Fall may not yet be in the air, but school definitely is. Camps and family vacations are ending, and children are queuing up in pediatric waiting rooms, coming in for school and sports physicals, as well as for the inevitable minor injuries and illnesses of the summer.

As children excitedly recount their summer activities and anticipate the upcoming school year with a mixture of hope and dread, another emotion permeates the pediatrician’s office: courage.

Aristotle called courage the first of human qualities because it is “the quality which guarantees the others.” Being a kid requires a modicum of courage every fall, for he or she is beginning something new. Some transitions are small — a new teacher — while others are dramatic — starting preschool, high school or a new job. From the child’s view, the comforts of summer are past and every new beginning is fraught with at least some trepidation. Parents may treasure the first day of school with commemorative photos, but those photos often capture the uncertainty of young children or the annoyance of older ones.

As school begins, parents should summon courage as well. They place trust in teachers, classmates and fellow parents who will gradually become the child’s community as the child becomes more independent. Uncertainties about whether the educational or social environment will be a good fit are accompanied by natural concerns about physical safety. Families do their best to optimize the situation for their children before sending them out like Alfred Tennyson’s Light Brigade.

In the face of a new season of COVID-19, what can pediatricians, with their knowledge and experience with viral illnesses, vaccination, child development and mental health, do to support parents and children in helping them develop the requisite courage?

This fall, the stakes for children are high, especially because we have shortchanged their educational and social development in the last two years. School is important. Learning loss during the pandemic is well documented and is worse for many children in economically vulnerable circumstances and for those children with special needs. Social interactions are essential: Children have to see the faces of their friends and teachers, and they must be able to communicate easily and participate in extracurricular activities. Positive, age-appropriate social interactions help protect children from depression, anxiety and mental health disorders, which increased significantly during the previous two years.


Thankfully, COVID-19 remains a mild illness for most children. More than 75% have recovered from an infection one or more times. Although COVID-19 infections have become more frequent with the newer variants, multisystem inflammatory syndrome, a serious condition seen in a small number of children early in the pandemic, has become much less common. This may be due to a combination of the variants being less severe and the childhood immunity wall developed through vaccination and natural infection.

As is true every year, children will get sick with colds this winter, and this will include COVID-19. With the knowledge that serious COVID-19 is becoming less widespread, especially in children, there are several actions that parents, teachers and administrators can take to optimize this school year for children by employing “the four As”:

∙ Accept the reality that viral illnesses are not only inevitable but necessary for building healthy immune systems in children.

∙ Avoid, as much as possible, disruptions to children’s schedules as we live through viral outbreaks this year. The immunity wall to COVID-19 is stronger now than at any time in the past, and we are better prepared for the virus than we were in 2020 or 2021. Barring any new developments, this should obviate the need for contact tracing, quarantines and lockdowns.

∙ Allow children to experience the full range of social interactions, especially smiles, hugs, group activities, sports and field trips.

∙ Assure children that the pandemic situation is improving and that optimism is warranted about the upcoming school year.


Children naturally spread germs when they are sick, but the adults around them are generally well protected through their own immune activation from frequent viral exposure. Recent literature suggests that adults who spend more time with young children tend to experience less severe COVID-19 illness compared with those who are not regularly exposed to children. When competing needs or risks exist, we should prioritize the needs of children if possible.

Nelson Mandela once said, “Courage is not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.” The next several months will be our crucible. COVID-19 outbreaks may occur even as we reconsider our responses to the improving circumstances.

As adults who love children, let’s commit to grasping the nettle. We must screw up our courage so they can flourish in the ways they deserve.