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As we approach the grim milestone of one year since the COVID-19 pandemic first hit the U.S., academic research and news reporting have documented the many troubling adverse effects of school closures and lockdowns for children, from malnutrition, to severe learning loss, and mental health difficulties.

But with vaccines rolling out and the pandemic鈥檚 end seemingly in sight, albeit with continued worries for new variants, some immunologists are voicing concern for another unforeseen side effect: that all that time spent in quarantine, indoor isolation and sanitized surroundings may inadvertently be .

鈥淣ormally, children are exposed to lots of viruses, particularly respiratory viruses,鈥� explained Dr. Donna Farber, an immunology professor at Columbia University. 鈥淎nd that’s important for establishing protective immunity for pathogens.鈥�

Since the pandemic hit, however, non-COVID respiratory infections have plummeted, likely due to masking and social distancing measures. Cases of respiratory syncytial virus (RSV), for example, which normally causes for children under 5 each year, have become almost non-existent, said Farber. One Texas hospital saw 600 instances of RSV in November 2019, but reported in November 2020.

While reduced illness may sound like good news, the numbers have Farber worried, especially for young kids.

Getting sick, she said, is actually an important step toward children growing up into healthy teenagers and adults. Immune development depends on the body turning cells called 鈥渘aive t-cells鈥� into 鈥渕emory t-cells鈥� that can respond quickly to known pathogens. After the body鈥檚 first exposure, 鈥渆verything鈥檚 revved up鈥� to stave off illness in the future, said the Columbia immunologist.

Children in lockdown, especially those whose schools have remained remote, may be largely sheltered from new microbes, which leaves Farber concerned for their immune development.

鈥淐hildhood is a time when you want to build 鈥� an immunity to particular pathogens that are everywhere,鈥� she said. 鈥淚f you don’t have that exposure, what’s going to happen to your immunity? Are you going to have built it up?鈥�

She bases her fears on a concept known as the 鈥渉ygiene hypothesis.鈥� If young children avoid early exposure to everyday microbes, the theory holds, their immune systems may not mature properly and can overreact to certain germs or environmental triggers. Children who are kept in very clean environments, research indicates, have . This phenomenon, many experts believe, explains the to items such as eggs, peanuts, and soy in the developed world.

As hand sanitizer and disinfectant wipes in grocery stores, Dr. Eline Luning Prak, professor of pathology at the University of Pennsylvania, echoes Farber鈥檚 concern for kids鈥� health in sterile, isolated COVID-19 environments.

鈥淸Q]uarantine could have adverse effects on the development of the immune system in children who are not exposed to the usual viruses,鈥� she told The 74 over email.

The fear is not unanimous, however. Dr. Nilu Goonetilleke, an associate professor of immunology at the University of North Carolina and a mother herself, thinks it鈥檚 unrealistic to imagine that most children have been kept in a completely sterile lockdown world.

鈥淚f the kids are going into the park, especially when they鈥檙e young and they’re still putting all their toys in their mouth 鈥� they’re still getting exposed to a lot of things,鈥� she said.

鈥淔rankly, I am enjoying a year without snot-covered children,鈥� she added. 鈥淚 assure you, the snot will be back.鈥�

The gradual return to post-pandemic normalcy may cause kids to pick up common colds, says Goonetilleke, and after lockdown, those colds may be a little more severe than usual. But children will recover and be fine in the long-term.

鈥淥ur immune system is always developing. It鈥檚 built to deal with this,鈥� she said. 鈥淚 think [kids] will be okay.鈥�

But Luning Prak is not as confident that they will bounce back so easily.

鈥淭he longer children remain in 鈥榟yper-hygienic鈥� conditions associated with quarantine,鈥� she said, 鈥渢he more chance there is for the effects to be long-lasting.鈥�

Even amid fears of weakened immune development, however, parents shouldn鈥檛 tear off their kids鈥� masks and let them lick handrails, Farber says. Without vaccines for children, the risk of infection remains potent. Youth under 15 have been shown to catch and transmit COVID-19 at about half the rate of adults, possibly thanks to nimble immune systems that respond more quickly to the virus and quell infection. But some young people with no underlying conditions have experienced after getting infected, and a concerning new variant emerging in and has spread much more quickly through children than other versions.

In the meantime, if parents do want to adjust their routines to encourage healthier immune development for their kids, they can take their children for walks outdoors and arrange playdates with friends, says Farber. In addition, some health experts say that Americans are 鈥� a primarily airborne virus 鈥� and the Columbia professor agrees that most parents can also probably cut back on disinfecting surfaces.

鈥淵ou don’t need to sanitize everything for the children,鈥� she said.

But amid all the 鈥渄o鈥檚鈥� and 鈥渄on’ts,鈥� the best way to ensure kids stay healthy will be to take every measure possible to reduce COVID-19 spread and help life return to normal.

鈥淚t鈥檚 really we just need to get rid of the pandemic,鈥� said Farber.

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