See also

COVID-19

Distraction techniques for COVID-19 swabbing

Key Points

1. Testing for SARS-CoV-2 (COVID-19) involves an oropharyngeal and deep nasal swab
2. Discomfort/distress may be experienced due to this procedure and preparation may minimise the impact for the child and their family
3. Droplet and contact precautions should be maintained whilst performing the swab; the person performing the swab should use appropriate personal protective equipment (PPE)

Background

Current testing guidelines for SARS-CoV-2 in children involve a combined oropharyngeal and deep nasal swab, aiming to collect epithelial cells.  Children may need more than one swab throughout the pandemic and minimising discomfort is important

Indications

The indication for a swab should be assessed according to current guidelines/case definitions. Case definitions may differ in each State: NSW Qld Vic

Contraindications

• Children at risk of upper airway obstruction (eg croup) who may become compromised further by the swab
• Bleeding disorders  - a child with a low platelet count (eg <30 x 10⁹/L) will need a transfusion or procedure to be deferred.  Expert advice is recommended
• Recent facial trauma / fracture / surgery
• Mucositis

Potential Complications

• Bleeding - there may be slight bleeding from the nose in some children
• Inadequate sample for testing leading to false negatives and need for repeat testing

Equipment

• Swab - a smaller infant swab is recommended for children <12 months of age. If not available, a larger swab can be used
• Tongue depressor

Analgesia, Anaesthesia, Sedation

Sedation is not routinely required
Use distraction techniques, visual schedules and communication strategies to help child predict or understand procedure
Consider showing child and parent this video of swab from a child’s perspective

Procedure

This is a two-part process involving an oropharyngeal and deep nasal swab

1. Wear appropriate PPE for droplet precautions: face mask, gloves, gown and protective eye wear
2. Ensure child is in a comfortable, secure position, preferably on a parent’s lap - the parent should cross one arm across the child’s body to hold the arms and place the other hand on the child’s forehead
3. Using a tongue depressor, flatten tongue and insert swab - swab tonsillar beds and back of throat, avoiding tongue. Gently rotate brush tip for 3-5 seconds
4. Using the same swab, hold with a pencil grip and insert horizontally (with child in sitting position) into one nostril parallel to the palate.  Insert to the following depth or until resistance is met:
   • 1 cm if <2 years
   • 1.5 cm if 2-6 years
   • 2 cm if 6-12 years
   • 2-3 cm if >12 years
5. Rotate swab 5 times against the nasal wall. Follow same method for other nostril
6. Remove swab and insert into transport medium or vial. Label vial with appropriate patient information
7. Safely dispose of PPE

Alternatives if procedure not successful

If procedure is not successful, give the child and parent some time and utilise distraction techniques before re-attempting.
Continue droplet and contact precautions until SARS-CoV-2 status is known

Parent information

COVID-19 swab from a child's perspective video
Getting tested for COVID-19

Last updated June 2020