Kids and masks in school: Doctors answer questions as mask guidelines change

The American Academy of Pediatrics has released new mask recommendations for children as more school districts and local communities lift indoor mask mandates. In the last week, the Centers for Disease Control and Prevention also issued new guidelines based on updated classifications that focus on COVID-19 hospitalizations and capacity. The new guidelines let people forego masks in over 70% of the country, where an area is classified with a low or medium COVID-19 community level.

In a news release Tuesday, AAP President Dr. Moira Szilagyi said, "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.”

Previously, experts cautioned that relaxing COVID-19 safety measures too early could lead to a potential resurgence of the virus in the near future.

The AAP recommends that families take several factors into consideration when deciding to relax or continue the use of masks:

• If their child is between ages 2 and 5 and currently ineligible for a 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

“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,” Szilagyi added.

Dr. John Brownstein, an epidemiologist at Boston’s Children Hospital, Dr. Amanda Mintzer, a clinical psychologist at the Child Mind Institute, and Dr. Neha Chaudhary, a child psychiatrist and chief medical officer of BeMe Health, spoke with "Good Morning America" on the best way families can make risk-tolerance decisions and how to talk to kids and teens about mask wearing.

Mintzer recommended that parents do their due diligence and stay open-minded before deciding what they are comfortable with. She also suggested parents talk to children about respecting other families and their decisions too. “(It) may be different from the mainstream and that's OK, too. Everybody has to do what makes them feel comfortable and I would say, as much as we can, encourage our kids to follow the program that we're setting for them rather than comparing," she said.

Here are what the experts recommend for parents and caregivers as they navigate questions from children.

Talk together as a family

Brownstein, Mintzer and Chaudhary emphasize that, above all, parents should talk to kids, see what each family member is comfortable with and make decisions collectively.

“The decision really is a family decision and it goes to probably a number of factors, which is whether the child and family are fully vaccinated and whether there’s anybody in the family and household that may have any underlying conditions where you might want that extra level of protection to protect the family,” Brownstein said.

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Chaudhary also emphasized a family’s unique circumstances and said to discuss guidance from the CDC and other sources together. “Framing it as a set of family rules can be helpful when there's conflicting information out there on what to do, when, or where,” she explained via email.

“I think always remember that kids take their cues from their parents," Mintzer said. "And so it goes back to values – what is important for your family? If you are a family that really still strongly believes that your child should be masked, despite the fact that let's say, maybe their school isn't requiring that, I think it's about imparting that value to your kids," she said.

Set an example

Another key to remember? Practice what you preach, Mintzer said. “You can't tell your kid to do this (or that), if you're not doing it as well," she said.

If a child is frustrated with having to wear a mask, Chaudhary added, “Parents should validate their children's feelings where they can, by saying things like, ‘I know you're tired of having to wear a mask. I also wish we didn't have to anymore,’ while modeling how to manage frustration and still abide by the rules. Kids are always watching parents to see how they handle situations, including frustrating ones.”

Be flexible

One of the biggest lessons from the pandemic has been that guidance continues to evolve, Mintzer said. “The most important message is encouraging flexibility, that these are changing times and that different government officials are making different decisions and we're just trying to get the best information that we can," she said. "It's hard to be flexible sometimes and sometimes it doesn't even make sense. It's important for us to practice going with the flow.”

If you and your family decide to make changes, Mintzer said that it’s important to let kids and teens know that and to know that it’s acceptable to do so. “I think we want to instill in them that it's OK to do something different and we want to do what makes us feel good, and we might change our minds, and that's fine, too," she said.

Brownstein added, “The important thing here is, there's no one size fits all. Every family, every child, everyone has a slightly different context by which they make these decisions. And we have to apply the family dynamics with what's happening in the school with what's happening in the community to arrive at a decision that makes the most sense. So, it's not like there's one right way to do this.”

Use age-appropriate messages

When talking to kids under 5 about mask-wearing and not mask-wearing, “It can help to make the mask-wearing some sort of a game or enjoyable experience," Chaudhary suggested. "Consider getting a mask with your child's favorite superhero on it, or putting kids on a point system where they are rewarded for mask-wearing. If masks are no longer required per the guidelines (for example, for kids who are over the age of 2 and vaccinated), parents can just inform kids that the rule has changed."

For children between 5-11 years old, Chaudhary pointed out, “Kids at this age are focused on rules – understanding what rules apply to them or what happens if they abide by the rules versus break them. Having a frank conversation about what those rules are, why they exist, and what the consequences are can be a helpful starting point for kids in grade school, particularly late elementary through middle school."

Finally, with teenagers, Chaudhary added, “Ask them what their understanding is of a certain topic. That can serve as a starting point to build off of in explaining guidelines as well as how you as a family expect to approach the guidelines and mask-wearing.”

Editor's note: This was originally published on Feb. 18, 2022.