Returning to school has taken on new meaning — and a new set of worries — for parents and other caregivers during the COVID-19 pandemic.

With a new school year now underway, recent spikes in Delta variant cases among children and teens, and many students still not eligible for COVID-19 vaccination, it’s no wonder many parents are concerned.

Between Aug. 20 and Aug. 26, an average of 330 children in the United States were admitted to hospitals every day with COVID-19, according to the U.S. Centers for Disease Control and Prevention (CDC). That's the highest rate of new COVID-19 hospitalizations among children in more than a year — a record that was broken several times in August, according to CDC data.

Closer to home, a Sept. 7 report from the Missouri Hospital Association says children age 17 and younger accounted for more than 25% of all new cases across Missouri during the first week of September. That’s the highest percentage recorded throughout the pandemic.

So, how can children and teens be safe while going to school in person?

BJC HealthCare and Washington University School of Medicine experts share some recommendations to help students stay healthy — and physically together in school — this year:

The best ways to stay safe from COVID-19

Vaccines — For the best protection against COVID-19, all adults and children over the age of 12 who are eligible for COVID-19 vaccination should get the vaccine.

“Because the Delta variant is so contagious, many more people are becoming infected — particularly unvaccinated people — and getting ill and transmitting infections,” says Steve Lawrence, MD, Washington University infectious diseases specialist at Barnes-Jewish Hospital. “I urge everyone to get vaccinated for their own personal protection, but also for the protection of others, especially those who can’t get vaccinated right now, like children under the age of 12.”

Hilary Babcock, MD, BJC infection prevention medical director and Washington University School of Medicine infectious diseases physician, agrees — noting the effectiveness of the vaccines.

“The vaccines are holding up well against the Delta variant, they are very safe, and the protection is very good against getting really sick, being hospitalized or ending up in the ICU,” Dr. Babcock says. “The best protection is to get vaccinated now.”

Face masks — Due to the highly contagious Delta variant, the CDC recommends universal indoor masking by all students (age 2 and older), staff, teachers and visitors to K-12 schools, regardless of vaccination status.

BJC and Washington University experts say face masks that cover the nose and mouth are an effective tool to protect students who are not yet able to get the vaccine or who have chosen not to be vaccinated.

In community settings such as schools, wearing masks is effective at preventing the spread of the virus for two reasons, says Clay Dunagan, MD, BJC chief clinical officer and Washington University School of Medicine infectious diseases specialist. One reason is to protect the person wearing the mask. “If you’re wearing a mask, the mask is filtering out potentially infectious virus particles,” he says. This lessens the chance that the mask wearer will breathe in the virus and become infected.

The other reason for wearing a mask is to prevent those who are infected from spreading the virus before they even know they’re infected. "We also ask people to mask because individuals who have an asymptomatic or pre-symptomatic infection may be shedding the virus and not know it,” Dr. Dunagan says.

“The combination of having everyone in a mask — so that those who are infected and those who are uninfected both have a mask on — is very effective at preventing spread.”

Worried that it’s not safe to wear a mask all day? According to the CDC, wearing a mask does not increase risk from germs or bacteria, and doesn’t increase carbon dioxide levels for children.

“When face masks are worn correctly and consistently, they are effective and safe to wear for long periods of time, such as during the school day,” says Dr. Lawrence. “And masks offer the best protection against this virus for children who cannot yet be vaccinated.”

Physical distancing — The CDC says students should remain at least 3 feet apart within classrooms. When possible, schools should use outdoor spaces and unused spaces for instruction and meals to help with distancing.

“Schools should make every effort to keeps students distanced as much as possible,” says Dr. Babcock.

When it’s not possible to maintain a physical distance of at least 3 feet, the CDC says it’s especially important to use other prevention strategies, such as screening, testing and universal indoor masking.

Dr. Babcock reiterates the importance of masking, saying, “We’re all excited to have our kids back in school in person, and the safest way to do that right now is with everyone in school wearing a mask.”

Tending to your kids’ mental health (and yours too)

“This last year and a half has been tremendously difficult in all areas, but it has been especially difficult from a mental health point of view,” says Jessi Gold, MD, Washington University psychiatrist at Barnes-Jewish Hospital. “No one has been spared from the mental toll this pandemic has taken on us, so be sure to take the time to care for yourself and your loved ones.”

Dr. Gold says the start of a new school year can be a time of anxiety even in the best of years, and such feelings are completely normal for both parents and children. She recommends practicing coping techniques that can be used during especially stressful moments.

“It’s important to have some coping skills prepared ahead of time to help in the moment of any stress,” she says. “These coping skills can include mindfulness, focusing on the present moment, going for a walk, deep breathing or hanging out with your dog or pet.”

Most of all, Dr. Gold recommends that you pick out skills that you and your child like, not just what other people say to do. “Do what is best and most helpful for you and your child.”

She also recommends adding some special activities into the daily routine.

“In this time of uncertainty because things are always changing, it’s important to plan some activities with your children so that they have something to look forward to and can be excited about. You could plan an outdoor activity, game night or a special meal, so that they have hope at the end of the day,” she says.

“Also, make sure you and your children have someone to talk to about your emotions, someone to be open and honest with during this pandemic. This is nothing to be ashamed of and is a strength.”

If worries and stress are affecting your or your child’s sleep, eating or interactions with others, Dr. Gold says it’s important to seek help from a mental health professional.

See Dr. Gold discuss the pandemic and mental health issues with KSDK-NBC and KMOV-CBS and read an article she wrote for SELF magazine.

Learn more about how to tell when a loved one needs help from a mental health professional.

For Missouri residents negatively impacted by the pandemic, BJC Behavioral Health provides free crisis counseling through the Missouri Department of Mental Health's "Show-Me Hope" program. Learn more or call 314.747.7492.

Overall tips for a healthy and successful school year

As schools adapt to changing conditions, the CDC says it is critically important to consider the health and well-being of students and address issues with COVID-19, mental and physical health, and managing other chronic health conditions.

The CDC offers these tips for a successful school year for students, teachers, school staff and their families.

• Take COVID-19 seriously. Students benefit from in-person learning and safely returning to in-person instruction is a priority.
• Mental health is important to the learning process. CDC data shows that the pandemic has created significant stress and trauma for children, adolescents and families. Schools can help promote student well-being with evidence-based strategies like establishing safe and supportive school environments and referring students to appropriate mental and physical health services.
• Routine vaccinations save lives. Getting required vaccines can help protect children and teens as they grow into adulthood. Making sure children get vaccinated is one of the most important things parents can do.
• Washing hands stops germs. Handwashing with soap and water is one of the best ways to remove germs, avoid getting sick, and prevent the spread of colds, flu and other diseases to others. If soap and water is not available, substitute hand-sanitizer.
• Eat well, be active and get enough sleep. Make sure children drink plenty of water, limit sugary drinks, and practice healthy eating at home and school to help achieve and maintain a healthy weight and to support brain development and healthy growth. It’s also important to help kids get the recommended 60 minutes or more of daily physical activity, as well as the right amount of sleep every night. Teens need at least eight hours of sleep per night, while younger students need at least nine hours.
• Be tobacco free. Youth use of any tobacco product is unsafe. E-cigarettes are the most commonly used tobacco product among U.S. middle and high school students. Tobacco products contain nicotine, which is highly addictive and can harm the developing adolescent brain — specifically the areas of the brain that are responsible for learning, memory and attention.
• Wear helmets and protect your head. Children and adolescents can get a concussion in any number of school settings, ranging from school sports activities to the hallway, the playground and even the cafeteria.

Healthy students are better learners. Following these health tips can lead students to a successful and healthy school year.

If you need to get vaccinated, visit bjc.org/coronavirus for information. If you need testing to see if you have COVID-19, visit bjc.org/coronavirus/testing for information.