The AAP strongly endorses the use of safe and effective infection control measures to protect children and adolescents. COVID-19 vaccination, ventilation, physical distancing, testing and use of a well-fitting face mask are all part of a comprehensive strategy to mitigate risk and help reduce the spread of COVID-19.
The AAP strongly recommends that all individuals over the age of 5 years receive the COVID-19 vaccine. Additional layered prevention strategies may also be important depending on individual and community level risk. The Centers for Disease Control and Prevention (CDC) has refined its guidance on COVID-19 protection and risk mitigation to include a measure of the impact of COVID-19 on health and health care systems, in addition to measures of community level cases.
- Face masks can be safely worn by all children 2 years of age and older, including the vast majority of children with underlying health conditions, with rare exception. In addition to protecting the child, the use of face masks significantly reduces the spread of SARS-CoV-2 and other respiratory infections within schools and other community settings. Home use of face masks may be particularly valuable in households that include members who are in quarantine or isolation, as well as adults and children who have medically complex conditions or are immunocompromised or at increased risk for severe disease.
- High-quality, well-fitting face masks should be worn by all individuals who are 2 years of age and older when the community level risk is considered “high.”
- Well-fitting face masks should be worn in accordance with CDC quarantine and isolation guidelines for those who have a SARS-CoV-2 positive test or were exposed to COVID-19.
- Certain segments of the pediatric population remain vulnerable to SARS-CoV-2 infection, and continued use of high-quality, well-fitting face masks in public settings may be warranted for these children and the individuals around them:
- Children <5 years old who are currently ineligible for COVID-19 vaccine, recognizing that masks are not recommended for children <2 years of age.
- Children who are immunocompromised, who may not have mounted a protective immune response to COVID-19 vaccine and are at high risk for severe COVID-19 illness.
- Children who are at higher risk for severe COVID-19 illness.
- Children and youth with special health care needs who may be vaccinated but still are at higher risk for severe disease.
- Children and adolescents who lack immunity to SARS-CoV-2 despite vaccination or previous SARS-CoV-2 infection.
- High-quality, well-fitting face masks should be made available to all children and families who remain vulnerable to SARS-CoV-2 infection.
- Well-fitting face masks may be considered for use in preschool or early education and child care settings for all children 2 years of age and older, including teachers.
- Schools that are in communities where community level risk is “low” or “moderate” that opt to discontinue face mask requirements should be supported in reinstituting face mask requirements as community levels and conditions warrant. Additionally, SARS-CoV-2 testing and vaccination should continue to be supported and encouraged by all schools.
- Children, adolescents and teachers who choose to continue wearing face masks in school settings should be supported in their decision to do so. Schools and other leaders should ensure that these individuals are not targets for bullying behavior.
Pediatricians are encouraged to discuss infection control practices with their patients and families.