Last updated on June 9, 2021

Finally, we are seeing life around us bounce back as more and more adults, and now young teens, are getting vaccinated. But if you have children under 12 who don’t have a COVID-19 vaccine option, how do you decide what is safe to do this summer?

The good news is that many traditional and fun summer activities can be safe for families with unvaccinated children if you follow a few simple safety rules. And, hopefully, by fall or winter 2021, we will start to hear news of COVID-19 vaccine approvals for children 2 to 11.

Why preventing COVID-19 matters, even for young children

While most young kids have mild disease with COVID-19, it is still better to prevent COVID-19 disease at this young age as some children (especially those with underlying chronic conditions) can still get very sick.

In addition, preventing the spread of COVID-19 is the best way for all of us to return to pre-pandemic life sooner. The more that we can do to stop the spread of COVID-19, the better chance we have of stopping the virus from changing (i.e., mutating) and creating a variant that our current vaccines might not protect against. For now, and continued good news, we see the current vaccines able to protect against the most common variants.

Follow the “two-out-of-three” rule

For unvaccinated children or adults, one of the world’s leading experts on viral transmissions recommends the two-out-of-three rule. The three are our best defenses against COVID19: masks, outdoors, social distancing.

Applying the two-out-of-three rule means:

  • If you are outside and able to continuously social distance, you may shed your mask.
  • If you are outdoors and not able to social distance, then you need to wear a mask.
  • If you are indoors, even if you can social distance, you need to wear a mask.

And, of course, wash your hands often with soap and water (hand sanitizer is the next best option).

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Tips for a safe and fun summer

NOTE: For children with underlying medical conditions (i.e., asthma, diabetes, genetic/metabolic disorders, sickle cell disease, heart disease since birth, immunosuppression, and/or obesity, to name a few), COVID-19 infection poses a higher risk of severe disease. Families will want to discuss their unique situations with their pediatrician to weigh the benefits and risks to each child and family.

Most of what is written below will be prefaced with an “it depends.” If your area has very low rates of new COVID-19 cases and high rates of COVID-19 vaccinations, then each of these activities becomes safer to do.

Yet, I would caution with unvaccinated children, always follow the rule of two-out-of-three. And be especially cautious if you have family members with underlying medical conditions and who are unvaccinated. Finally, reach out to your pediatrician, who knows your child’s medical history and family circumstances, for further guidance.

1. Get out on the open road

Travel is an excellent option for the summer to enjoy being with family outside of the homes we have been sheltering in for the past year. How you travel will determine the risk to your unvaccinated children.

As I write this, the Centers for Disease Control and Prevention’s (CDC) website still advises delaying travel until you are fully vaccinated. But this guidance is challenging for families with vaccinated and unvaccinated members, especially children under 12.

If eligible family members can get vaccinated, they should do so to protect themselves and others. If you are looking to travel with unvaccinated children, there are ways to reduce the risk of COVID-19 to the unvaccinated.

Car travel with as few stops as possible is one of the safer ways to travel with young children. You will want to plan your route and continue to monitor COVID-19 guidance by state.

Federal air travel regulations (and those for trains and buses) still require all passengers, regardless of vaccine status, to wear a mask. Follow these tips for safe travel on these modes of transportation:

  • Plan short routes with no or few stops. Trips that are shorter and have no stops are safer.
  • For unvaccinated children, wearing a well-fitting mask with no valves (double masking if tolerated) and even a face shield to help reduce the risk of being infected and keep little hands from rubbing eyes, nose and mouth.
  • Hand sanitize often and wipe down surfaces frequently.
  • If travel conditions allow, social distance from others outside your family or pod.
  • As noted above, be aware of the travel restrictions and regulations regarding COVID-19 at any stops and your destination.

Before you go, download the Teladoc mobile app onto your smartphone or tablet. If you get sick, you can reach a Teladoc doctor anytime, anywhere.1 2 If you forget any of your prescription medication, you may be able to have a Teladoc doctor send an emergency refill prescription to the nearest pharmacy.

2. Head to the pool

Swimming is a great outdoor activity when done safely. Outdoor swimming is safer than indoor swimming, and you will want to avoid indoor swimming until your children can be vaccinated. In addition to the usual precautions of having a watchful eye on your children while swimming and applying sunscreen frequently, the key is seeking out a pool without crowds. That might mean hitting a public or hotel pool right when it opens.

Remember that rule of two-out-of-three: Swimming occurs without a mask and outdoors, so you will need to enforce the social distancing to prevent the spread of COVID-19. Swimming in crowded pools will place unvaccinated children in close contact with other unvaccinated children. Maintaining your pods while venturing out will allow your children to interact with other children, swim safely and reduce the risk of COVID-19.

kids playing outdoors while wearing masks

3. Get sporty

Getting back into youth sports outdoors is a great way to encourage physical activity, socialization and character development through good sportspersonship. Most youth sports are likely to have players in close contact. If you have ever watched youth soccer and how little ones cluster around the soccer ball or naturally huddle on the sidelines, you will know that keeping 6 feet apart is nearly impossible. For that reason, it is safest to wear masks even outdoors. Remember the rule of two-out-of-three: outside, not socially distanced, requires wearing a mask.

Outdoor sports that naturally create social distance, such as tennis, may be safe without a mask if social distancing can be maintained. Personally, as a youth coach, I find it easy for children to adapt to masks, and you spend more time enjoying the sport than being the “keep 6 feet apart” monitor.

It’s important to remember, during the hotter summer months, to have more frequent water breaks—socially distanced—and adjust the intensity of practices to ease into fitness with a mask. Most club and school teams have done this successfully with older children who were not yet vaccinated.

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4. Keep calm and camp on

Many summer camps will be set up to run like in-person schools were this school year. And, as a parent, knowing how well a summer camp is following the established CDC guidance is your best bet for a safe and fun summer. I recommend using these checklists provided by the CDC to see how well a summer camp measures up to the “gold standard of safety.”

In the summer of 2020, camps that followed the CDC recommendations were able to prevent the spread of COVID-19 (very low risk), while summer camps that did not had COVID-19 outbreaks. Camps, like schools, that have large populations of unvaccinated children are at risk for a COVID-19 outbreak, so must be more vigilant about following these guidelines.

5. Avoid doing this at the mall

Again, sticking to the two-out-of-three rule, a mall is indoors (unless you live in a part of the country with mild year-round winter and have outdoor malls), so the safest way to visit an indoor mall is by wearing a mask, social distancing from others not in your family or pod, and always washing your hands.

I would avoid eating indoors when unvaccinated. Eating requires removing your mask for extended periods of time indoors and increases the risk of being infected with COVID-19. Luckily, summer is perfect for picnics, so grab a to-go meal from the food court and find a nice spot outside or go to the mall after a meal so no one gets the munchies.

Easing into summer

As vaccinations go up and new cases of COVID-19 go down, the risk of spreading the virus is lower. So now is a great time to enjoy the outdoors and ease into activities we did pre-pandemic. Each family should make its own decision about when to stay at home and when to venture out. Summertime lets you take this change at a pace that feels right for your family.

While this guidance is perhaps not all what you wanted to hear, by following it, you will keep your unvaccinated kids safer in this home stretch before a COVID-19 vaccine is available for children under 12.

Here’s wishing you and your family a safe and worry-free summer, but just in case you need it, know that you can reach out to a Teladoc doctor online or by app 24/7. Here are all the ways we can help.

Think you might have COVID-19?

If you have a fever or feel feverish, have cold-like or flu-like symptoms, or feel run-down, reach out to schedule a Teladoc appointment online or by app to speak with a Teladoc doctor.

Want to get the COVID-19 vaccine?

More vaccine appointments are becoming available every day. If you are eligible, to protect yourself and others, don’t travel without the vaccine. Get the latest vaccine information here.

Published June 8, 2021

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About the author

Bridget K. McCabe, MD, MPH, FAAP

Medical Director of Clinical Quality and Informatics at Teladoc Health

Dr. Bridget K. McCabe is a dual board-certified physician and the Medical Director of Clinical Quality and Informatics at Teladoc Health, where she is scaling clinical quality across the national and international network of virtual providers. She also serves as the Executive Medical Director of The Institute for Patient Safety and Quality of Virtual Care, the first Patient Safety Organization dedicated to quality improvement in the virtual setting. She is board certified in pediatrics and clinical informatics, and holds a medical doctorate with distinction in the field of neuroscience and a Master of Public Health in Clinical Effectiveness from Harvard University.

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