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Updated COVID-19 guidance addresses physical distancing in schools, emotional toll on students

March 25, 2021

Editor’s note: This guidance has been updated since this story was published. For the latest school guidance, visit interim guidance is based on current evidence and best data at the time of publication. Updates are provided to reflect changes in knowledge about the impact of the disease on children and adolescents. For the latest news on COVID-19, visit

The AAP has updated its interim guidance for safe schools during the COVID-19 pandemic, which aligns with revised recommendations from the Centers for Disease Control and Prevention (CDC) on physical distancing between students in classrooms.

The AAP guidance also includes new information on emotional support for students who have lost loved ones, rising rates of food insecurity, ventilation in school buildings and risks for children with chronic illnesses.

What hasn’t changed is the Academy’s call for in-person instruction of students when possible, noting that schools and school-supported programs are vital for youths’ development and well-being.

“The AAP continues to strongly advocate that all policy considerations for school COVID-19 plans should start with a goal of having students physically present in school,” the interim guidance states.

Physical distancing measures

The CDC previously recommended spacing student desks at least 6 feet apart to the greatest extent possible. Based on evidence from the U.S. and internationally, it reduced the distance to at least 3 feet when students are in classrooms and are wearing masks.

“This update mirrors the guidance that the American Academy of Pediatrics has offered,” AAP President Lee Savio Beers, M.D., FAAP, said in a statement. “As a nation, we should be prioritizing helping schools reopen safely so that children and adolescents can benefit from everything that schools provide.”

The AAP guidance highlights several recent studies that found no increase in community or school transmission when students were at least 3 feet apart. For example, a large retrospective study in Massachusetts public schools showed student and staff case rates were similar regardless of whether school districts required physical distancing of at least 3 feet or 6 feet. Of note, most districts required universal masking.

The AAP guidance notes that staff and educators who have been fully vaccinated should continue to wear face masks at all times.

The CDC continues to recommend 6 feet between middle and high school students in communities with more than 100 cases per 100,000 cumulative over seven days who are unable to cohort. It also advises 6 feet of distancing between cohorts, between adults and between students and teachers.

Emotional support for children

More than 543,000 people in the U.S. have died from COVID-19. Each death affects an estimated nine people, and children are among the 4.5 million people who are grieving, the guidance notes.

“Schools should consider providing training to classroom teachers and other educators on how to talk to and support children during and after the COVID-19 pandemic including how to support grief and loss among students,” the guidance states. “Students experiencing significant personal losses can be referred to school and community-based bereavement support programs, centers, and camps, as well as to their pediatrician or other pediatric healthcare provider. Students with additional mental health concerns should be referred to school mental health professionals.”

Food insecurity

Rates of food insecurity rose from one in seven children in 2018 to one in four in September 2020, according to figures from the U.S. Department of Agriculture Economic Research Service and the Urban Institute.

Furthermore, rates are higher among children whose parents are Hispanic/Latinx or Black (about 40%), according to the Urban Institute.

Pediatricians can access the AAP/FRAC Food Insecurity Toolkit for information on how to screen families and connect those in need to federal nutrition programs.


The interim guidance recommends opening windows and doors to improve ventilation, unless doing so would be a safety or health hazard (e.g., trigger asthma symptoms). It also states that child-proof fans and high-efficiency particulate air filters can be used.

If the weather permits, schools could hold classes and activities outdoors.

Children with chronic illness

Some children with chronic illness may be at risk for hospitalization and complications from SARS-CoV-2, the guidance states. Therefore, these children and their families should work with their pediatrician and school staff to determine if children should return to school in person.

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