March 1, 2022

In the wake of updated guidance from the U.S. Centers for Disease Control and Prevention (CDC) on COVID-19 on how communities can approach public health measures to reduce the risk of illness, the American Academy of Pediatrics (AAP) offers considerations for families to inform their decisions.

CDC’s updated recommendations allow communities to relax risk mitigation measures like masking when all three of the following conditions are met: low COVID-19 transmission rates, low hospital admission rates, and adequate hospital capacity. Communities with high levels of immunization also have more protections that make masks less critical, though many children and individuals lack this protection.

“While CDC’s new approach is reasonable, pediatricians urge state and local policymakers to keep in mind the unique needs of children when considering COVID-19 mitigation measures. For some children—including those too young to be immunized and many with special health care needs—masking will still be an important layer of protection for a while longer,” said AAP President Moira Szilagyi, MD, PhD, FAAP. “We encourage each family to make a plan that works best for them, while also modeling empathy and discouraging bullying of any child who chooses to mask to protect themselves and their family even when not required to do so.”

AAP advises families to consider the following factors in making this decision:

• If their child is between ages 2 and 5 and currently ineligible for COVID-19 vaccine
• If their child is immunocompromised and may not have a protective immune response to the COVID-19 vaccine, or is at high risk for severe COVID-19 illness
• If their child is not immunized
• If other members of their family are at higher risk of severe disease or are not immunized
• If they live in a community with “high” COVID-19 transmission

These factors may lead adults and children to continue wearing face masks in public indoor settings, including schools, even if not required. According to the AAP, children, adolescents, and teachers who choose to continue wearing face masks in school settings should be supported in their decision to do so.

CDC’s guidance calls for public health decision-making on masks based on local conditions. Based on CDC’s new guidance, universal mask policies are still necessary in many parts of the country. In addition, localities will need flexibility to reinstitute masking as local situations warrant. Policies that serve as impediments to this local decision-making are inappropriate and should be eliminated.

“The toll of the pandemic has not been felt equally across racial or economic lines, and we must acknowledge these inequities as we help families navigate the right choices to keep themselves and their children safe and healthy,” said Dr. Szilagyi. “Families of children with special health care needs may also now be forced to stay home from school or other activities if universal masking goes away. One of the best ways to protect our communities is to encourage everyone ages five and older to get vaccinated.”

The AAP strongly recommends that all individuals ages 5 years and older receive the COVID –19 vaccine. Additional layered prevention strategies such as testing, ventilation, and masking can also create a cocooning effect that offers protection for children too young to be vaccinated or who have health conditions, such as immune-compromise or lung conditions, that are more likely to result in severe disease from COVID-19 infection.

“While we are disappointed by new data that may suggest waning efficacy of the vaccine in preventing mild infection with the Omicron variant in children ages 5 to 11, the vaccine is effective in protecting children from severe illness and hospitalization, and pediatricians still recommend every eligible child receive the vaccine,” said Dr. Szilagyi.