Keeping your child safe from COVID-19 this summer

As this article went to press, nearly half of all Americans were fully vaccinated against COVID-19. The relief is obvious as the world rushes back to open after more than a year under pandemic precautions. Airline travel has quadrupled compared with this time last year, and families are now eagerly planning vacations, summer activities, and visits with family and friends.¹

Although many parents—and about half of all children between ages 12 and 18—have been vaccinated, there still isn’t an approved vaccine for younger children.² Parents are torn between what they and their older, vaccinated children can do and what they can do safely with younger, unvaccinated children.

The Centers for Disease Control and Prevention (CDC) has released guidance for unvaccinated people of all ages, as well as specific information to help pediatricians counsel parents regarding safe activities for unvaccinated children and what types of precautions to follow.³

The CDC’s guidance for pediatricians includes helpful keys with visual aids showing which precautions to use and when.⁴ Charts depicting masked and unmasked faces and color-coded in green, yellow, and red break down activity-specific advice about safety levels and what precautions for both vaccinated and unvaccinated people.

Examples include the following:

• Safest activities for unvaccinated people with no mask required— outdoor activities with members of own household or small outdoor gatherings with vaccinated individuals
• Safe activities for unvaccinated people wearing a mask—outdoor events with a mix of vaccinated and unvaccinated people
• Less safe activities for unvaccinated people, even when wearing a mask— dining outdoors with people from multiple households, visiting a salon or barbershop, going to an uncrowded indoor event, attending small indoor gatherings with vaccinated and unvaccinated people from multiple households
• Least safe activities for unvaccinated people even when masked—attending crowded outdoor events, full-capacity indoor worship services, going to a movie theater, eating indoors at a restaurant, participating in an indoor exercise class or sporting event

Meanwhile, the CDC indicates that all these activities are safe without a mask for vaccinated individuals.

Gary E. Kirkilas, DO, a Phoenix, Arizona, pediatrician and spokesperson for the American Academy of Pediatrics (AAP), said counseling parents on what is safe for unvaccinated children can be difficult. “There are a million variables of different activities by location,” he said.

“It kind of helps to think in those 4 terms because people think with outdoor activities, it is generally safe,” Kirkilas said, explaining that an indoor event with 1 family would be a safer choice than an outdoor event with many families. “Less contact with multiple households for a short time is usually the way to go.”

What the CDC guidance lacks is advice on individual risk factors, Kirkilas added. That’s where pediatricians come in. Pediatricians who know families, individual risk factors, and other nuances are well positioned to offer suggestions for COVID-19-safe activities.

Generally, Kirkilas asks the following questions to his patients and their families, and suggests these 2 bullet points:

• Children and adults who are unvaccinated should wear a mask.
• Everyone, even vaccinated children and adults, should wear masks on public transportation. This can pose a problem for parents who are eager to get back to “normal” but whose children may not understand why they need to take different precautions than their parents do.

Discussing COVID-19 precautions with children can be challenging, Kirkilas said, especially as more parents get vaccinated before their children are eligible. For younger children, he says, parents should set a good example: Wear a mask—even if vaccinated—to encourage younger children to do the same. Don’t over-explain COVID-19 precautions if children ask about adults who aren’t wearing masks. Simply explain that until they get a shot to protect them from getting sick, they need to continue wearing a mask to stay safe.

For older children, Kirkilas said, a conversation using plain language should suffice. Explain the importance of masks and why children might need to wear one even if their parents don’t. Pediatricians can also help talk with older kids about the issue. Kirkilas said pediatricians can help clear up vaccine misinformation that kids aged 12 to 15 years are especially susceptible to believing.

Official vaccine support and education campaigns from national medical groups has already begun. On June 23, the American Academy of Pediatrics, the US Department of Health and Human Services, the US Centers for Disease Control and Prevention, and many other medical organizations issued a statement in support of the COVID-19 vaccines for children, underscoring that "The vaccines are safe and effective...we strongly encourage everyone aged 12 years and older who is eligible to receive the vaccine under Emergency Use Authorization, as the benefits for vaccination far outweigh any harm."

Kirkilas said that Pfizer is currently investigating the vaccine in children aged 5 to 11 and 2 to 5 years. Dose changes may be needed in these age groups, whereas the dose for children aged 12 to 15 years is the same as for adults. Emergency use authorizations for children younger than 12 years are expected between fall 2021 and the start of 2022, Kirkilas said.

The whole family should participate in the vaccination discussion, according to Kirkilas. “The mistake that’s made sometimes is when you just talk to the parent,” he said. “You really need to involve the child.” Legally, children under 18 must have consent from a parent, he said, but older children appreciate being involved in the conversation about why they are getting the vaccine and how it works.

Pediatricians also will need to communicate with parents who have chosen not to vaccinate. “As pediatricians, a lot of us are used to parents being for or against vaccines. All you can do is provide education about what it does and why it would be good,” he said, adding that he compares the COVID-19 vaccine to more traditional vaccines like the influenza shot. “I try to link things that are known to things that are unknown. And remember to be respectful when talking to teens and parents who have chosen not to vaccinate.”

References

1. TSA checkpoint travel numbers (current year(s) versus prior year/same weekday). Transportation Security Administration. Updated June 17, 2021. Accessed June 12, 2021. https://www.tsa.gov/coronavirus/passenger-throughput
2. COVID-19 vaccinations in the United States. Centers for Disease Control and Prevention. Updated June 17, 2021. Accessed June 12, 2021. https://covid.cdc.gov/covid-data-tracker/#vaccinations
3. Guidance for unvaccinated people: guidance for wearing masks. Centers for Disease Control and Prevention. Updated April 19, 2021. Accessed June 12, 2021. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
4. Choosing safer activities. Centers for Disease Control and Prevention. Updated May 28, 2021. Accessed June 21, 2021. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/participate-in-activities.html