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AAP urges in-person learning, masking in updated guidance on safe schools

July 18, 2021

Editor’s note:  The AAP interim guidance for schools has been updated since the time this article was published. Please visit COVID-19 Guidance for Safe Schools and Promotion of In-Person Learning. For the latest news on COVID-19, visit

Keeping masks on in school and urging everyone who is eligible to get vaccinated against COVID-19 are among several coordinated interventions recommended in updated AAP interim guidance that strongly advocates for in-person learning during the 2021-’22 school year.

“Remote-learning highlighted inequities in education, was detrimental to the educational attainment of students of all ages, and exacerbated the mental health crisis among children and adolescents,” according to the guidance.

Given the evidence on low in-school transmission rates of SARS-CoV-2 with proper prevention measures and the availability of effective vaccines for those ages 12 years and older, “the benefits of in-person school outweigh the risks in almost all circumstances,” the guidance states.

Minor updates also were made to AAP guidance on camp attendance.

Pediatricians can refer to the guidance documents when counseling families and collaborating with local schools and communities.

Back to class; wear a mask

Pediatricians should emphasize a layered approach that prioritizes attending school in person, while protecting students and staff from SARS-CoV-2 variants that may be more transmissible, said Sonja O’Leary, M.D., FAAP, chair of the AAP Council on School Health Executive Committee.

The AAP continues to recommend that all staff and students who are 2 years or older wear face masks unless medical or developmental conditions prohibit their use.

Universal masking serves multiple roles, according to Dr. O’Leary.

“As we start the 2021-’22 school year, a large portion of students are not eligible to be vaccinated and there are COVID variants that are more contagious. Because of this and because we want to have all students in school, the AAP advocates for all students, teachers and staff to wear masks while indoors in school,” she said.

In addition, schools may lack the resources to monitor vaccine status or enforce mask policies based on vaccination status.

Another benefit of universal masking is that it protects students and staff from other respiratory illnesses that would take time away from school, according to the guidance.

Importance of attendance

When in-person school services were not available during the pandemic, disparities worsened, especially for children who are English language learners, children with disabilities, children living in poverty, and children who are Black, Hispanic/Latino and American Indian/Alaska Native.

“Remote learning highlighted racial and social inequity — another important reason to get students back in school safely,” Dr. O’Leary said. “This pandemic and the last 18 months of remote learning have shown us the importance of physically being together, especially for children and adolescents.”

Schools and school-supported programs are fundamental to child and adolescent development and well-being and provide children and adolescents with academic instruction, social and emotional skills, safety, reliable nutrition, physical/occupational/speech therapy, mental health services, health services and opportunities for physical activity, among other benefits, according to the guidance.

The AAP also recommends that schools monitor in-person and virtual attendance daily and identify and support students at higher risk for absenteeism.

When working with school districts, pediatricians also can:

  • promote racial/ethnic and social justice by promoting the well-being of all children in any COVID-19 plan,
  • focus on ensuring equitable access to educational supports and medical and behavioral health care for children living in under-resourced communities,
  • be aware of academic accommodations and supports for all students, including those with individualized education programs, and
  • ensure the school environment provides an all-encompassing approach for mental health support.


Pediatricians are urged to work with schools and local public health authorities to promote childhood vaccination messaging before the start of school and throughout the school year.

“It is vital that all children receive recommended vaccinations on time and get caught up if they are behind as a result of the pandemic,” the guidance states.

While the influenza vaccine generally is not required for school attendance, it should be highly encouraged for all students and staff.

The AAP recommends consulting the CDC for additional information on mitigation measures around physical distancing, testing, contact tracing, ventilation, cleaning and disinfecting.

Updated camp guidance

Following are highlights of the updated AAP Guidance for Families and Pediatricians on Camp Attendance During the COVID-19 Pandemic:

  • COVID-19 vaccination is recommended for all eligible staff and campers ages 12 and older. If all staff and campers are fully vaccinated, individuals do not need to wear masks while at camp.
  • All campers and camp staff should wear face masks indoors (unless medical or developmental conditions prohibit use), especially in mixed vaccination settings.
  • In general, masks are not required during outdoor activities unless in a crowded setting or during sustained close contact.
  • Policies on the use of face masks, physical distancing and testing may vary based on the vaccination status of camp staff and campers.


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