Rebecca Kendall has gotten used to asking everyone who interacts with her 6-year-old son, Asher, whether they’ve been vaccinated. While the 42-year-old mother is fully inoculated, her son is too young to get a shot, so the pair have remained cautious.

But as summer approached, Kendall decided to enroll Asher in Camp Anglewood, a day camp near her Elkins Park home that will continue taking coronavirus precautions.

“The pandemic has been hard on him,” she said of her son, who is on the autism spectrum. “This kid needs to have a real summer.”

As Pennsylvania and New Jersey see their vaccination rates among residents 12 and older rise, and case rates fall, adults and teens are wading back into the world. Restaurants, bars, and shops are bustling again, and masks are optional in many businesses. On Friday, Philadelphia lifted its indoor mask mandate. But uncertainty and anxiety remain for many, including children under the age of 12 and their parents.

Children’s risk of contracting a severe case of the coronavirus remains low, experts say. In Pennsylvania, cases in children aged 5 to 18 have represented 13% of all reported infections since the pandemic started, according to state data, and they made up 13% of all cases reported the week of May 28 to June 3, the most recent period for which those data were publicly released. In New Jersey, cases among those under 18 represent about 12% of all documented infections.

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Coronavirus vaccines could be approved for children under 12 as early as the fall, according to reports last week from Pfizer and Moderna. But until then, pediatricians and public health experts said a small risk remains for unvaccinated kids, especially if they interact with other unvaccinated people without taking precautions.

“As more people get vaccinated, we have seen there has been much less spread of the virus,” said Denise Johnson, Pennsylvania’s acting physician general. “But we know that the cases we are seeing now are primarily in people who are unvaccinated.”

That reality can leave parents, many of whom are themselves fully vaccinated, with difficult decisions about how much to immerse their family in the reopened region after 16 months of restrictions. As public health guidance moves from mandates to recommendations, experts say adults must balance their little ones’ physical safety and mental health, acknowledging that keeping children isolated for months more is not only unrealistic but potentially detrimental.

From parents, “I’m hearing a little bit of anxiety and more just people trying to work through how to handle this,” said Cheryl Bettigole, Philadelphia’s acting health commissioner.

In North Philadelphia, Natalie Mathurin, the lead pediatrician and associate medical director for Greater Philadelphia Health Action Inc., reminds patients at her Hunting Park health center that children under 12 should continue following measures that many adults have stopped taking.

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“We don’t want to be so restrictive to children that they aren’t able to enjoy themselves and have fun,” she said. “But I want parents to do this within a lens of realism. What’s real is [children] aren’t protected, so you have to do everything besides the vaccine to protect.”

Experts recommend children between the ages of 2 and 12 continue to wear masks in public, at gatherings, and in indoor spaces outside the home, especially when others in the room may be unvaccinated, and to opt for outdoor activities when possible. Inside, unvaccinated kids should continue to keep a six-foot distance from others, experts say, and if children are younger than 2 or otherwise unable to wear a mask, lower-risk activities, such as small outdoor gatherings with vaccinated people, are recommended.

“The other thing to keep in mind in all of this is that it’s more than just mask or no mask. We’re looking at: What is the case rate right now? What is the positivity [rate]?” Bettigole said. “As those numbers fall [as they have recently], it gets safer. Your risk goes down.”

» READ MORE: Children may be afraid to remove their masks. These steps can help reassure them.

Masking up

Even though she is fully vaccinated, Alexis Buckley, 41, said she continues to wear her mask “to set a good example” for her daughters, Lauren, 10, and Kaitlyn, 7. The girls are used to wearing their masks at school, Buckley said, so it’s become instinctive to put them on whenever they walk out of their East Norriton home.

Meg Snead, the acting secretary of the Pennsylvania Department of Human Services, said she, too, advises her 3- and 7-year-old daughters to keep their masks on in public.

“Err on the side of caution in terms of mask-wearing, particularly if you’re unsure if you’re going to be around vaccinated or unvaccinated people and you’re not necessarily comfortable having that conversation,” she said.

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Bettigole recommends this strategy.

“As a parent we typically say, ‘Kids do what we do, not what we say,’ ” the health commissioner said. “So for a lot of parents, even though they don’t need a mask because they’re vaccinated, it’s better to just keep the mask on because they want their kids to.”

Ideally, Pennsylvania and Philadelphia officials said, children should also wear their masks if they’re outdoors and playing within six feet of other unvaccinated children. However, with the risk of outdoor transmission much lower than indoors, they said there can be exceptions to the recommendation.

“As parents, we pick our battles all the time,” Bettigole said. “So if your child is happy to wear their mask, great. If you’re constantly fighting with that child and you make that parental decision that they’re going to take their mask off outside but you’re going to make them wear it inside, this is not the worst decision you’ve ever made.”

Waiting for their shots

Buckley lets out a sigh of relief when she thinks about the day her girls can get their shots just as she, her husband, and the rest of their extended family has.

“I guess the risk to them is so small, but you just don’t want to have the one kid who has the complication,” Buckley said. “I’ll feel a lot better when they’re vaccinated.”

So will Kendall, who was isolated for nearly a year with her son. She admits she has reservations about giving him a relatively new vaccine, she said, “but I’m going to put my faith in science, and want some normalcy back in his life.”

After the reports last week about the shots being OK’d for children as soon as the fall, Susan Ramirez-Chung, a pediatrician at Advocare Fairmount Pediatrics, said parents were asking for clarity on the timetable and if they can sign up their children in advance.

“The reason they ask,” she said, “is they want to go back to a pre-COVID life, whatever that may look like.”

Parents at her practice — which draws from affluent areas of the city and the suburbs — are “a little bit of a mixed bag,” she said, when it comes to how they’re handling reopening with children under 12. Some have kept all family members, vaccinated and unvaccinated, masked everywhere they go, she said, and couples have shifted their work schedules to care for their children at home. Others have returned to pre-pandemic activities and are taking a less stringent approach, especially if they have multiple children, some of whom are older and vaccinated. But across the board, she said, many of these parents say they plan to vaccinate their kids.

In North Philadelphia, Mathurin said she already has a handful of patients younger than 12 on a list that the health center will call when that age group becomes eligible. Many have older siblings who have already been vaccinated, she said, and parents want to see all their children get back to normal soon.

» READ MORE: Pa. and N.J. kids are lining up for COVID-19 shots as parents experience both relief and hesitancy

As young children wait for their shots and continue with restrictions, physicians and public health experts said the mental health impacts of the pandemic are at the front of their minds.

“I think as a parent it’s important to just talk to your kids,” Snead, the state DHS secretary, said. “I think having an open dialogue about your experience as we’ve gone through the pandemic and as we transition out of it will be important to ensuring we know exactly what types of trauma they have faced and can address it.”

During office visits, Mathurin educates families not only about vaccines and the need for continued precautions but also about the importance of keeping children mentally healthy during this time.

“It’s important to think about it: How has COVID affected your child?” she said. “I think that question is going to need to be asked for a long time.”