Population Care

What doctors wish parents knew about keeping unvaccinated kids safe

Sara Berg, MS , News Editor

Now that children 12 and older are eligible for COVID-19 vaccination, it means many people will be able to move through the world with a little more freedom than before. But for parents with kids 11 and younger, returning to a sense of normalcy might be more limited as they are left wondering which activities they can safely do together when not everyone in the family is vaccinated against COVID-19.

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While Pfizer-BioNTech’s COVID-19 vaccine was authorized for emergency use in ages 12–15, there are no vaccines authorized for use in the U.S. for younger ages. This means children 11 and younger should continue to mask up for the time being. All three manufacturers with U.S.-authorized vaccines—Pfizer, Moderna and Johnson & Johnson-owned Janssen Pharmaceuticals—are studying the safety and efficacy of their COVID-19 vaccines in children as young as 6 months old. But it will likely be a few more months before there is a vaccine approved for those under 12.

AMA member Christopher Garofalo, MD, a private practice family physician in Attleboro, Massachusetts, shared advice on safer activities that families can do together.

While parents shouldn’t bring their “kids out to 10 concerts this year where there are 20,000 people … going to the beach, going hiking or other outdoor activities are great choices to do together as a family,” he said. “If you have some children who are too young to be vaccinated, you still need to be cautious, but I wouldn't make it a hard stop and say, ‘Oh, you can't do this until everybody's vaccinated.’”

“You can do things that are more in group settings like going to a baseball game or family cookout,” Dr. Garofalo added, noting that “most of the activities that kids do during the summer are outdoors—whether it’s playing their summer sports or going to camp.”

“As we’ve been saying since the beginning of the pandemic, anything outdoors is much safer than a similar activity indoors” he said, adding that “anything that we can do outdoors is going to be preferable, so go for hikes, go swimming and play sports.

Learn more from the Centers for Disease Control and Prevention (CDC) on choosing safer activities.

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While outdoors is preferred, Dr. Garofalo explained that “there are events that families can do indoors together,” but “the message that needs to be shared is the more densely packed in you are—and this is even true for outdoor events—the more at risk you are.”

“If you’ve got people packed into a small space, it is not a good idea in terms of going out to dinner,” he said. But “if you are going out to eat inside  a restaurant, especially if most of those people are vaccinated and relatively far apart from one another, that should be a pretty safe activity to do.”

However, the challenge is that there is no way to know an individual’s vaccination status. And with masks removed while seated, it is safest if people eat outside at restaurants.

A clear choice for a safe activity to do as a family is to visit grandparents or other relatives who are fully vaccinated.

“This is going to come up much more as we get into the fall and we start talking about Christmas, Thanksgiving, Hanukkah, Kwanzaa and other holidays—it’s going to become more important,” said Dr. Garofalo. But “for every person who is vaccinated, you decrease the risk of everybody else who is around you from contracting COVID-19.”

That means that “unvaccinated kids can spend time with grandparents and other relatives who are fully vaccinated,” he said. But if families are “gathering with two or more households that include anyone unvaccinated or at high risk, masks should still be worn, and activities should be held outside as much as possible.”

Read about what doctors wish patients knew about life after vaccination.

After more than a year of canceled trips, families are growing eager to travel again. While the CDC does not recommend flying until you are fully vaccinated against COVID-19, if a family does travel it is important to follow all precautions.

“Even if you have been vaccinated, wear your mask and distance yourself as much as you can,” said Dr. Garofalo, adding that “it’s going to be a little tougher to distance because airports can be a place where you are packed in pretty tightly with a lot of other people.

“Also, depending upon which airport you might be at, there could be a lot of international travelers who may not have vaccination rates like we do in the United States,” he added.

Read about six things doctors wish patients knew about flying during the pandemic.

As families begin planning for vacations, amusement parks might be on the agenda. While these parks may be moving toward lifting restrictions, it is still important to take proper precautions, especially for children who are not yet vaccinated against COVID-19.

Regardless of where you go, “for the most part, amusement parks like Universal or Disney are outdoors, but there are some attractions that are indoors,” said Dr. Garofalo. “If you want to go to Space Mountain, for example, you do have to sometimes wait in line, but there are many strategies that you can use to reduce that risk.”

It is important to practice physical distancing, wash your hands and wear a mask if you are unvaccinated and there are large groups of people, explained Dr. Garofalo. But it seems that “most people can go to an amusement park and feel comfortable with their unvaccinated children.”

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“It certainly makes people a little more nervous about going into summer and doing everything that they did before the pandemic, especially if they have someone who isn't vaccinated,” said Dr. Garofalo. But “if you’ve got two parents and three kids in the household and one of those children can’t get vaccinated or isn’t of age yet … all those other family members in the house who are vaccinated help to protect that one child who isn’t vaccinated for whatever reason.

“And we’re going to see that going forward—there are some kids who just can’t get vaccinated,” he added.

Discover what doctors wish parents knew about COVID-19 vaccination.

While wearing a mask outside is not required for unvaccinated or vaccinated individuals, it is important to be mindful of when to wear a mask. For example, masks are still recommended in crowded outdoor settings or during activities that involve sustained close contact with other people who are not fully vaccinated.

Additionally, “there may be some kids who, if they’re immunocompromised in some way or they have some health issues, should still wear a mask,” said Dr. Garofalo, adding that “even if the parents don’t have to wear a mask, it might be nice if the parents did anyways, sort of in solidarity with their kids—that way the kids don’t feel different.”

“There’s no harm in wearing the mask,” especially because “most of the children would probably feel a lot more comfortable if their parents were doing it too,” he said, adding that “it’s going to make it easier [because] if you’re not wearing a mask, your child’s probably not going to wear one either or they’re not going to want to.”

That’s why it is important to “model the behavior that you want your child to have,” Dr. Garofalo said.

The AMA has developed frequently-asked-questions documents on COVID-19 vaccination covering safety, allocation and distribution, administration and more. There are two FAQs, one designed to answer patients’ questions, and another to address physicians’ COVID-19 vaccine questions.