To Mask Or Not To Mask Kids: Here's What Pediatric Experts Say

FLORIDA — It's one of the most acrimonious issues today facing parents, for whom the health and welfare of their children is of paramount importance: Should students wear a mask in school?

Parents have become emotional, indignant and belligerent during school board meetings when they feel their child's safety is threatened.

In the face of a rapidly evolving coronavirus crisis in which even top researchers admit they don't have all the answers, parents have either mixed feelings or unwavering viewpoints when faced with the decision of whether to send their child to school in a mask or have their child vaccinated against the coronavirus.

Florida Gov. Ron DeSantis has stated unequivocally that the use of a mask in schools should be the decision of the parent, not the school system. And he's issued an executive order to the effect.

"There's been talk about potentially people advocating at the federal level, imposing compulsory masks on kids," he said at the signing of Florida's Parents' Bill of Rights. "We're not doing that in Florida, OK? We need our kids to breathe. The federal government has no right to tell parents that in order for their kids to attend school in person, they must be forced to wear a mask all day, every day."

DeSantis also said he will withhold critical state funding from school districts in Florida that attempt to mandate masks.

"Many Florida school children have suffered under forced masking policies, and it is prudent to protect the ability of parents to make decisions regarding the wearing of masks by their children," he said.

Nevertheless, the masking policies vary among Florida's 67 school districts.

Some counties are simply making masks optional.

Others, such as Hillsborough County, have mandated that students wear masks but give parents the chance to "opt out" of the mask requirement without giving a reason.

Broward County is mandating masks at school, although staff and students are permitted to opt out for "legitimate" reasons.

What the school board meetings with their endless debate don't show is the heartbreaking moments when a first-grader cries inconsolably, begging not to wear a mask to school because she can't breathe.

They don't show the frustrated expressions on the faces of high school students who struggle to understand what the teacher is saying when the mask muffles her voice and the students can't see her lips move.

They don't show the teasing and ridicule a middle school student encounters when wearing a mask while his classmates go without.

How do parents balance the need to protect their children from a potentially deadly virus while addressing their child's anxiety about wearing masks?

"Parents are facing some tough decisions," said Dr. Sonja O'Leary, chairwoman of the American Academy of Pediatrics Council on School Health.

“We need to prioritize getting children back into schools alongside their friends and their teachers," she said. At the same time, "we all play a role in making sure it happens safely. The pandemic has taken a heartbreaking toll on children, and it’s not just their education that has suffered but their mental, emotional and physical health."

What the American Academy of Pediatrics Advises

The AAP said there is mounting evidence that the delta variant and other variants of the coronavirus are more contagious than the original coronavirus that prompted the declaration of the pandemic in March 2020.

However, there is no evidence at this time that children become sicker after contracting the delta variant.

While urging all children to return to school, the AAP advocates combining layers of protection that include vaccinations, face masks and clean hands hygiene to make in-person learning as safe as possible, O'Leary said.

The AAPA also advises all children age 12 and up who are eligible to be vaccinated do so.

Noting that there is a significant number of students who are too young to be vaccinated, the AAP recommends masking all students older than 2 years old and all school staff unless medical or developmental conditions prohibit the use of masks.

Likewise, schools should:

• Have adequate and timely COVID-19 testing resources available at schools.
• Keep rooms in schools well-ventilated, cleaned and disinfected.
• Have procedures in place to quickly identify and quarantine infected students and staff.

What Johns Hopkins Children's Center Advises

Pediatricians Dr. Anna Sick-Samuels of Johns Hopkins Children’s Center and Dr. Allison Messina of Johns Hopkins All Children’s Hospital advocate vaccinations for all children age 12 and older.

"The U.S. Food and Drug Administration and the U.S. Centers for Disease Control have granted emergency use authorization for the Pfizer COVID-19 vaccine for children 12 to 15, which means these organizations have reviewed clinical trials data and determined that the vaccine is safe and effective," Messina said.

She said current testing being done may lead to the authorization of one or more vaccines for children as young as 2 years old in the coming months.

Experts, including those at Johns Hopkins, believe that the benefits of being vaccinated for COVID-19 outweigh the risks. Although COVID-19 in children is usually milder than in adults, some kids can get very sick and have complications or long-lasting symptoms that affect their health and well-being, said the two pediatricians. Although this is rarer, the virus can cause death in children.

Like adults, children also can transmit the coronavirus to others if they’re infected, even when no symptoms are present. The pediatricians said the COVID-19 vaccine protects against this potential harm to the child and others, including family members and friends who may be susceptible.

Interestingly, the Johns Hopkins pediatricians said failure to get a vaccine could jeopardize the broader community.

They said each child or adult infected with the coronavirus provides a chance for the virus to mutate and create a variant that might prove more dangerous or resistant to the available vaccines and therapies.

Vaccinations mean fewer infections among the population and reduce the chances of a dangerous coronavirus variant emerging.

Nevertheless, some parents fear vaccinating their children could do more harm than good. Since April 2021, there have been more than a thousand reports of cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) happening after some COVID-19 vaccinations in the United States, according to the U.S. Centers for Disease Control and Prevention.

"Considering the hundreds of millions of COVID-19 vaccine doses that have been administered, these reports are very rare," said the Johns Hopkins pediatricians. "The problem occurs more often in adolescents (teens) and young adults, and in males. The myocarditis or pericarditis in most cases is mild and resolves quickly."

As for returning to brick-and-mortar schools, the pediatricians agree with the AAP. Sends kids back to school but arm them with masks and teach good hand-washing practices.

"Going back to in-person school is not a major COVID-19 risk factor for children if they maintain prevention measures such as wearing masks and physical distancing. Attending parties, play dates and in-person family gatherings such as weddings and funerals is associated with a higher risk of children testing positive for the coronavirus," the pediatricians said.

Boston Children's Hospital Advises

Boston Children’s Hospital, named the No. 1 children's hospital in the country by U.S. News and World Report this year, said the delta variant appears to be much more contagious than previous versions of the virus.

Vaccinated people can get breakthrough infections of the delta variant and may be able to spread it. However, typically breakthrough cases are either mild or asymptomatic. Most cases of infection with the delta variant in the U.S. are occurring in people who have not been vaccinated, said the hospital.

With that in mind, Dr. Thomas Sandora, hospital epidemiologist, recommends everyone over the age of 5 wear a face covering when they are in public, including schools, but said children under age 2 and people who have trouble breathing should not wear face masks.

He also advocates coronavirus vaccinations for children who are eligible.

The hospital said there's another epidemic associated with the coronavirus that may pose a greater health risk to children.

Erica Lee, a psychologist in the Department of Psychiatry at Boston Children’s Hospital, said returning to schools may be a difficult transition for some children and parents should be on the lookout for signs of depression:

• Sadness or lower mood.
• Being more irritable or cranky.
• Isolating from family or friends.
• Disinterest in usual or preferred activities.
• Not wanting to go to school or avoiding schoolwork.
• Hurting themselves or talking about suicide.

She said parents can help with the transition back to school by talking to children about their concerns as well as discussing any misconceptions your child might hear at school.

"If your kids have heard scary rumors or express concern about the safety of school, go over the facts. You can review the school’s safety protocols together (such as wearing masks, washing hands and using hand sanitizer) and talk about other rules their school has in place to help keep them safe," she said.

To help the parents of reluctant children, Boston Children's Hospital's website provides a series of tip sheets:

• Explaining COVID-19 to 3-5 year olds
• Explaining COVID-19 to 6-12 year olds
• Explaining COVID-19 to 13-18 year olds
• Talking to your children about COVID-19

See related stories:

• Parents Set For FL Mask Mandate Showdown As 1st School Day Nears
• Florida Posts Record Number Of New Coronavirus Cases: CDC
• CDC Recommends Mask In All Schools; DeSantis Will Fight Mandate
• DeSantis To School Boards: You Better Not Mandate Masking Kids
• Tampa Bay Hospitals Sound Alarm With Wave Of Delta Variant Cases