(CNN) – Parents experience whiplash. After two years of pandemic restrictions, several states – including California, Oregon, Illinois, Delaware, New Jersey, Connecticut and New York – have announced that they will end indoor mask mandates. In some cases, it includes easing the mask requirements in schools.
Against this background, the US Food and Drug Administration has said it will delay the approval of the COVID-19 vaccine for children under 5. And while coronavirus cases are declining, they remain at a high level in large parts of the country.
What should parents know about COVID-19 safety for their children? Are activities like play dates, dance classes and movie tours OK to resume? If masks become optional in school, does that mean your kids have to take them off? What about children who are worried about coronavirus and are not ready to stop certain precautions? And what is the advice for parents of children under 5 years?
For this updated parenting guide, I spoke with CNN Medical Analyst Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and the mother of two young children.
CNN: It feels like there’s been a sudden change over the last few weeks. Have circumstances really changed that much when it comes to COVID-19 child safety?
Dr. Leana Wen: I think there has been a marked change, although I would say that the change began in November, when vaccines were first approved for 5- to 11-year-olds. Children who received their shots as soon as they became available were fully vaccinated in time for the winter break. The hope was that they and their families could have a fairly normal Christmas, New Year and other winter parties.
The problem was that the omicron variant appeared just before the holidays. In many parts of the United States, it rose rapidly and overwhelmed hospitals. There was no time for children to enjoy the normality that vaccination promised to bring. When omicron first arrived, we also did not know how well the vaccines protect against it.
Now we know that the vaccines work well to protect against serious disease due to omicron. Cases are also declining rapidly in most communities. That is why many elected leaders, including many who have been very cautious about mitigation measures, have announced easing of restrictions. I think they are right to do so, because things have changed a lot in a short time.
CNN: Does that mean it’s safe for parents to organize indoor play dates and take their kids to the cinema now? What about indoor dancing, football, choir, swimming and other leisure activities that some families have postponed?
When: This is an important issue to consider. Just because restrictions are lifted does not mean that everything is suddenly safe. COVID-19 infection levels are still quite high in many communities completing remedial measures. Government-required measures are coming to an end, but that does not mean that individuals have to make all the risky choices. There are many things we could do that are risky but that we do not always choose to do.
Almost everything we do carries some risk when it comes to contracting COVID-19. The question every family should ask is this: How much do we want to keep avoiding coronavirus? And what is the price we are willing to pay to do that?
Many families will decide that they have already done everything they can and are willing to do. If every member of their household is vaccinated and boosted when they are eligible, it would be reasonable to decide that they will no longer restrict their children’s activities. For a vaccinated child, the chance of serious illness from COVID-19 is very low. Many parents do not want their children to give up more activities and would like to resume indoor play dates, movies and all leisure activities.
Others still want to be careful. They may be concerned about the possibility of long-term symptoms of COVID-19 infection. Maybe they live with someone who is immunocompromised or otherwise vulnerable. They may decide on a case-by-case basis to reduce the risk where possible while trying to keep the cumulative risk low.
For example, they can hold play dates outdoors unless the other children are also vaccinated. They may allow their children to go to the cinema, but require them to wear a high quality mask (N95, KN95, KF94) at all times. They can ask their children to choose the one or two sports or leisure activities that they enjoy the most and remove the less appreciated activities.
The point is that families will make different choices based on their medical conditions, risk tolerance and the value of returning to normalcy. In a way, this does not differ from many other decisions families make using criteria that are unique to their individual situation.
CNN: If masks become optional in school, should children wear them or take them off?
When: It is again up to the individual family’s medical conditions and how much they want to keep avoiding COVID-19. I want to ask one more question: How much does it mean for them to be maskless? A younger child or one with learning disabilities may benefit more from mask-free policies. A child may not want to mask either, because their friends do not mask either. All of these are reasons to consider, bearing in mind that masks reduce coronavirus infection – especially a high-quality mask.
CNN: What about kids under 5 years old – should they keep masking in school? What about their older siblings?
When: All families, including those with young, unvaccinated children, should decide how important it is for them to keep avoiding COVID-19. Covid-19 infections are not always mild, especially if the child is unvaccinated and there is still a potential risk of long-term symptoms. Those who want to keep preventing coronavirus infection should keep masking, and this includes children under 5 and their older siblings. There will be many families who will no longer prioritize preventing Covid-19 infection – such as families who may have just contracted and recovered from coronavirus. Under these circumstances, it would be reasonable to resume pre-pandemic activities and, in some cases, to waive masks.
CNN: There are many children who may not be ready to give up pandemic restrictions. What is your advice to them and their parents?
When: First, start with empathy and reassure your child that these are very normal emotions. I think we can all understand how, after two years of living with so many precautions, it’s hard to pick them back.
Second, go slowly and easily into activities that are the most enjoyable. Maybe your child is not ready for an indoor, maskless birthday party with 50 people. How about getting together with two close friends for a dinner or overnight stay?
Third, focus on the positive. If your child has missed a sport or activity, how will it feel to return to doing something they truly love? If you have not been able to travel, how much fun would it be to go to a place they have always wanted to visit? If you were too busy before the pandemic, consider this option of not adding every activity back to your schedule. And keep checking in as a family while you all get used to this transition period.