September 15, 2021

Ohio AAP Masking Guidance for In-Person Schooling and Approved Exemptions

The Ohio Chapter, American Academy of Pediatrics recommends universal masking for student’s two years and older and school staff attending in-person, regardless of vaccination status. Face masks are proven to be effective at reducing the transmission of COVID-19 by about 85%. With many children still ineligible to receive the COVID vaccine, face masks are the best way to prevent spread and protect students, staff, families, and the larger community. In-person schooling provides the best environment for children to learn, access to needed social resources like free breakfast and lunch programs, and social interactions important for a child and teens mental and physical health. Keeping students in school, uninterrupted will be best achieved through universal mask wearing. 

Wearing face masks is crucial to prevent further spread of COVID-19. Pediatricians may be receiving requests from parents or caregivers for mask exemption letters for their child. It is important pediatricians explain that face masks can be worn safely by nearly all children two years and older, including many with underlying health conditions. Exemption requests should only be granted for students who meet one of the listed criteria below.

The Ohio AAP’s list of masking exemption conditions includes the following:

    • If the child is under 2 years of age
    • Anyone who is unable to remove the face covering without assistance.
    • Significant psychological issues under the treatment of a physician such as severe anxiety
    • Severely autistic and those children with developmental delay who may become agitated or anxious because of a mask.
    • True facial deformity that causes airway obstruction

Physicians writing exemption requests may wish to use the following template:

This letter serves to document the medical condition of my patient ________________________ DOB ________.  This patient has the following diagnosis and ICD-10 code: __________.  Due to sensory/cognitive issues, this patient is struggling with wearing a mask consistently. Since mask wearing is an essential component of protection against COVID-19 transmission, I would prefer that the patient keep the mask on for as much of the day as possible. However, as it is important for the patient to remain in educational programming, I respectfully ask you to allow the patient to remain if masking cannot be tolerated.  Thank you in advance for your attention to this matter.

COVID-19 Resources for Families and Providers: Visit http://oldsite.ohioaap.org/covid19resources for additional information, resources, and the latest news on COVID-19.

Additional Face Mask Resources:


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This page is for practice managers and office employees to discuss issues they’re experiencing in their practices. Many problems that we hear about can help other practices, so we invite you to share best practices by posting issues and by responding to issues other practices are experiencing. This page is monitored by the Ohio AAP. Advice and opinions expressed on these discussion boards are the views of the poster and do not necessarily reflect the views of Ohio AAP. If you have any issues, questions, or feedback, please contact Melanie Farkas.