Coronavirus Disease 2019 (COVID-19) in Kids

Yes. Children of all ages can get sick with COVID-19. Though fewer children overall have been sick with COVID-19 compared to adults, kids can be infected, get sick and spread the coronavirus to other people.

Yes. Just like adults, children without symptoms of COVID-19 can still spread the virus to others. This is called asymptomatic spread.

Since the start of the pandemic, doctors have been learning more about the disease and how it affects kids. Here are several things we have learned about COVID-19 in children:

• The number of childhood cases of COVID-19 tends to mirror the cases in the surrounding community; as cases rise in adults, they also rise in children.
• In fact, when we look at the percentage of children with COVID-19 as a proportion of total cases, the cumulative (total) percentage of children has also gone up. This means that, proportionally speaking, more children are getting sick with COVID-19 than at the beginning of the pandemic. Data through Feb. 25, 2021 from the American Academy of Pediatrics and the Children’s Hospital Association found that children have represented 13.1% of the total cases of COVID-19 in the U.S.
• Because many cases of COVID-19 in people younger than 18 are mild or even asymptomatic, it’s highly likely that we are missing some cases of COVID-19 among children.
• When comparing the burden of disease of COVID-19 and influenza in children, COVID-19 has caused more cases, hospitalizations and deaths in kids than a typical year of influenza.

In short, while it is fortunate that COVID-19 has not proven to be as serious in children compared to adults, it is inaccurate to say that COVID-19 does not affect children or that it isn’t as serious as the flu. And, in addition to the sheer number of children who do get sick with COVID-19, consequences from the pandemic are also affecting many more children mentally, emotionally and socially.

Babies younger than 1 year old might be more likely to have severe illness from COVID-19.

What about premature babies?

We do not have much scientific data on the impact of COVID-19 in children who were born prematurely. However, we know that other respiratory illnesses, such as the flu and respiratory syncytial virus (RSV), are more serious for premature babies. This is because babies who were born early tend to have poorly- or underdeveloped lungs that make it harder to fight infection. Additionally, pre-term babies have smaller airways and more secretions, which can make breathing more difficult.

A recent study at Children’s Colorado showed prematurity was a risk factor for being hospitalized for COVID-19. We cannot draw conclusions from a single study, but we expect to learn more as additional studies are published.

For kids who were born prematurely but do not have other medical conditions (called comorbidities) and are no longer in critical care, this risk likely decreases after the age of 2. Parents of babies who were premature should follow the same precautions. Make sure your child has received all other vaccines they are eligible, as we have good vaccines for the other conditions preemies are at risk for, including the flu.

Children with certain underlying medical conditions like obesity, asthma, chronic lung disease, diabetes, weakened immune systems and heart disease since birth might also be at increased risk compared to other children. (More on this below.)

More evidence is emerging that children with obesity who become infected with SARS-CoV-2 are at an increased risk of becoming severely ill if they get COVID-19. Recent studies, including one at Children’s Colorado, have shown that obesity is a top risk factor for severe COVID-19 in children.

Remember, scientific evidence about COVID-19 in people younger than 21 is limited. We will learn more as additional data becomes available.

Current evidence from scientific studies shows that some people with underlying medical conditions are or could be at greater risk of severe illness from COVID-19.

Increased risk

When compared to other children, kids with the following conditions might be at an increased risk for severe illness from COVID-19:

• Multiple chronic conditions that affect several parts of the body (medical complexity)
• Neurologic, genetic or metabolic conditions
• Congenital heart disease

People of all ages – including kids – with the following underlying medical conditions are at increased risk of severe illness from COVID-19:

• Cancer
• Chronic kidney disease
• Immunocompromised state (weakened immune system) from solid organ transplant
• Obesity
• Serious heart conditions, such as heart failure, coronary artery disease or cardiomyopathies
• Sickle cell disease
• Type 2 diabetes

Possible increased risk

People of all ages with the following conditions might be at an increased risk for severe illness from COVID-19:

• Asthma (moderate-to-severe)
• Cerebrovascular disease
• Chronic lung disease
• Cystic fibrosis
• High blood pressure
• Weakened immune system from blood or bone marrow transplant, immune deficiencies, HIV or use of immune-weakening medicines
• Neurologic conditions
• Liver disease
• Pregnancy
• Pulmonary fibrosis
• Smoking
• Thalassemia (a type of blood disorder)
• Type 1 diabetes
• Vaping

Learn more about COVID-19 in children and teens from the CDC.

Scientists are learning more about how SARS-CoV-2 spreads between people. It spreads most commonly during close contact. The latest evidence shows that:

• COVID-19 can spread through respiratory droplets, such as saliva and mucus, when people cough, sneeze, breathe, talk, sing and shout. These droplets can land on others or on surfaces. The virus can infect others if it comes into contact with their eyes, nose or mouth.
• Less commonly, COVID-19 can also be spread through airborne transmission, which occurs when tiny respiratory droplets are able to linger in the air for minutes to hours due to poor ventilation. Current science shows that airborne transmission is less common than close contact, but it’s an important consideration for small or indoor public spaces with less air flow.

Learn more about how COVID-19 spreads from the CDC.

Remember, kids can spread the virus, even if they do not have symptoms. It’s important for everyone – including children and teens – to follow public health guidelines like cleaning hands frequently, wearing cloth face coverings (with some exceptions like babies and toddlers), and physical distancing whenever possible. Each of these methods offers some but not complete protection. This is why it’s important for families to use these methods together to protect themselves and others from COVID-19.

There are several steps parents and families can take to help prevent children (and everyone) from getting COVID-19. Use all of the following methods to protect your family and decrease the spread of COVID-19:

1. First and foremost, get vaccinated as soon as you are eligible. Vaccines are the strongest layer of protection we have against COVID-19.
2. Wear a well-fitted cloth face covering when you are indoors around others you don’t live with, and when you're outside in crowded places.
3. Wash your hands frequently and thoroughly, especially after interacting with others.
4. Keep space between yourself and people you don’t live with (referred to as social distancing or physical distancing).
5. Stay at home when you feel sick (and keep your kids home when they feel sick, too).
6. If you or your child gets sick, get tested.
7. Avoid large gatherings and, when possible, socialize outside, not inside.

Remember, there’s no way to eliminate all risk, but there are simple and effective steps we can all take to protect each other and limit the spread of COVID-19 within our neighborhoods and communities. Practicing these public health measures isn’t just about protecting yourself and your family – it’s about protecting the most vulnerable people in our community.

The most common symptoms of COVID-19 in children are:

• Fever
• Dry cough
• Tiredness (fatigue)

Some patients with COVID-19 also experience the following symptoms:

• New loss of smell and/or taste
• Aches and pains
• Headache
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea
• Rash on the skin and/or discoloration of the fingers or toes
• Shortness of breath (feeling like you can’t take a full breath)

Most children with COVID-19 have mild symptoms and some have no symptoms at all. Some children can get severely sick from COVID-19. If your child has an underlying medical condition that may put them at higher risk, call their doctor as soon as you notice symptoms.

The symptoms of COVID-19 are similar in kids and adults. However, young children may have trouble explaining their symptoms. For example, it may be hard for a child to explain that they cannot taste or smell. Instead, they may say that their food doesn’t taste good or that it tastes funny.

People develop symptoms 2 to 14 days after they are exposed to COVID-19. The average time it takes to develop symptoms is 5 days. This is called the coronavirus incubation period, or the time from when a person is exposed to when they have symptoms.

Most children who have COVID-19 will not become seriously ill. However, whether or not you think it could be COVID-19, you should call 911 or go to the emergency room if you notice any of the following serious symptoms:

• Trouble breathing
• Persistent (ongoing) pain or pressure in the chest
• New confusion
• Inability to wake up or stay awake
• Bluish lips or face

Important: Do not delay getting emergency care for your child because you are worried about possible spread of COVID-19. Emergency departments, including at Children’s Colorado, have infection prevention plans to protect you and your child from getting sick with COVID-19 if your child needs emergency care.

There are several types of COVID-19 tests now available. A viral test called polymerase chain reaction (PCR) is considered the best method or “gold standard” for detecting an acute (active) COVID-19 infection. If your child receives a positive PCR test, it means your child has an active COVID-19 infection and can spread the virus to others.

What parents and caregivers should know about COVID-19 testing

Though there are several types of COVID-19 tests now available, such as rapid tests or saliva tests, each varies in terms of accuracy and its ability to detect negative and positive results. Some tests are faster, but they are also more likely to miss detecting the virus. This can create a false negative, meaning the person has the virus but received an incorrect result.

There are several reasons a child might need to be tested, including:

1. They have symptoms of COVID-19.
2. They have been exposed to someone infected with the virus.
3. Their school, childcare center or doctor requires it.
4. They need to be tested before being admitted to the hospital or before a medical procedure that requires anesthesia.
5. They need to be tested before and after traveling.

If you’re unsure, start by calling your child’s pediatrician, who can help you decide if testing is appropriate.

Like other aspects of healthcare, pediatric expertise matters. If your child needs a COVID-19 test, we recommend looking for testing locations designed for kids and families. Here are a few things for parents to consider:

• Do they have experience with children? Healthcare providers who have experience working with pediatric patients can help calm any fears and make your child more comfortable.
• What type of test do they perform? As we detail below, a test’s accuracy can vary greatly, and there are pros and cons for each type.
• How do they collect a sample? Knowing this ahead of time can help you share what to expect with your child.
• Can they get tested by their pediatrician? Some primary care providers can test patients in their practices and send a sample to a hospital lab. This may help your child feel more comfortable.

Use the table below to learn about the different types of COVID-19 tests, the pros and cons and what to do based on your child’s test result. If you have questions about the accuracy of a specific test, you should ask your doctor.

Remember: We do not fully understand the new coronavirus. Having COVID-19 in the past does not mean your child is protected from another infection. Though rare, there have been several confirmed reports of reinfection. It may also be possible to be infected with a different variant of SARS-CoV-2, like what can happen with the flu and some cold viruses, but we don't know yet. Scientists are still learning about the virus and how it affects people.

For the most accurate results, look for COVID-19 testing that meets the following criteria:

• Molecular PCR testing
• Done in a hospital or public health department laboratory
• Tested on a sample collected via nasopharyngeal swab (where the nasal passages and throat meet)

Most coronavirus testing takes place at drive-through testing sites that allow lab workers to take samples with a swab through the car window. This helps keep everyone safe by limiting interactions between people who may be sick with the healthy workers.

In some cases, your child’s doctor may be able to take a sample in the doctor’s office. This is typically available when your child already has an appointment.

Testing at Children’s Colorado

Children’s Colorado performs PCR testing to diagnose COVID-19. We take additional steps to make coronavirus testing as comfortable and easy as possible for kids and families, including new saliva testing for symptomatic patients ages 4 to 18. Learn how and what to expect during coronavirus testing for kids at Children’s Colorado.

If your child’s doctor suspects they may have COVID-19, they will order a viral test. Typically, this is the PCR test explained above, though rapid tests may also be available.

At Children’s Colorado, our Pathology and Lab Services use the gold standard of PCR testing to diagnose an active COVID-19 infection. We offer viral PCR testing and antibody testing for COVID-19 in the Denver Metro and Colorado Springs areas. Learn where and how to get a COVID test for your child and find more frequently asked questions about our testing process.

Quarantine separates people who have been exposed to COVID-19 and may still develop illness from others. So, if you come into contact with someone who has COVID-19 or find out later that you were exposed to someone who had COVID-19, you should enter quarantine.

This is different from isolation, which separates people who are sick from others. Both quarantine and isolation are incredibly important for containing the spread of infectious diseases like the coronavirus.

Because coronavirus symptoms can appear between 2 and 14 days after an exposure, the recommended quarantine period is also 14 days.

In early December, the CDC published additional options to reduce the length of quarantine, but only with symptom monitoring and diagnostic testing. The reduced quarantine allows more flexibility for people who need to participate in essential activities.

You should only shorten quarantine in order to participate in essential activities in specific situations. The new guidance means:

1. If you do not develop symptoms after 10 days of quarantine, even without a test, you can end quarantine on day 10. (This guidance has been adopted by many schools.)
2. If you do not develop symptoms AND you receive a negative PCR or antigen test between days 5 and 7, you can end quarantine on day 7.

Important: Under no circumstances should you end quarantine before 7 full days have passed since the exposure.

A full 14-day quarantine remains the safest and most effective way to reduce possible spread. If your child or family can maintain a 2-week quarantine, we highly encourage it. If you develop symptoms of the coronavirus during quarantine, you should isolate yourself and get tested.

People staying in communal settings that present higher risk such as nursing homes, jails and shelters should quarantine for 14 full days and should not shorten quarantine.

Learn how to quarantine and how to isolate from CDPHE.

The safest option is to remain quarantined for a full 14 days. This is because the incubation period for the coronavirus (the time it takes to show symptoms and trigger a positive test) can take up to 14 days.

If you have been exposed to someone with COVID-19 but do not develop symptoms after 7 days, keep these scenarios in mind:

Coronavirus treatment depends on the severity of the illness. Most children who have COVID-19 tend to have mild symptoms that can be managed at home. If your child tests positive for COVID-19 you should inform their doctor.

Treating kids with mild symptoms of COVID-19

If you or your child tests positive for COVID-19, treatment is focused on relieving symptoms. This includes:

• Getting lots of rest
• Taking acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) for any fever or achiness
• For children over 4, managing any cough or runny nose with cold medication
• Staying hydrated by drinking lots of clear fluids, like water

Call your child’s doctor if they experience any shortness of breath, seem to be getting worse or are not getting better within a few days.

Be sure to follow the CDC’s guidelines for caring for someone sick at home and when your child can be around others after they have had or likely had COVID-19.

Treating kids with more severe cases of COVID-19

Some children will develop more concerning cases of COVID-19, though this is relatively rare. Current science shows that approximately 1% to 2% of children who have COVID-19 will require hospitalization. Of those cases, about 1% of hospitalized kids will need critical care in an intensive care unit (ICU).

Treatment is available for kids and teens who have more serious cases of COVID-19. Treatment options include:

• Dexamethasone (a drug called a corticosteroid that can help decrease inflammation or swelling in the body)
• Remdesivir (a new antiviral)

Though pediatric studies on these treatments are not yet available, dexamethasone and remdesivir have helped adults with COVID-19. Doctors are also studying convalescent serum, a blood product from plasma donors who have recovered from COVID-19, as a potential promising treatment for COVID-19.

A small number of children who had COVID-19 have gone on to develop a new inflammatory syndrome. This is called multisystem inflammatory syndrome in children associated with COVID-19, or MIS-C. Though MIS-C is rare, it is serious.

Yes. Children’s Colorado is here for all kids. That was true before the COVID-19 pandemic and it’s true today. Doctors in our Infectious Disease Program are experts in treating infectious conditions in children, including COVID-19.

Non-urgent care

If you believe your child needs attention for possible COVID-19, first call their pediatrician. If you do not have a pediatrician, you can call our ParentSmart Healthline at 720-777-0123 for advice from a pediatric nurse. This service is free and available 24/7.

Urgent or emergency care

Children’s Colorado also offers pediatric urgent and emergency care at several locations. Learn more about our urgent and emergency care and how to decide when to go where. If you believe your child is experiencing a life-threatening emergency, always call 911.

If you do go to urgent care or an emergency room for possible COVID-19, remember to:

• Call ahead;
• Tell the team about your symptoms as soon as you arrive; or
• Share your test results (if known)

This will help keep all patients and health workers safe.

Getting medical care during the pandemic

At Children’s Colorado, keeping patients safe is our top priority. Learn about the many precautions we’ve put in place to keep patients and families safe during the pandemic. Or find our coronavirus resources for families, all in one place.

There is a large international effort underway to develop vaccines against COVID-19. In the U.S. the Food and Drug Administration (FDA) has authorized or approved three vaccines against COVID-19. You can find more info about all available COVID-19 vaccines through the Centers for Disease Control and Prevention (CDC).

Read common questions and answers about the COVID-19 vaccines, or get the latest COVID-19 vaccine updates to learn about the process behind creating and approving these vaccines in the U.S.

Only one vaccine with FDA emergency use authorization is available for children so far; that's the Pfizer vaccine, which became available for kids ages 5 and older in early November 2021. For now, the Moderna and Janssen (Johnson & Johnson) vaccines are authorized for adults 18 years and older.

Studies including children younger than 5 are in progress, and we anticipate the results of these studies in 2022.

It’s important that COVID vaccines are studied in kids before using them widely. There are good reasons for studying kids separately from adults and for studying kids after adults.

As a group, healthy kids are at lower risk of experiencing severe COVID-19. That’s the main reason younger kids were not included in the first round of vaccine studies. Additionally, kids’ bodies are different than adults' – including their immune systems – and they may react differently to a vaccine than adults do. We need to make sure the vaccines are both safe and effective in the pediatric population before they can be distributed. That process takes place in clinical trials.

The good news? Things are moving. We encourage families to be patient while waiting for a safe and effective vaccine for younger kids. Remember that behind the scenes there is an extensive approval process, and once a vaccine is approved and available, there’s another extensive surveillance system monitoring vaccine safety within the population.

Yes. There are strict requirements and rigorous safety standards that must be met before any vaccine, including COVID-19 vaccines, can be approved by the Food and Drug Administration (FDA) and distributed to the public. The COVID-19 vaccines have gone through the rigorous process to prove both safety and effectiveness. They have been authorized for emergency use by the FDA and recommended by the CDC.

One way to think about it is that while the business side of vaccine development and distribution was fast-tracked, the science was not. Although the process has been accelerated, no corners have been cut.

Another thing to keep in mind is that this work is building on decades of remarkable progress in the development of vaccines. When the Food and Drug Administration authorizes a COVID-19 vaccine and the Centers for Disease Control and Prevention recommends it, it means that vaccine has gone through every single step of the vast, rigorous and complex process required to understand the safety and effectiveness of any new vaccine.

In short: Vaccines have historically been remarkably safe and effective, and they’re the single best way to prevent infectious diseases. We need them to stay safe. This is true for COVID-19, and dozens of other vaccine-preventable diseases from polio to measles to the flu.

We believe in the safety of currently approved and authorized vaccines and that they will help us end of the pandemic. Please be sure to speak with your healthcare provider if you have any questions or concerns about your personal risk.

All three COVID-19 vaccines available in the U.S. are extraordinarily effective, especially for preventing hospitalizations and severe cases of COVID-19.

All three vaccines available in the U.S. are very effective at preventing the most severe cases of COVID-19. This is great news, and it means we now have several safe and effective vaccines to help us end the pandemic while reducing individuals’ risk of severe illness.

As many public health experts and doctors say, the best COVID-19 vaccine is the one you are offered. What they mean is that getting the vaccine as soon as you are eligible – not the type you get – is what matters most. However, now that vaccines are more readily available, there are a few details to consider as you deliberate about which vaccine may be right for you.

What to consider when deciding which COVID-19 vaccine to get:

Your age

• Right now, kids and teens ages 5 to 18 can only receive the Pfizer-BioNTech vaccine. This is because the Moderna and Johnson & Johnson vaccines are authorized for adults (ages 18 and older). Additional studies for all three vaccines are underway, so this could change soon.
• Women younger than 50 should be aware of the rare risk of blood clots with low platelets after receiving the Johnson & Johnson vaccine. Other COVID-19 vaccines are available where this risk has not been seen.

The number of doses required

• The Johnson & Johnson vaccine is a single-dose vaccine, which means you only need to get 1 shot for the full benefits of this vaccine. The Pfizer and Moderna mRNA vaccines require 2 shots, several weeks apart, to achieve full vaccine immunity. If it’s difficult for you to get to an appointment, getting the Johnson & Johnson vaccine may be easier.

Vaccine availability near you

• The vaccines have different storage and transportation requirements, which means some facilities may carry one or multiple vaccines, depending on their capabilities. For example, Children’s Colorado offers the Pfizer vaccine since, so far, it’s the only vaccine authorized for kids. Rural areas or mobile vaccination clinics may be more likely to carry the Johnson & Johnson vaccine, since it can be stored at higher temperatures.

The vaccines work. The COVID-19 vaccines available in the U.S. continue to be remarkably effective in reducing risk of severe disease, hospitalization and death, including against the delta variant.

If you want to look into each vaccine and determine which you prefer to receive, we encourage it. But if you have limited time or access to the vaccines and you understand the considerations for each, you don’t have to worry about which brand you receive.

If you have questions about your health, your level of risk or additional considerations for the type of vaccine you should get, please speak with your doctor.

It's perfectly normal to have questions about the COVID-19 vaccines. We're providing regularly updated Q&A, virtual events, videos and articles so you can learn all about the COVID-19 vaccines. You can also read our complete list of COVID vaccine FAQs, organized by topic.

COVID-19 is a new condition, and we’re learning more about it as additional scientific evidence becomes available every day. This means that health guidance may change as we learn more about how the coronavirus spreads and how to treat it.

We will update this webpage regularly as we learn more about COVID-19 and its impact on children and teens. We also recommend the following trusted resources for additional information on the COVID-19 pandemic.

• Centers for Disease Control and Prevention (CDC): Information and resources from the public health authority in the U.S.
• Colorado Department of Public Health and Environment (CDPHE): COVID-19 resources from Colorado’s health department
• HealthyChildren.org: Resources for parents from the from the American Academy of Pediatrics (AAP)
• U.S. Food and Drug Administration (FDA): Information from the federal agency that regulates medications, vaccines, medical devices and other health-related products in the U.S.
• World Health Organization (WHO): Information for the public from the global health authority

Fortunately, most kids and teens who have COVID-19 fully recover from it within 14 days of their first symptoms.

A small number of children have developed an inflammatory condition called multisystem inflammatory syndrome in children, or MIS-C for short. Though this is serious, it is rare.

There have been reports of cases where COVID-19 symptoms last for several weeks or months following infection. This has been called long-COVID, post-COVID syndrome or post-acute COVID syndrome (PACS). The official term in the medical community is now PASC, short for post-acute sequelae of SARS-CoV-2.

Doctors and scientists are still learning about this phenomenon. Most cases have been in adults, though cases in children have been reported.

Read what the CDC says about long-term effects of COVID-19.

Though influenza (flu) and COVID-19 are both contagious respiratory illnesses, they are caused by different viruses. COVID-19 is caused by infection with a new coronavirus (SARS-CoV-2) and the flu is caused by infection with influenza viruses. There are several seasonal influenza viruses, and they circulate each year during what we call flu season.

Because some of the symptoms of the flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis. If you think your child has the flu or COVID-19, the best thing to do is call your child’s doctor to ask whether your child should be tested.

The CDC explains the key differences between COVID-19 and the flu.

If your child had a suspected or confirmed case of COVID-19, you should keep an eye on them for several weeks to make sure they are feeling better and that their symptoms improve and go away over time. Be sure to watch for any symptoms of MIS-C. Though MIS-C is rare, you should be aware of it and keep in touch with your child’s doctor if you have concerns.

In general, your child should remain in isolation until 10 days after their positive COVID-19 test.

Advice for parents of young athletes

If your child participates in competitive sports or vigorous exercise, we recommend checking in with their doctor before they return to sports and play. Their pediatrician can give them an exam to ensure that your child does not have lingering symptoms and is ready for exercise.

Generally, if your child has had confirmed or suspected COVID-19 they should wait at least 14 days after their symptoms appeared before returning to sports or vigorous exercise. This is because your child could still be contagious and may spread the coronavirus to teammates or others. It may also take up to two weeks for some symptoms to appear.

There have been reports of myocarditis (the swelling of the heart muscle) and sudden cardiac arrest in some competitive athletes who have had COVID-19. When the heart muscle is inflamed, there is a higher risk for the heart to work abnormally and to have an irregular heartbeat. Though this is unsettling, parents should not panic.

We are still learning about COVID-19 in kids and its potential effects on the heart. While there is evidence that COVID-19 impacts the heart in some adults, we need additional studies and data before we understand how the disease may affect the cardiovascular system in children and teens.

We recommend having your child checked out by their pediatrician before returning to sports if they are a competitive athlete and meet any of the following criteria:

• Over age 12
• Have a history of heart problems, including heart murmurs or high blood pressure
• Had a severe case of COVID-19 or had to be hospitalized
• Had MIS-C
• Have symptoms of pain or tightness in their chest, fainting or tiring very easily during exercise

Their pediatrician will perform a sports physical and can refer them to a pediatric cardiologist, if needed.

There is some disagreement between pediatricians about whether the return-to-play guidelines following COVID-19 infection are overly cautious. At Children’s Colorado, pediatric cardiologists in our Heart Institute recommend remaining cautious until additional scientific studies are published and we know more about the risks. Please speak with your child’s pediatrician to learn about your child’s individual risk and if they should receive a checkup.