Health Department Director Dr. David Damsker says new information from area hospitals forced the updated guidance for its 13 school districts.
"While our COVID-19 cases among school-aged children remain very low, hospitals are growing concerned that any pediatric COVID-19 cases could stress the system. Because of this, hospitals in Bucks County have recommended that schools begin the fall semester with a mask requirement," Damsker said in a statement.
SEE ALSO: Pennsylvania to offer COVID-19 testing, vaccines for schools
All other school guidance issued Sunday by the county remains in effect.
There are mixed reactions over the county's decision.
"Some people think it makes you feel better but I think in the long run it's going to do some damage because you're not seeing visual cues," said Erin Gardner of Warrington.
Larissa Hopwood's son is immunocompromised.
"It's definitely a bit of relief that they are recommending this. This is one piece in a bigger picture we really need to look at," she said.
With about two weeks until the first day of school for many districts, there are still debates raging about COVID testing, contact tracing and requiring masks. Some schools are on board with all three.
The Hatboro-Horsham School District in Montgomery County is requiring masks.
"I want a choice. I don't want a mandate. I don't want to tell anybody what they can and can't do. I want choice," said one parent who was against mandatory masking.
"I don't know about you, I want my kids in school and if that includes masks, I hate it, but we have to do it," said another parent.
In Pennsylvania, 58 children under 18-years-old are hospitalized with confirmed or suspected COVID-19. In New Jersey, 88 children are hospitalized with COVID and 11 children are hospitalized in Delaware.
Dr. Sage Myers, an attending physician in the Emergency Department at Children's Hospital of Philadelphia, says hospitalizations are increasing.
"I know there are definitely more in the community as we've seen across the country in places as it spikes. I think it's difficult to tell, with us so early in the curve, where we are going to go," said Myers during an event to vaccinate Philadelphia school kids at the Philadelphia Zoo on Tuesday.
Myers added the best way to get kids' lives back to normal is vaccination.
Districts throughout Pennsylvania, excluding Philadelphia County, which receives its own federal funding, must decide to opt-in or opt-out of free group testing of students with parent consent.
"The program alerts schools quickly if COVID is detected in a classroom or school," said Acting Pennsylvania Secretary of Health Alison Beam.
Weekly student and staff testing works for Mastery Charter Schools with 14,000 students in Pennsylvania and New Jersey.
"So far 94% of our parents who have responded have consented to testing," said Laura Clancy, Health and Safety Lead for Mastery Charter Schools.
Along with the free federal program called, "Operation Expanded Testing," Mastery Charter Schools is enacting a multi-level mitigation approach.
"Universal masks, enhanced ventilation, weekly testing, appropriate distancing, all of those elements really prevented in-school transmission and we want to continue that safety record," said Clancy.
As for the Philadelphia School District, masking is required for all, testing is required for staff, and available for students in-school who may exhibit symptoms.