When this article went to press, nearly half of all Americans had been fully vaccinated against COVID-19. The relief is evident as the world rushes back to reopen after more than a year under pandemic precautions. Air travel has quadrupled from 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 the ages of 12 and 18 — have been vaccinated, there is still no 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. can do with younger, unvaccinated children.
The Centers for Disease Control and Prevention (CDC) has released guidelines for unvaccinated people of all ages, as well as specific information to help pediatricians advise parents about safe activities for unvaccinated children and what types of precautions to take.3
The CDC Guidelines for Pediatricians include helpful visual aids that show what precautions to take and when.4 Charts showing masked and unmasked faces and color-coded in green, yellow, and red provide activity-specific advice on safety levels and precautions both vaccinated and unvaccinated people.
Examples include the following:
Safest activities for unvaccinated people without masks required – outdoor activities with members of their own household or small outdoor gatherings with vaccinated people Safe activities for unvaccinated people wearing masks – 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 barber shop, going to a quiet indoor event, attending small indoor gatherings with vaccinated and unvaccinated people from multiple households Least safe activities for the unvaccinated -vaccinated people, even if masked – attending crowded outdoor events, full capacity indoor worship services, going to a movie theater, eating indoors at a restaurant, participating in an indoor fitness class or sporting event
Meanwhile, the CDC indicates that all of these activities are safe without masks for vaccinated individuals.
Gary E. Kirkilas, DO, a Phoenix, Arizona pediatrician and spokesperson for the American Academy of Pediatrics (AAP), said it can be difficult to advise parents on what is safe for unvaccinated children. “There are a million variables of different activities by location,” he said.
“It kind of helps to think in those four terms because people with outdoor activities think it’s generally safe,” said Kirkilas, explaining that an indoor event with 1 family would be a safer choice than an outdoor event with many families. “For a short period of time, less contact with multiple households is usually the solution.”
What the CDC guidelines lack 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 make suggestions for COVID-19 safe activities.
In general, Kirkilas asks the following questions to his patients and their families, and suggests these 2 points:
Children and adults who have not been vaccinated must wear a mask. Everyone, even vaccinated children and adults, must wear masks on public transport. This can be a problem for parents eager to get back to ‘normal’, but whose children may not understand why they should take different precautions than their parents.
Discussing COVID-19 precautions with children can be challenging, Kirkilas said, especially as more parents are getting vaccinated before their children become eligible. For younger children, he says, parents should lead by example: Wear a mask — even if they’re vaccinated — to encourage younger kids to do the same. Don’t over-explain the COVID-19 precautions when children ask about adults not wearing a mask. Just explain that they need to keep wearing a mask to stay safe until they get an injection to protect them from getting sick.
For older children, Kirkilas said, plain language conversation should suffice. Explain the importance of masks and why children may need to wear one even if their parents don’t. Pediatricians can also help talk to older children about the problem. While the AAP and other organizations have not taken official positions on recommending vaccines that are still under emergency approval, Kirkilas said pediatricians can help clear up misinformation about vaccines that children ages 12 to 15 are particularly prone to believe. .
Official support and education campaigns from national medical groups may emerge as vaccines are approved and use expands in children. Kirkilas said Pfizer is currently studying the vaccine in children ages 5 to 11 and ages 2 to 5. Dose adjustments may be necessary in these age groups, while the dose for children aged 12 to 15 years is the same as for adults. Emergency authorizations for children under 12 are expected between fall 2021 and early 2022, Kirkilas said.
According to Kirkilas, the whole family should participate in the vaccination discussion. “The mistake that is sometimes made is when you just talk to the parent,” he said. “You really have to involve the child.” Legally, children under 18 must have parental consent, he said, but older children appreciate being involved in the conversation about why they’re getting the vaccine and how it works.
Pediatricians will also need to communicate with parents who have chosen not to vaccinate. “As pediatricians, many of us are used to parents being for or against vaccines. All you can do is educate 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 flu 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.”
TSA checkpoint travel numbers (current year(s) versus last year/same weekday). Administration for transport security. Updated June 17, 2021. Accessed June 12, 2021. https://www.tsa.gov/coronavirus/passenger-throughputCOVID-19 Vaccinations in the United States. Center for Disease Control and Prevention. Updated June 17, 2021. Accessed June 12, 2021. https://covid.cdc.gov/covid-data-tracker/#vaccinationsGuidance for Unvaccinated People: Guidelines for Wearing Masks. Center 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 Choosing Safer Activities. Center 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