Should My Child Wear a Mask to School this Fall?

By Diane Arnaout, M.D.

The American Academy of Pediatrics is recommending that all children over age 2 wear masks in school this fall. The internet rejoiced, everyone agreed it was a great plan, scientists and politicians shook hands, and no one had anything to say about it.

Ha. Kidding. I promptly picked up some curly fries and wine when I heard about it and laid face-down on my office floor. Not the most sanitary place to do some deep breathing, but whatever.

I hate to joke about serious things like this, but if I don’t, I may cry. The idea of a uniform and agreed-upon plan for halting the spread of a disease that could prevent the deaths of many seems like a pipe dream at this point.

Let’s walk through this and see if I can help you with your decisions this fall.

What did the American Academy of Pediatrics recommend?

• “Everything possible must be done to keep school in-person.” This is because the rates of academic struggle, obesity, and mental health crisis all rose tremendously this past year. Kids need to be in school. We all agree on that.
• They recommend all eligible kids receive the COVID vaccine (12 and up currently)
• Universal masking for anyone in school over age 2 (all students and all staff)
• Flexibility in policy – COVID is an ever-changing scenario and if something isn’t working well, schools need to recognize it and change it
• Attendance of students should be closely watched, and mental health resources for both students and staff should be available
• There should be ongoing federal, state, and local funding to schools to help them with all this.

Why is the AAP recommending all kids wear masks this Fall?

• The AAP is asking all students to wear masks in order to not only protect those that cannot be vaccinated yet, but also the families of these children, and the community as a whole.
• The AAP advocates for children. ALL children. Not just your kid. The wealthy ones. The poor ones. The sick ones. The healthy ones. The physically and mentally challenged. The kid who is being raised by his elderly grandmother and doesn’t have the means or transportation to get that vaccine yet. The kid who doesn’t have enough food at home but gets 2 good meals at school. The child who doesn’t have access to the fancy laptop or functioning internet. The AAP gives us advice based on what will help our community better support and protect our kids.
• Guess what? Last year, we masked in schools. We washed hands more. We asked sick kids to stay home. And schools were then found to not contribute significantly to the spread of COVID-19. (Click here for more information)
• We also noticed a pleasant, NONEXISTENT flu and RSV season as an added side-bonus.
• What happened this summer? We took our masks off, had playdates, saw friends, had parties. And now have plunged into a winter-sized scourge of viral illness. My office has been booked days in advance. The hospital is full. In July. These school strategies work not only in regards to COVID, but all viral illness– both focused studies and my own practice numbers have proven this.

What is the “Delta variant”?

• The COVID virus is mutating (as we expected), and this is the newest and most common version of it in the U.S. right now
• It is crazy, freaking contagious. More so than the original bad boy.
• Verdict’s out on whether it makes you sicker. I suspect it will put a larger burden on hospitals just given the number of unvaccinated people who may be infected.
• Vaccines seem to be working well against it.
• A recent study from the United Kingdom showed that children and adults under 50 were 2.5 times more likely to become infected with Delta.

Why should my vaccinated kid wear a mask?

• Because keeping track of who is vaccinated and who isn’t is a huge burden on schools. And trust me, they have already suffered enough burden.
• Because many kids cannot have the vaccine yet, or haven’t had access to it.
• Because we don’t yet know how well the vaccines work against the new COVID variants and until we are more comfortable with seeing how effective it will be, this is the most low-risk and safe thing we can do.

Will masking harm my kid? Why are all these people saying these awful things about masks?

• Putting a piece of thin cloth on your child’s face does not harm your child.
• I have written one mask exemption this entire year. One. It was for a child with a very rare lung disease. The child’s lungs are anatomically and physiologically very different than a normal child’s and keeping oxygen levels up even without a mask was a struggle for this kiddo.
• The worst I’ve seen is a mild face rash here and there. Otherwise, don’t believe the hype. Masks are not causing TMJ problems, lost social development, increased CO2 levels, increased illness, etc etc. It’s a lot of weak arguments with no evidence and as a pediatrician who saw and examined thousands of children this past year: the kids are fine.

Does masking protect other people? Or me?

• Both.
• Even if your child is the only child wearing a mask in the class, it will protect him. (Click here for more information)
• This all works better if everyone masks.
• If an unmasked sneeze happens nearby, a mask prevents your child from inhaling AS MUCH virus into his airway – and there is brewing evidence that the MORE virus particles you inhale into your body, the more severe the subsequent illness may be.
• I also think it really keeps kids from touching their face, picking their nose, putting fingers in mouth, etc. Our absolute lack of flu and RSV last winter can attest to this.

What if only some kids are wearing masks? Will my kids get bullied?

• I don’t know. I doubt it. We did a whole year where everyone masked and school-aged and young kids were generally pretty cool and flexible about it. Most don’t seem to care either way. The bullies in this scenario often seem to be the adults.

When are the vaccines for the younger kids going to be ready?

• Pfizer’s clinical trial data for children age 5 to 11 is likely coming in September. If approved, shots for kids this age will be available within 1-2 weeks after that.
• Ages 2 to under 5 coming soon after that, in October.
• 6 months to 2 years soon after that.

What about my child under 2 who can’t wear a mask?

• It’s okay. Send them to daycare. Send them to mother’s day out. Do the swim lesson. Get the speech therapy. You need it to work, thrive, survive. COVID seems to be milder in young kids. And while I can never guarantee anything in life 100%, I think the benefits outweigh the risks for kids in this age group.

What if the daycare doesn’t require their staff to be masked? Vaccinated?

• I’m hopeful that daycare centers will strongly encourage their staffs to vaccinate and mask up, but I know that not all will. I think you should ask the questions and expect answers from childcare centers. You can certainly make that a part of your decision-making process when choosing where to place your child.

Do kids really get severely sick with COVID?

• COVID in children is mostly mild. No one debates that. But kids (especially the older kids) contribute to the spread in the community.
• Let’s not forget the times it’s not mild. I’ve seen kids with post-COVID chronic fatigue, long-term smell and taste change or loss, multisystem inflammatory problems, psychosis, and cardiac issues that have kept them out of sports for the year.
• We are still learning about the long-term consequences of COVID infection. There is thought that up to 30% of people who have had COVID will develop long-term medical problems.
• I talked to one of the Cook Children’s Pediatric ICU doctors the other day, Dr. Linda Thompson. I wanted her input about kids with more severe illness as she has seen much more of it than I. She said she’s seen more severe illness in older children compared to the younger ages. She also mentioned “please let everyone know I vaccinated my 14-year-old as soon as I could.”

What do you recommend, Dr. Diane? What will you be doing with your kids?

My kids (6 and 7 years old) will be going to school in-person this fall. They will be wearing masks regardless of what the other children are doing. They can take them off when outside. We will talk about it a lot before it happens, and expectations will be clear.

We will practice wearing them while we watch our screen time to get used to them again on our faces. We will pick the favorite fabrics. If our community numbers drop and my children are able to safely get vaccinated this winter, I can’t wait to tell them to take ‘em off.

But until enough of us get vaccinated, COVID is not going away. And it will likely surge again this winter.

As long as the numbers keep climbing in the community, we have to protect not only the kids, but all of us. Remember those hospital numbers in January? Remember the goal of not over-straining our medical resources? Remember Uncle Pete who had a heart attack and there wasn’t a single hospital bed available for him last winter?

I’ve said it before and I’ll say it again: we are building this boat as we float in it. We don’t know what the future holds for us and we are making the best decisions we can in a situation that no one has yet conquered. Having patience as we gather the data and learn from our successes and mistakes is the beautiful and necessary process of science.