As Mask Mandates Lift, Should Children Under 5 Still Wear a Mask?

Two years since the COVID-19 pandemic first hit the United States, most COVID-19 safety restrictions – including indoor mask mandates – are being lifted across the country. For some families, this is cause for celebration, but for others, it sparks concern and worry. One reason: There are still no FDA-approved COVID-19 vaccines for children younger than age 5.

Julia Shaklee Sammons, MD, MSCE, Assistant Vice President of the Office of Preparedness, Prevention and Response, and Lori Handy, MD, MSCE, Medical Director of Infection Prevention and Control, both at Children’s Hospital of Philadelphia (CHOP), recently discussed masking, vaccines and how families can best transition to this new stage of living with COVID-19.

“After experiencing the largest surge in disease activity to date (in December/January) with the arrival of the Omicron variant, COVID-19 disease activity and hospitalizations sharply declined,” Dr. Sammons said. “Now, even as case volumes have begun to rise again, rates of hospitalizations continue to be low. As we head into the next few months, we expect that trend to continue.”

Most places in the U.S. are at a very different point in the pandemic compared to two years ago. Community immunity has increased – through vaccination and natural infection – and the most recent omicron variant, though more contagious, was less severe. Many children who tested positive for COVID-19 in recent months showed signs and symptoms similar to common seasonal viruses like croup and bronchiolitis.

“We are at a point in time where the reduced level of severe disease and hospitalizations, coupled with improved immunity as a population, afford us the ability to thoughtfully lift some of the measures we have had in place, including masking,” Dr. Sammons said. If hospitalization rates rise again, mandatory masking may be a tool we take back out of the toolkit.

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Should my child still wear a mask? Consider these factors

Not all families are comfortable giving up masks – especially those who are (or live with someone who is) immunocompromised, or those with younger children who cannot yet receive an FDA-approved COVID-19 vaccine.

“Some parents may choose to continue to mask their child – or mask themselves when they’re out in public,” Dr. Sammons said. “It’s all about an individual’s risk tolerance.”

Masking is still very effective at stopping the spread of germs – even one-way masking, Dr. Sammons added. “So, if you choose to take your toddler out shopping, or they’re going to daycare or preschool, their mask is still providing protection – even if those around them aren’t masking any longer.”

When deciding if your young child should continue wearing a mask now that mandates have been lifted, consider:

• Your family’s risk tolerance level. Are others in the household fully vaccinated against COVID-19? Does anyone have a serious illness or compromised immune system? Can you afford to take time off work if your child becomes sick?
• The rate of community transmission and hospitalizations in your area. Overall, risk of exposure is much lower if you are in an area with low transmission rates. Follow what’s happening in your area by referencing the CDC’s COVID tracker map. For families who have concerns about unmasking until vaccines are available for our younger kids, counties in yellow or blue have lower rates of transmission and indicate areas where risk of exposure would be the lowest.
• Where you’ll be – and with how many people. If you are headed to a crowded, indoor event, the risk of exposure is higher than at an event that is hosted outdoors, with space for children to run and play farther apart from one another.

For more expert commentary from CHOP clinicians, read "There Will Always be Germs. Let Your Kid Go to the Birthday Party," from the Philadelphia Inquirer.

Get vaccinated when you can

As more people get vaccinated, we build herd immunity against COVID-19 in more schools and communities. The more eligible people who get vaccinated, the more we protect ourselves as well as the more vulnerable among us who cannot get vaccinated due to age or other factors.

And by continuing other tried and true infection prevention strategies we’ve practiced before and through the pandemic – staying home when sick, hand washing/sanitizing, coughing/sneezing into your elbow instead of hands, and yes, masking when necessary – the greater chance we have to get our kids back to their daily routines and activities, and keep them healthy so we can keep them there!

Julia Shaklee Sammons, MD, MSCE, and Lori Handy, MD, MSCE, are both attending physicians in the Division of Infectious Diseases at CHOP. In addition, Dr. Sammons is Assistant Vice President of the Office of Preparedness, Prevention and Response; and Dr. Handy is Medical Director of Infection Prevention and Control.