As we inch closer to a post-COVID-19 world, parents with young children still have many lingering questions. A return to normal daily life seems within our grasp, but what does this mean for unvaccinated children? And how should families with young children safely proceed going forward?

As we acclimate to fewer adults wearing masks, there are some reassuring facts for families to know. With warmer weather, more children will be spending time outdoors, where virus transmission is rare . And children are less likely to infect each other, so the number of outbreaks in schools has been low. Lastly, with nearly 40,000 new cases, as of May 25th, the United States saw the lowest number of weekly Covid-19 cases among children since early October, according to the American Academy of Pediatrics.
While we keep informed of the latest CDC guidelines for children and evolving mask mandates (which can vary by state), we're considering the overarching questions that all families with unvaccinated children continue to ask.

Every day, we're learning more about COVID-19 and how it impacts our children. Here's the very latest:

Will my child need to wear a mask when he returns to school in the fall?

It depends. The American Academy of Pediatrics recommends that everyone over the age of two continues to wear a mask in school, regardless of their vaccination status. The CDC says that fully vaccinated teachers and students don't have to wear a mask in the classroom—but unvaccinated students do. There's no national mandate regarding mask wearing and schools, so it's important to check with your child's school system for their guidance before ditching the mask for good. Your school may require students to wear masks anyway, despite the CDC's stance or your child's vaccination status.

I've heard that children will only have mild COVID symptoms. Is that true?

​While there is evidence that children are more likely to be asymptomatic or experience mild to moderate symptoms of COVID than adults, it is possible for children to have severe cases. Case in point: Mississippi is currently seeing a surge in severe pediatric COVID-19 cases, due to a surge in the highly contagious Delta variant. According to state health official Dr. Thomas Dobbs, there are currently seven children in intensive care units, with two on life support. In a series of tweets, Dr. Dobbs said that "pretty much ALL cases in MS are Delta variant right now" and that the vast majority of all cases, hospitalizations and deaths are among the unvaccinated population. "Please be safe and if you are 12 or older - please protect yourself," he tweeted. Dr. Alan Jones, associate vice chancellor for clinical affairs at the University of Mississippi Medical Center, told local news station WAPT , "We have had more pediatric admissions than we had early in the pandemic." We know that COVID impacts each patient differently and it can be difficult to estimate just how sick they'll get. To protect yourself and your children, officials urge anyone who is eligible to receive a vaccine to do so, and to continue social distancing and mask-wearing when appropriate.

When will kids under 12 be able to get the vaccine?

Moderna now joins Pfizer in offering a vaccine for kids ages twelve to seventeen. But what about younger children? According to the New York Times , because kids of different ages can have varying responses to vaccines, it is standard practice to test older children first to study their response, thus potentially modifying the dosage a younger child would receive. The good news is that studies in younger children have begun. In fact, Pfizer and Moderna clinical trials are currently assessing the efficacy and safety of their vaccines in babies as young as 6 months . If the results of the trials are as positive as they are expected to be, it's looking like young children could be eligible for the vaccine in the coming months. Dr. Anthony Fauci , the government's leading infectious-disease specialist, has projected that children as young as 4 years old (and younger) "would likely be able to get vaccinated by the time we reach the end of calendar year 2021 and at the latest, into the first quarter of 2022."

If my child contracts COVID, how will it affect them?

According to the CDC , symptoms of COVID-19 are similar in adults and children and can look like colds, strep throat, or allergies. The most common symptoms in children are fever and cough, but children may exhibit other signs, from shortness of breath to nausea or vomiting (see the full list of COVID-19 symptoms in children here ). Per CDC guidelines, if your child tests positive, monitor their symptoms, paying close attention to fever, sore throat, an uncontrolled cough and diarrhea/vomiting. Consider who your child has come into contact with and keep your child at home during this time. Contact your healthcare provider on the best way to proceed. With more than 74 million children in the United States, the CDC reports that there have been about 300 COVID-19 deaths and a few thousand serious illnesses (comparatively, the CDC registered 188 flu-related deaths in children during the 2019-2020 flu season). Parents can be relieved that children's risk of illness from COVID-19 is as low as it is for the flu. And there's more uplifting news: as stated above, with nearly 40,000 new cases, the US saw the lowest number of weekly Covid-19 cases among children since early October, according to the American Academy of Pediatrics.

What are the long-term COVID risks in kids?

"Although kids tend not to be so badly affected by COVID-19 and often have asymptomatic or mild cases, we are seeing kids who have decreased exercise tolerance, joint pain, fatigue, and brain fog after COVID-19 infection," says Katharine Clouser, M.D. , a pediatric hospital medicine specialist at Hackensack Meridian Children's Health. Dr. Clouser says you might notice that children with lasting symptoms related to a previous COVID-19 infection may experience the following:
  • a struggle to make it through the day in school
  • exhaustion
  • trouble concentrating
  • increased difficulty with schoolwork, leading to lower-than-usual grades
  • decreased performance in athletics compared to their pre-COVID level
  • fatigue or breathing problems while participating in sports
"In older kids, you may notice a behavior change or observe that something is just 'off,'" said Dr. Clouser. "Your child may even say that they just don't feel right." As stated by Hackensack Meridian Children's Health, "you should be concerned if your child, who normally enjoys the playground, now prefers to sit on a bench and watch others."

How does the mask mandate affect kids?

As vaccinations increase and COVID-19 case numbers fall, health experts continue to recommend that children wear masks in indoor and group settings. This is frustrating for many parents , as they now see adults out in public who no longer have to wear them. However, Dr. Kengo Inagaki, a pediatric infectious disease specialist at the University of Michigan C.S. Mott Children's Hospital, tells ABC News that the United States still has a ways to go in its vaccination efforts, and transmission is still a problem. "People of any age can share the virus," he told ABC News. "So even with kids, it's best to have them wear the mask to reduce the risks." Dr. Rob McGregor, Chief Medical Officer at Akron Children's Hospital , says, "the CDC recommends that children continue to wear masks when they are in public, especially indoors or in large crowds, until they are eligible for the vaccine." To support their young children, vaccinated parents should also continue to wear masks in public spaces or large gatherings until the whole family is vaccinated. For indoor public spaces, families with vaccinated adults should assess the risk versus benefit to each gathering, because you won't be able to know who has been vaccinated and who has not. If you do go indoors, all family members should remain masked.

When will kids officially go back to school?

In a recent interview with the U.S. Secretary of Education, Miguel Cardona, Motherly asked about the safe reopening of schools . Secretary Cardona responded, "It's critical that it's safe. What we're finding is with the rollout of vaccination, with the new guidance from CDC and with the data that we're seeing that shows that schools are not places where there's spread happening if mitigation strategies are followed, I'm really confident that we should be open now for in-person learning for all students and it can be done safely. But I expect that in the summer and in the fall, that our default is every day in-person option should be offered for every student." With news this week that New York City will require in-person learning this fall, it's expected that more school districts across the country will follow suit while continuing to enforce COVID-19 prevention methods , like mask-wearing and physical distancing.

What can families with unvaccinated children safely do this summer?

In a recent survey of 828 health experts ranging from epidemiologists to pediatric infectious disease physicians, the vast majority said that while children still need to wear masks and be socially distant, "minimally risky activities could help counteract the mental health effects of pandemic living.""Kids need to be able to be kids," said Mac McCullough, an associate professor at Arizona State University. "Outdoor activity isn't perfectly safe, but its benefits are likely to outweigh its risks across an entire population."While the experts emphasized that specific activities should depend on the exact circumstances and on local case rates, despite that uncertainty, children could still go inside public places or be in outdoor crowds, as long as they wore masks. While more than half of experts said unvaccinated children from different families should not gather indoors, just over one-third said families could gather indoors if they limited the number of families they saw this way (like in a pod). Alternatively, "almost two-thirds of the experts said unvaccinated children should still wear masks while at playgrounds or playing sports outdoors, even though the virus is much less likely to spread outside." And with summer travel ramping up , 86% of experts said it is most likely safe for children to fly this summer, as long as they and everyone else on the plane is fully masked. That being said, parents should consider double-masking children and limiting the number and length of flights. In general, traveling by car is preferable. For more details on the study results, see here .

Can unvaccinated children visit grandparents?

Dr. Sandra Kesh , Deputy Medical Director and Infectious Disease Specialist at WestMed Medical Group says, "Yes, this is a wonderful reason to get vaccinated. I would still encourage mask use, especially when socializing indoors and if the child is exposed to other children at school, but these visits can and should happen! This has been a particularly trying year for our grandparents, and vaccination allows us to resume the family visits that mean so much to them."
This story was originally published on May 26. 2021.