Since the start of the pandemic, more than three million children in the U.S. have tested positive for COVID-19.
A recent report in the medical journal Clinical Infectious Diseases is calling into question what we thought we knew about children and COVID-19. It suggests the known number of infections among children is likely an underestimate for two main reasons.
First, children are likely to be asymptomatic.
"I think that's been a pretty consistent finding in the literature that we do think that children are more likely to be asymptomatic carriers of this virus relative to adults," said Dr. Stacey Rose, assistant professor with Baylor College of Medicine.
Asymptomatic infection could be as high as 50 percent in children--twice as likely as adults-- according to the report.
Rose said that likely ties into the lower rate of testing among children -- the second reason why cases among children may be undercounted.
Pediatricians may have a difficult time determining whether a child should be tested.
"As with any scenario you're always trying to weigh the risk and the benefits," said Dr. Rose.
If a nasal swab is too uncomfortable for a child, Dr. Rose says a saliva test is better than not testing at all. And, another type of test may be expanding.
"There's been some interest in anal swabs which you might say that's not really better than a nasal [swab] but it might actually be. You've got to remember when we have infants we [take] rectal temperatures all the time," she noted.
Although, children tend to not become as sick from COVID-19, they can infect others.
"I think one of the points that this article is making is that we also don't want to dismiss the idea of COVID in pediatrics because [children] are likely playing, perhaps, a bigger role in the transmission and overall continuation of the pandemic," Dr. Rose concluded.
The report suggests random testing among children is needed. It points to a study in England where random testing found children and teens were more likely to be infected than any other age group, and twice as likely to transmit the virus to those in their household.
As for antibody testing, Dr. Rose says its role remains to be seen.
In Texas, more than 5,000 children and teens -- between 0 to 19-years-old -- have tested positive for COVID-19 and 47 have died.