found anything that comes in deeply through the nose is very challenging, and there is no topical anesthetic we can use to make it more comfortable.”
Karen Turner is a patient advocate who works with children with developmental disabilities at Massachusetts General Hospital in Boston. Many of the kids she sees visit the hospital regularly and must get the Covid-19 test numerous times. She said some of the proven strategies that help kids with autism cope with fight-or-flight situations can also help kids cope with the Covid-19 test.
She suggests putting children in a weighted vest during a swab to provide deep pressure, which is shown to be calming. Another method often used to help autistic children deal with anxiety-producing events is to create a booklet known as a social story that illustrates the situation. Turner says showing a child a social story that depicts all the steps of the Covid-19 test can defuse some of the fear.
Meanwhile, at the Mayo Clinic, nurses have found that parents should keep children from lying on their backs when they get the test since it is natural to feel a loss of control in that position. “Sitting up is best,” Rodemeyer advised.
“Obviously, we would love it if there was a less invasive way to do this, but for now, the nasal swab is the best and most accurate way to do this testing,” said Rodemeyer. “Children are going to have to go out into the world, go to the hospital, and take this test. Covid-19 isn’t going away.”