Pediatricians south of the border are recommending that kids go back to school in September, wearing cloth masks, staying in small groups, maintaining distance from each other, and riding buses in assigned seats.

The Canadian Paediatric Society is also urging a return to classrooms in the fall, but stops short of giving specific recommendations for how schools should look.

The American Academy of Pediatrics says children should be outside whenever possible, desks should be 1 metre to 2 metres apart and students should be guided to wash their hands regularly and to spread out during singing and exercising.

Children should be allowed to use the playground in small groups, but should wear cloth face masks and maintain a 1-metre distance from others (that’s half the widely recommended 2 metres), the AAP said in a series of recommendations issued June 26.

The CPS says long-term school closures due to COVID-19 have had negative consequences on all children and teens and that those with special needs or from low-income or unsafe homes who rely on the physical and mental health services, food programs, safety, and supports offered by schools are “disproportionately impacted.”

“The immediate and short-term effects of isolation on children and youth are surfacing while the potential for long-term physical, emotional, development and academic effects grows,” the CPS wrote in a June 25 letter to provincial and territorial education ministries.

“Schools are more than places of learning,” said Dr. Karen Leis, a Saskatchewan pediatrician and chair of the CPS’s Action Committee for Children and Teens in a press release. “They provide important mental health supports, nutritious food and – for some children – a refuge.”

Pediatric organizations on both sides of the border say the risk of COVID-19 among children is low and that safety measures can further minimize the risk of transmission.

According to the CPS, evidence about the effects of COVID-19 on children justifies a return to school in September. In Canada, just 1 per cent of total hospitalizations from the virus were among those 19 and under, and there were no associated deaths in that age group as of June 21, says the CPS.

The CPS offered no specific recommendations, but said back-to-school planning should include consultation with experts in child and adolescent development, along with infectious disease and public health specialists.

Among its long list of recommendations, the APA advised that teachers move between classrooms to keep students from coming into contact in the halls, and that students eat lunch with their same class group, instead of in a crowded lunchroom or cafeteria.

Those who must take a bus to school should be given an assigned seat and required to wear a face covering and schools should mark hallways and stairs with one-way arrows.

The American pediatrics group says temperature-checking “is not possible for most schools,” but anyone with a fever should be instructed to stay home. Students with high-risk medical conditions should continue distance learning and that schools should be prepared to shift to online instruction should new waves of COVID-19 hit.

Health care leaders at Canada’s top children’s hospitals sounded the alarm Monday, saying COVID-19 is creating a “crisis” in children’s health and even violating children’s human rights, including their rights to a quality education, highest standards of health, protection from violence and access to recreation.

Lack of access to childcare, recreational activities and uncertainty around the coming school year are keeping children isolated, cut off from essential supports and facing a backlog for assessments, therapies and surgeries, said a group of CEOs from three children’s hospitals in Halifax, Ottawa and Toronto, and Children First Canada.

“In areas like mental health care, we are already seeing a surge in demand for crucial services that were stretched to begin with,” said Alex Munter, president and CEO of CHEO in Ottawa in a group press release.

“Everyday matters in the life of a child and these kinds of delays for specialist care, developmental therapies or needed surgery will have huge impacts on kids’ well-being and development. This issue needs to be an important priority for all levels of government.”

The latest calls for a return to school join those of an advisory group from the Hospital for Sick Children (SickKids) in Toronto last month, which strongly urged schools to reopen. The expert panel said there is mounting evidence that children are less susceptible to COVID-19 and less likely to transmit it to others, and that the negative impacts of keeping kids out of school are much more dire.

Its recommendations included: screening students for symptoms, teaching proper hand hygiene, implementing some physical distancing but allowing children to play together, and smaller class sizes with spaced out furniture and cohorted groups.

That expert panel recommended against requiring students to wear masks.

On Monday, a group of education workers in Ontario issued its call for the province to create an independent advisory panel of public and workplace health experts, parents, students, and educators to guide school reopening.

A letter by Ontario Education Workers United has been signed by close to 1,000 teachers and support staff from 36 school boards.