Summertime is about to get sweeter for kids—and their parents. At least that's what pediatrician Elizabeth Hill, M.D., hopes as mask mandates have been lifted for vaccinated adults across the country.

"There's a lot of anxiety around lifting these mask mandates and what it means, but I just want to highlight that we are really lucky these recommendations are coming out in the spring," Hill says. "There are countless health benefits to outdoor play, and I am excited this may push kids outdoors more this summer because there are fewer restrictions on outdoor play [for unvaccinated children]."

Hiking, riding bikes, playing kickball, searching for bugs in the backyard—these activities and more should be considered safe for kids to do with friends without a mask.

"The evidence shows that outdoor activities are really, really low risk," says Hill, who is also a mother to three young children. "There are very few cases of known transmission in an outdoor setting. I feel really comfortable with my kids playing outdoors unmasked."

This is great news as the weather warms and summer nears. Kids may have more of an opportunity to get outside than they did in 2020, and parents will have more of a reason than ever to encourage outdoor play thanks to its relative safety from COVID-19.

Still, Hill says her behavior will in part be dictated by the families she's socializing with. If another parent prefers her children wear masks for outdoor play, she says she's happy to comply. 

Can kids do indoor activities without a mask?

But what about indoor dining, sleepovers, and trips to the movies? Can kids resume these activities without a mask while remaining unvaccinated? After all, it may be a long time before the vaccine is approved for use in children under 12.

"Kids still need to be masked when socializing indoors in most circumstances," Hill says.

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Exceptions would be small gatherings that fall within CDC guidelines, such as vaccinated grandparents visiting unvaccinated grandchildren. In these cases, the CDC has stated there's no need to wear masks or practice social distancing.

Hill says she gets a lot of questions from families on if they can or should do certain activities, and she says it has a lot to do with the family's personal situation.

"It depends on the actual thing the family is doing, the health of the members of that family, other activities they might be doing, and each family's individual risk tolerance," Hill says. "There's not a one-size-fits-all approach to this. Every family has to decide where they fall with their comfort level."

Families also have to decide which indoor activities are most important to them, and which risks they are willing to take.

Worth noting, kids who have had COVID in the past still need to use masks indoors. While we know a lot about how well the vaccine protects people from COVID and prevents transmission, we know less about how having had COVID in the past affects future risk of transmission. For now, if you're not vaccinated but have had COVID in the past, you still need to mask indoors.

What if my child or someone in my household is immunocompromised?

Kids who are immunocompromised or at a higher risk of severe disease for any reason should definitely take more precautions than a child without those risk factors. This also goes for children who live with someone who is immunocompromised or at a high risk of severe disease. For these special circumstances, it's always a good idea for families to discuss best practices with their doctor.

Not back to normal yet: COVID is still here

The end of the mask mandate does not mean the pandemic is over. Things are not back to normal, says Hill.

"There are still things we should avoid," Hill says. "Having a sleepover with a different kid every weekend is a really risky practice. But if two families are closely 'podded' together and already spending lots of time indoors unmasked together, a sleepover between those kids may not add that much more risk."

"We see more spread of this virus when there are many points of contact, so keeping your indoor bubble small is still important," Hill says.

This means families should take care in situations where adult vaccination status may be unknown or unclear. The CDC considers small, indoor gatherings that mix vaccinated and unvaccinated people from multiple households to be "less safe" and suggests unvaccinated people mask up and practice social distancing in these cases.

For unvaccinated people, the CDC still recommends masks in any indoor setting and at crowded outdoor events. Even with a mask, indoor dining, attending full-capacity worship services and singing in an indoor chorus are among the activities rated "least safe" by the CDC.

Parents will have to evaluate summer activities like camps to make sure they are following CDC guidelines. Fully vaccinated people should "continue to take prevention steps, including wearing masks" when working in youth settings, including camps, according to the CDC. 

If families with unvaccinated children want to travel, they should assess the risks—and vaccinated adults should be sure to follow the latest CDC guidance as it evolves. Right now, the CDC recommends fully vaccinated adults still wear masks on all forms of public transportation, including planes.

Still, Hill says she's looking forward to seeing more "normal kid stuff" in her general pediatrics practice, such as skinned knees, bruised elbows and a renewed focus on regular summer safety tips like wearing bike helmets and sunscreen.

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