The aim of the study was to identify factors predicting laboratory-positive coronavirus disease 2019 (COVID-19) in pediatric patients with acute respiratory symptoms.We conducted a cross-sectional analysis of a prospective cohort study.Data from 1849 individuals were analyzed. COVID-19 was confirmed (reverse transcription-quantitative polymerase chain reaction) in 15.9% of patients, and factors predicting a positive test result were evaluated through prevalence odds ratios and 95% confidence intervals.Increasing age, personal history of obesity, and household contact with a case were found to be associated, in the multiple regression model, with increased odds of a positive test result. Young patients residing in areas with higher population sizes, as well as those with severe respiratory symptoms, were less likely to be laboratory confirmed.Early identification and isolation of children and teenagers with suggestive symptoms of COVID-19 is important to limit viral spread. We identified several factors predicting the laboratory test result. Our findings are relevant from a public health policy perspective, particularly after the restart of in-person academic activities.Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.