As the number of vaccinated adults increase—and Covid-19 restrictions start to ease—parents of children too young to be vaccinated are caught in a dilemma: What can their children do and not do amid this changing pandemic landscape?

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Covid-19 cases among children rise in some parts of the U.S.

Several states—including Colorado, Michigan, and Vermont—have reported notable spikes in Covid-19 case rates among children. For instance, according to the Michigan Health & Hospital Association, the state saw the number of children hospitalized with severe Covid-19 hit 70 during the week of April 19, twice as many as the worst days of November.

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On a national level, too, Covid-19 cases among children have recently started to account for larger proportions of the country's overall Covid-19 case rate, Medscape reports. For example, a report from the American Academy of Pediatrics (AAP) and the Children's Hospital Association (CHA) said that children accounted for one in five Covid-19 cases nationwide during the second week of April. And a separate report from AAP and CHA found that children accounted for more than 20% of weekly Covid-19 cases in the United States for the first time in the third week of April.

In addition, doctors have recently reported that more parents are refusing to have their sick children tested for Covid-19, meaning Covid-19 cases among children could be undercounted.

"We've had parents tell us, for instance, 'No we have a big tournament this weekend, I don't want to have to deal with Covid,'" Kristen Stuppy, a pediatrician, said. "And they're forgetting the fact that it's still going to be Covid even if you don't know that it's Covid. So from a public health perspective it scares me."

What activities are safe for unvaccinated children?

Even as children comprise a greater share of Covid-19 cases, their parents and other adults are increasingly likely to have been vaccinated, with more than 152 million Americans as of Monday having received at least one dose. And although FDA on Monday expanded its emergency use authorization for Pfizer's Covid-19 vaccine to include children ages 12 to 15, there is still no vaccine currently authorized for use among children younger than 12.

Amid this mix of eligibility, many vaccinated parents of children who either are not yet vaccinated or who are not yet eligible for vaccination are trying to determine what they can and cannot do safely with their children.

Many experts have recommended caution. For instance, Jose Romero, Arkansas secretary of health and a pediatrician, said taking unvaccinated children out in public "is certainly a risk." However, he said if parents wish to take their children out in public, they should try to limit their interactions to vaccinated individuals and wear masks when around people who aren't.

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For her part, Nia Heard-Garris, a pediatrician with Northwestern University, said parents who wished to take their children out to play with other children should focus on outdoor activities. "[O]utdoor play dates are probably the safest right now, especially for unvaccinated children," she said, adding that—in her opinion—unvaccinated children should wear a mask to play with other children.

Experts gave similar recommendations to The Atlantic's Sarah Zhang when she asked about a hypothetical birthday party for unvaccinated preschoolers in the fall. According to Zhang, experts recommended thinking about ways to reduce the risk of spreading coronavirus, such as keeping the party small and outdoors.

Experts also told Zhang the biggest thing to consider for unvaccinated children is how quickly the virus is spreading in the surrounding community. "If there's very little virus circulating, that's a pretty low-risk situation," Sean O'Leary, a pediatrician at Children's Hospital Colorado, said.

On the other side of the debate, however, some experts said parents can likely take certain measured risks without being unreasonable.

For instance, David Leonhardt, an editor for the New York Times, wrote in an op-ed that while much is unknown about Covid-19, parents of otherwise healthy children should balance the comparatively low risks posed by the disease for young children against the risks of continued isolation. To put those risks in perspective, Leonhardt worked with health experts to look at CDC data comparing Covid-19 with influenza in recent years. They found the flu is often deadlier for children than Covid-19 has been, despite the fact that most children receive flu vaccines.

"For people under the age of 18, Covid is really not that big of a risk," Stephen Kissler, a researcher at the T.H. Chan School of Public Health at Harvard University, said. "I do think of it as on par with the risk from the flu."

Meanwhile, citing research demonstrating the harms associated with "[k]eeping children at home—away from their friends, activities, schools, and extended family," Leonhardt also spoke with Jennifer Nuzzo, an epidemiologist at Johns Hopkins, who said she's worried more about how a year of life amid Covid-19 has affected her children socially.

"I can accept the risks of my kids getting Covid, in part because I compare it to the risk of them getting other infectious diseases and the risk seems very, very small," Nuzzo said. "I feel that if my kids were to get Covid, they would be OK. I also see the direct harms of their not having a normal life" (Cornish, NPR, 4/29; Leonhardt, New York Times, 4/22; Associated Press, 4/28; Zhang, The Atlantic, 4/21; Wingerter, Denver Post, 4/22; Einhorn, NBC News, 4/22; Franki, Medscape, 4/21).