Pediatric COVID-19 Vaccine Dosing Quick Reference Guide
COVID-19 Vaccines in Infants, Children, and Adolescents
Management Strategies in Children and Adolescents with Mild to Moderate COVID-19
Pediatricians and Family Physicians Toolkit
COVID Vaccines for Kids 6 Months & Older: FAQs for Families
What should parents know about the COVID vaccine for kids under 5?
MIAAP Updates COVID-19 Guidance
The Michigan Chapter of the American Academy of Pediatrics (MIAAP) recommends universal mask-wearing in school for student’s two years and older and school staff attending school in-person, regardless of vaccination status.
Face masks have been proven to be effective at reducing the transmission of COVID-19 by about 85%. Two recent studies have confirmed that schools with mask-wearing requirements have a reduced chance of COVID transmission. Face masks are a crucial layer of protection to prevent spread of COVID along with handwashing, physical distancing, staying home when sick, and vaccination when available. These measures protect students, staff, families, and the larger community,
In-person schooling provides the best environment for children to learn, access needed resources like free breakfast and lunch programs, and maintain social interactions important for a child or adolescent’s mental and physical health. Keeping students in school uninterrupted will be best achieved through universal mask wearing.
Many families have questions about whether their child should be exempt from wearing a mask. In truth almost all people, including young children, can wear masks safely. Students with the following conditions may need accommodations and/or exemptions to remain in school:
A child with a severe autism spectrum disorder who becomes agitated wearing a mask.
A child with a severe psychiatric or behavioral disorder that is specifically exacerbated by wearing a mask (e.g. severe anxiety disorder or sensory processing disorder)
A child with a disability that prevents them from removing the mask without assistance.
Beyond these categories, there are no medical diagnoses that warrant blanket exemptions from wearing a mask. Specifically, asthma, allergies, and sinus disease are not contraindications to wearing a mask.
Families may struggle with getting their children to wear a mask. The AAP provides helpful tips for parents to normalize mask-wearing and make children feel more comfortable:
References:
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
Jehn M, McCullough JM, Dale AP, et al. Association Between K–12 School Mask Policies and School-Associated COVID-19 Outbreaks — Maricopa and Pima Counties, Arizona, July–August 2021. MMWR Morb Mortal Wkly Rep 2021;70:1372–1373. DOI: http://dx.doi.org/10.15585/mmwr.mm7039e1
Budzyn SE, Panaggio MJ, Parks SE, et al. Pediatric COVID-19 Cases in Counties With and Without School Mask Requirements — United States, July 1–September 4, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1377–1378. DOI: http://dx.doi.org/10.15585/mmwr.mm7039e3
COVID-19 Interim Guidance: Face Masks
The American Academy of Pediatrics (AAP) strongly endorses the use of safe and effective infection control procedures to protect children and adolescents. During the coronavirus disease 2019 (COVID-19) pandemic, effective infection prevention and control requires the correct and consistent use of a well-fitting face mask for those who are not fully vaccinated. Face masks should fit over the mouth and nose and fit snugly along the side of the face without any gaps.
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. Children 2 years of age and older have demonstrated their ability to wear a face mask. In addition to protecting the child, the use of face masks significantly reduces the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) and other respiratory infections within schools and other community settings. Home use of face masks also may be particularly valuable in households that include medically fragile, immunocompromised, or at-risk adults and children.
During the COVID-19 pandemic, use of face masks should continue until the child or adolescent is considered fully vaccinated – two weeks after receipt of the final COVID-19 vaccine dose.
Consistent use of a face mask is one part of a comprehensive strategy (in addition to physical distancing, hand washing, and vaccination) to mitigate risk and help reduce the spread of COVID-19, particularly in those who are not fully vaccinated or not eligible to receive a COVID-19 vaccine.
Pediatricians are encouraged to discuss infection control practices with their patients and families.
When you wear a face mask, you protect others as well as yourself, especially if you are not vaccinated and/or are around others who are not vaccinated. Per CDC guidance, face masks and physical distancing are no longer needed for persons who are fully vaccinated unless it is required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local businesses, and workplace (eg. health care settings) guidance.
Schools, child care programs, and camps are encouraged to continue to support the use of face masks for children and staff until vaccine is available and uptake within the pediatric population is high enough to prevent transmission of SARS-CoV-2.
A face mask is NOT a substitute for physical distancing. For those who are unvaccinated, face masks should still be worn in addition to physical distancing indoors around people who do not live in your household. Face masks should be used outdoors for those who are unvaccinated if in large group settings and/or when physical distancing recommendations cannot be maintained. Public health mask mandates may vary based on the level of SARS-CoV-2 circulating in each community and it is recommended that local guidance be followed.
Face mask use should be continued for those who are unvaccinated and playing indoor sports (except for sports in which the mask may become a hazard) and outdoors sports that have close contact (see AAP interim guidance on Return to Sports and Physical Activity).
Face masks should be worn any time you are traveling on a plane, bus, train, or other form of public transportation traveling into, within, or out of the United States and in US transportation hubs such as airports and bus stations.
People who are immunocompromised might not have a full immune response to COVID-19 vaccination and should talk to their health care provider about taking extra precautions (eg, continued use of masks and hand washing) to prevent infection.
Wear a face mask inside your home if someone you live with is sick with symptoms of COVID-19 or has tested positive for COVID-19.
Wash your hands with soap and water for at least 20 seconds or use hand sanitizer with at least 60% alcohol after touching or removing your face mask.
Additional Information
Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2 (CDC)
Interim Public Health Recommendations for Fully Vaccinated People (CDC)
Information for Families from HealthyChildren.org
Interim Guidance Disclaimer: The COVID-19 clinical interim guidance provided here has been updated based on current evidence and information available at the time of publishing. Guidance will be regularly reviewed with regards to the evolving nature of the pandemic and emerging evidence. All interim guidance will be presumed to expire on September 30, 2021 unless otherwise specified.
Post-Covid Return To Play
AFTER TESTING POSITIVE FOR SARS-COV-2, HOW SHOULD CHILDREN AND ADOLESCENTS RETURN TO PHYSICAL ACTIVITY AND/OR SPORTS?
The AAP recommends not returning to sports/physical activity until children or adolescents have completed quarantine, the minimum amount of symptom-free time (as outlined above) has passed, they can perform normal activities of daily living, and they display no concerning signs/symptoms. All children younger than 12 years may progress back to sports/physical education classes according to their own tolerance. For children and adolescents 12 years and older, a graduated return-to-play protocol is recommended. The progression should be performed over the course of a 7-day minimum. Consideration for extending the progression should be given to children and adolescents who experienced moderate COVID-19 symptoms, as outlined above.
All children and adolescents and their parents/caregivers should be educated to monitor for chest pain, shortness of breath out of proportion for upper respiratory tract infection, new-onset palpitations, or syncope when returning to exercise. If any of these signs and/or symptoms occur, the AAP recommends immediately stopping exercise and the athlete should see their pediatrician for an in-person assessment. Consideration should be given for pediatric cardiology consultation.
The following progression was adapted from Elliott N, et al, infographic, British Journal of Sports Medicine, 2020:
Stage 1: Day 1 and Day 2 - (2 Days Minimum) - 15 minutes or less: Light activity (walking, jogging, stationary bike), intensity no greater than 70% of maximum heart rate. NO resistance training.
Stage 2: Day 3 - (1 Day Minimum) - 30 minutes or less: Add simple movement activities (eg. running drills) - intensity no greater than 80% of maximum heart rate.
Stage 3: Day 4 - (1 Day Minimum) - 45 minutes or less- Progress to more complex training - intensity no greater than 80% maximum heart rate. May add light resistance training.
Stage 4: Day 5 and Day 6 - (2 Days Minimum) - 60 minutes - Normal training activity - intensity no greater than 80% maximum heart rate.
Stage 5: Day 7 - Return to full activity/participation (ie, contests/competitions).