9 questions about traveling with kids, answered by infectious-disease experts

Across the country, life is returning to normal. People are gathering again without masks, local coronavirus restrictions are dropping and travel is on the rise.

But parents of children who aren’t old enough to get vaccinated yet are in a sort of limbo, watching millions of people reemerge while wondering what they can safely do with their kids this summer.

While children are at lower risk for severe illness than adults in general, 3.9 million cases of COVID-19 and 308 deaths had been reported in the United States by mid-May. And the Centers for Disease Control and Prevention still recommends delaying travel until people are fully vaccinated.

“Parents are reading all these articles about singles who are full of savings and planning these ‘YOLO’ trips,” said Katie Stewart, a travel adviser with the family-focused agency Ciao Bambino. She said she recently had a conversation with a client whose mind-set was much different: “I don’t want a YOLO trip. I just want to come home and know my kids aren’t sick.”

The Centers for Disease Control and Prevention added a wrinkle with the new guidance that vaccinated people can go without a mask in many situations both indoors and outdoors, leaving parents to wonder if the mask-free person nearby is inoculated or just taking advantage of looser guidelines.

“It’s definitely made a lot of families rethink their travel plans and recoil,” said Sahera Dirajlal-Fargo, who specializes in pediatric infectious-disease and travel medicine at UH Rainbow Babies & Children’s Hospital in Cleveland. “A lot of our patients are saying, ‘Everyone else is moving on. What about us?’”

For doctors who are experts in both pediatrics and infectious diseases, the questions come from patients, friends and family. They say experts know so much more about the virus this year compared to 2020, and families can make smart decisions that will let them get away safely.

“I think it’s unfortunate we all feel that the younger kids have been left out,” said Dirajlal-Fargo, who is also part of University Hospitals Roe Green Center for Travel Medicine and Global Health. “I really want to emphasize the optimism of: we know what works and we didn’t a year ago. So we can have a more quote unquote normal summer. There are lots of activities that can be done safely.”

What kind of travel is safe for a fully vaccinated teen or tween?

Fully vaccinated children can travel pretty much as they did before the pandemic — with some caveats.

If travel includes visiting someone who is at high risk for serious illness — or who has an underlying issue that might make the vaccine less effective — that would require some extra vigilance.

“You probably need to take extra precautions even though everyone is vaccinated,” said Andrew Pavia, chief of the division of pediatric infectious diseases at University of Utah.

Sharon Nachman, chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital, said parents need to remember how long it takes to be fully vaccinated with the Pfizer-BioNTech shot that has been authorized for those 12 and older: Two doses three weeks apart, plus another two weeks for full immunity. The Food and Drug Administration cleared the vaccine for emergency use in older children earlier this month.

“The idea that you’re going to get one dose now and run out and be totally covered and protected is not true,” she said. “You have to complete the series.”

Still, she said, if families already have plans in place before children get a second dose, “something is better than nothing.” They should still take precautions around crowds, she said.

What is safest for unvaccinated children?

Everything parents have learned about what’s safe for their kids still applies this summer, experts say.

“Outdoors is better than indoors if you’re going to be around other people,” said Sean O’Leary, vice chair of the committee on infectious diseases for the American Academy of Pediatrics and a professor at the University of Colorado Anschutz Medical Campus. “Less contact is better.”

Also important to consider: how much virus is spreading at the destination.

Dirajlal-Fargo said shorter plane rides are better than longer ones so kids can keep their masks on the whole time, but traveling by car is preferable. And, Nachman said, bringing meals instead of going to restaurants is a smart choice.

Nachman said families should also be sure to have a couple of masks on hand a day for kids in case they get wet or dirty.

For kids who have underlying health conditions, “you really need to be as conservative as you can,” Dirajlal-Fargo said. In a high-profile case last month, a young child with preexisting conditions became Hawaii’s first pediatric COVID-19 death after showing symptoms within hours of flying to the state with his vaccinated parents.

Many families this year are choosing vacation options similar to last year’s, said Rainer Jenss, founder of the Family Travel Association: beach vacation rentals, dude ranches or camping. He said that while issues like mask-wearing for small children add “another stress point in an already stressful process,” many vaccinated adults are making the decision to travel with their children to see loved ones.

“At the end of the day, it’s still an individual decision based on their overall comfort level,” he said in an email.

Stewart, of Ciao Bambino, said she has talked to her clients about staying longer in a familiar location where they can be more in control of interactions with other people.

“We need a break. And so let’s pull back from this idea that this vacation we’re taking because parents are vaccinated needs to be this blowout,” she said. “Go someplace you already feel safe, you already love.”

Can unvaccinated children safely visit vaccinated adults who don’t live with them?

Experts give this a green light, again with some caution.

“Attending gatherings with fully vaccinated family and friends is still the best way to keep our kids safe,” Dirajlal-Fargo said. “Hugging grandparents is fine.”

But if a vaccinated person might not be fully protected because of underlying health conditions, then mask-wearing would be a smart protective measure.

Unvaccinated visitors should also make sure they feel well and haven’t been exposed to coronavirus recently, Nachman said.

What do we know about the risk of unvaccinated children from different households traveling together if their parents are vaccinated?

Many variables play into making a decision about this kind of trip, O’Leary said: Will the kids be inside or outside? Do any of them have underlying medical conditions? How much COVID-19 is circulating in the destination? And will any of the children be returning home to at-risk people?

“It’s not just a simple answer; there are sort of multiple factors at play in those decisions,” he said. “You also have to factor in personal risk aversion.”

Pavia said if at the time of the trip there are low rates of infection and all the kids are operating in safe places, it would be “reasonable” for them to get together — preferably outside, to be safer. But if there are still substantial amounts of transmission and some kids are interacting with many other unvaccinated children indoors, then a get-together could pose more risk.

Families shouldn’t be afraid to ask questions, Nachman said, such as: What is everyone doing before the trip? What while they do while they’re away? How many people will they be in close contact with?

How should parents respond to the CDC’s change in mask guidance?

Mask use will continue to be important for younger kids on vacation in traditionally risky settings such as crowded stores or indoor events, Pavia said.

“I think many of us are concerned that the unintended consequence of the new CDC guidance is it will reduce mask-wearing by unvaccinated people and increase the risk for people who can’t be vaccinated,” he said. “I do think that means that you need to recalibrate a little bit what you’re going to do with your children who are 12 and under.”

Planning ahead will be important, Dirajlal-Fargo said, so parents can check vaccination rates and COVID numbers in the destination; they should avoid crowded indoor places once they arrive.

In an email, Nachman said vaccinated parents of younger children may need to continue to wear a mask so their kids will as well.

“I think parents need to consider how difficult it will be to explain to younger children that they need masks while parents and other adults do not,” she said. “Please consider the messaging and your child’s age when you think about mask-wearing in public spaces.”

Is it dangerous for unvaccinated children to fly?

Because masks are still required on planes and in airports, unvaccinated children can fly relatively safely, experts say.

“I think that if you’re sitting at the window seat and your two family members are sitting next to you and two of three of you are vaccinated . . . you’re less likely to get sick,” Nachman said. She said it’s important to spread out from other people at the airport and keep masks on.

Dirajlal-Fargo said kids should limit how much they eat and drink to keep their masks on the entire time they’re on the plane.

How safe is travel for infants and toddlers who are too young to wear a mask?

Young babies are at higher risk for respiratory viruses, which makes traveling with them a “really personal decision,” O’Leary said.

Nachman said she expects that parents will want to fly with babies to see the grandparents who haven’t met them yet. She said the safest way would be to bring the baby in a car seat, put the seat between the parents (and away from other people) and avoid other travelers in the airport.

“Is it possible (that they will get infected)? Yes,” she said. “Is it likely? No.”

The CDC says children under 2 should not wear a mask. Very young infants are not that exposed to other people, Pavia said, but protecting an older child who is more mobile gets more difficult. He said parents should think about the length of the flight, how they’re going to get to and through the airport, and how healthy the child is.

Dirajlal-Fargo said travel by car would be the safest, but if parents are flying, they should choose off-peak times to travel.

For babies breastfeeding from a vaccinated parent, experts know there are antibodies in the breast milk — but still don’t know how much protection that might provide.

“Certainly breastfeeding is definitely, definitely helpful,” Nachman said. “Can I tell you it is as good as a vaccine? No, I cannot.”

Should international travel be off the table for unvaccinated children at the moment?

Any kind of international travel requires extra attention to health and safety, Dirajlal-Fargo said — and that’s magnified in a pandemic.

“It’s not completely off the table; you just have to be really prepared,” she said.

Pavia said parents have to consider the requirements of the place they’re going and the prevalence of the disease in the destination. Families will also need to get tested before they return to the United States, so they have to figure out those logistics.

The United States is vaccinating its population faster than many other countries, Nachman said, so parents should be aware of the vaccination rate in the country they’re visiting.

“There’s a lot of caution, I would like to say, with international travel,” she said. “Where are you going? What’s the vaccination update at that location? How many people are ill now, and what’s happening?”

Should unvaccinated kids be tested for COVID before and after travel?

Experts point to CDC guidelines for unvaccinated travelers, which say people should get tested one to three days before a trip and three to five days after travel.

Pavia said if kids are visiting unvaccinated or vulnerable people, testing would be an “extra layer of protection.” Likely, if many unvaccinated kids will gather, parents should consider having them tested in advance.

“That would be a good circumstance where testing could add a nice layer of safety,” he said.