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Girl with mask in school

AAP emphasizes use of face masks to protect children with special health needs

December 6, 2022

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Wearing face masks continues to be an important way to protect children and youths with special health care needs (CYSHCN) who are especially vulnerable to severe disease from COVID-19.

The pandemic has taken a toll not only on the physical health of this group but also their development, education and mental health. Subgroups of CYSHCN, specifically children with medical complexity are more likely to have severe acute biological effects of COVID infection, requiring admission to the hospital or intensive care unit.

“Ensuring equity for CYSHCN at all levels should be a priority for pediatricians and all service sectors,” the AAP said in updated guidance. “Community and public health strategies should ensure prioritization of needs of CYSHCN, including mitigation of community transmission, individual protection against disease, protection of workforce, and access to all needed services, including school and child care.”

The AAP’s updated interim guidance on caring for this population calls for children 2 years and older with special health care needs to wear face masks in areas with medium and high community levels, especially in indoor public spaces and outside when physical distancing is not possible. Close contacts of CYSHCN also should consider wearing masks.

Masks continue to be beneficial in reducing the risk of transmission of SARS-CoV-2 as well as other viruses in schools and child care centers even if universal masking is not required.

Masks are part of a multilayer risk-reduction strategy that also includes vaccination of everyone 6 months and older who is eligible. In certain situations, health care providers may consider the need for pre-exposure prophylaxis in immunocompromised patients or those with contraindications for vaccination.

Health care providers in the medical home should partner with the family to address the ongoing physical and mental health needs of CYSHCN. In outpatient settings, health care providers should use telehealth for CYSHCN when needed, especially in areas with high community transmission of COVID or other respiratory viruses, such as influenza and respiratory syncytial virus. For in-person visits, consider encouraging face mask use by patients and their families and use of personal protective equipment by health care personnel and staff. Health care personnel should honor requests made by families to wear a mask, even when it is not required.

In inpatient, long-term care and post-acute care settings, the AAP recommends increased risk mitigation strategies during surges of any respiratory illness and stresses that crisis standards of care should not discriminate against CYSHCN and people with disabilities in allocating scarce resources.



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