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Face masks and children. Are masks safe for kids?

A father with mask on adjusting his child's mask

With mandates requiring kids to wear masks indoors during school, many parents have raised concerns about the safety of their children while wearing a mask. 

The goal of this article is to provide a reference of all existing research to date and help inform parents if masks are safe to wear for children.

TLDR; According to the latest research masks are safe and recommended for children above 2 years of age providing there are no health issues which compromise breathing or ability to remove the mask. 

The key to effective mask protection in children is a good fitting and high-filtering mask.

Research studies examining the safety of masks for children.

We’ve compiled all known and published research regarding kids masks and provided the link to each study along with the general outcome in the sections below. 

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Mask Study Title & Link

Mask Study Summary

Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic

Italian study which involved 47 children ages 2 to 12 measured respiratory performance after 30 minutes of wear, and during 12 minutes of walking.

Research Link

No changes in respiratory performance were found among all age groups.

Assessment of the Wearability of Facemasks against Air Pollution in Primary School-Aged Children in London

24 children ages 8-11 used N95 respirators and surgical masks testing a variety of social factors and mask acceptance. 

Research Link

Respiratory performance was not measured however the study concluded that perception among children was a key factor in increasing mask wearability and efficacy. This study ultimately suggested further research be performed (although it implies not because of an alarm for respiratory issues).

A randomised clinical trial to evaluate the safety, fit, comfort of a novel N95 mask in children

106 children ages 7-14 used N95 respirators testing CO2 levels, fit, and comfort.

Research Link

Study concluded no dangerous levels of CO2 recorded and the use of N95 masks. “In conclusion, the mask evaluated in this study is safe for use in children 7 to 14 years old with no underlying medical conditions and in the setting of routine daily activities including brisk walking.”

*The controversial jama research letter which caused many to believe masks were unsafe for children

A research letter, published in JAMA, on June 30th 2021 suggested that mask wearing caused increased levels of CO2 inhalation in children. 

The study titled, “Experimental Assessment of Carbon Dioxide Content in Inhaled Air With or Without Face Masks in Healthy Children“, can be found here

The research and methodologies used were peer-reviewed soon after it was published with multiple faults and discrepancies found in how the research was conducted. 

Ultimately, the letter was retracted from JAMA on July 16th 2021 however many popular news and media sources referenced this research upon it’s released to suggest against mask usage for children. 

While there is an admittedly low number of research studies on the effects of mask wearing on children, all research performed to date show no danger to children. 

Additionally, assumptions can be made based on previous research performed over the years in other medical research areas, such as children with asthma which provide relevant data and a baseline understanding for doctors and pediatricians regarding potential breathing issues.

*As with any medical related issue, please consult with a medical professional for official guidance. 

official statements from health organizations about the safety of kids face masks

Here is a list of mask guidance for children from top medical organizations and the link to each guidance page. 

Use the dropdown Q&A sections below for direct guidance and comments from each organization.

cdc mask guidance for kids

Guidance, recommendations, & Statements

health organization

CDC Graphic Kids masks guidance
The CDC has provided the following relevant guidance regarding mask wearing and children.
 

Cloth masks and surgical masks do not provide an airtight fit across the face. The CO2 escapes into the air through the mask when you breathe out or talk. CO2 molecules are small enough to easily pass through mask material. In contrast, the respiratory droplets that carry the virus that causes COVID-19 are much larger than CO2, so they cannot pass as easily through a properly designed and properly worn mask.

Masks should not be worn by child under 2 years of age.
 

A person with a disability who cannot wear a mask, or cannot safely wear a mask, for reasons related to the disability.

CDc - centers for disease control

Face masks can be safely worn by all children 2 years of age and older, including most children with special health conditions, with rare exception.
 

Children with weakened immune systems or who have health conditions that put that at high risk for infections are encouraged to wear an N95 mask for protection.

 The APA also answers the following questions regarding masks for children (toggle each section for the answer):

There have been concerns that face masks can reduce oxygen intake, and can lead to low blood oxygen levels, known as hypoxemia. However, masks are made from breathable materials that will not block the oxygen your child needs.

Masks will not affect your child’s ability to focus or learn in school. The vast majority of children age 2 or older can safely wear face masks for extended periods of time, such as the school day or at child care. This includes children with many medical conditions.

No, wearing a face mask will not affect your child’s lungs from developing normally. This is because oxygen flows through and around the mask, while blocking the spray of spit and respiratory droplets that may contain the virus. Keeping your child’s lungs healthy is important, which includes preventing infections like COVID-19.

No. There have been false reports that face masks can lead to carbon dioxide poisoning (known as hypercapnia) from re-breathing the air we normally breathe out. But this is not true. Carbon dioxide molecules are very tiny, even smaller than respiratory droplets. They cannot be trapped by breathable materials like cloth or disposable masks. In fact, surgeons wear tight fitting masks all day as part of their jobs, without any harm.

However, children under 2 years of age should not wear masks since they may not be able to remove them without help. Children with severe breathing problems or cognitive impairments may also have a hard time tolerating a face mask and extra precautions may be needed.

No. Wearing a face mask does not weaken your immune system or increase your chances of getting sick if exposed to the COVID-19 virus. Wearing a mask, even if you do not have symptoms of COVID-19, helps prevent the virus from spreading.

AAP - AMERICAN ACADEMY OF PEDIATRICS

World Health Organization

Children aged 5 years and under should not be required to wear masks. This is based on the safety and overall interest of the child and the capacity to appropriately use a mask with minimal assistance.

There may be local requirements for children aged 5 years and under to wear masks, or specific needs in some settings, such as being physically close to someone who is ill. In these circumstances, if the child wears a mask, a parent or other guardian should be within direct line of sight to supervise the safe use of the mask.

WHO and UNICEF advise that the decision to use masks for children aged 6-11 should be based on the following factors:

  • Whether there is widespread transmission in the area where the child resides
  • The ability of the child to safely and appropriately use a mask
  • Access to masks, as well as laundering and replacement of masks in certain settings (such as schools and childcare services)
  • Adequate adult supervision and instructions to the child on how to put on, take off and safely wear masks
  • Potential impact of wearing a mask on learning and psychosocial development, in consultation with teachers, parents/caregivers and/or medical providers
  • Specific settings and interactions the child has with other people who are at high risk of developing serious illness, such as the elderly and those with other underlying health conditions

WHO and UNICEF advise that children aged 12 and over should wear a mask under the same conditions as adults, in particular when they cannot guarantee at least a 1-metre distance from others and there is widespread transmission in the area.

WHO - WORLD HEALTH ORGANIZATION

age clarification

After reading this article, you may find a discrepancy between the WHO, CDC, and APA regarding acceptable age ranges for mask wearing.

CDC: Recommends ages 5+

APA: Recommends 2+

WHO: Recommends 5 and under with adult supervision

This can be confusing but there’s really no conflicting information.

It’s simply a different way of saying the same thing but we’ve created a graphic to help illustrate and summarize the do’s and don’ts of mask wearing for children.

Which masks are "best" for kids to wear?

The most common concern from parents who are worried about their child wearing a mask is a potential lack of breathing. 

While limited, studies do show that wearing a mask does not increase CO2 or limit oxygen for children.  

The exception to this is during periods of exercise or for any child with existing breathing issues.

Upon the writing of this article, 4C Air editors verified with several school districts in California that masks will not be worn during periods of increased physical exertion such as recess or gym. 

There is however, one large misconception about the actual efficacy of masks. 

The entire point of wearing a mask is to prevent the inhalation of potential airborne pathogens or dangerous particles. 

In reality, cloth and surgical style masks offer minimal protection from these types of contaminants yet these types of masks are still heavily used for children. 

The most likely reason for this is a lack of better alternatives. 

While “a” mask offers better protection than no mask, the fit and filtration performance are what really provide the needed protection behind wearing a mask.

Thankfully, there are alternatives available for parents looking to provide their child with the best protection. 

4c air bresafe patented nanomaterial developed at stanford university

A list of the best face masks for kids that have been tested for breathability and filtration protection

A simple Google search for the “best kids masks” will reveal hundreds of pages and ads claiming to have the best mask for your child to wear. 

This is difficult to navigate and since most parents don’t have hours upon hours to research and verify these claims.

No worries!

We’ve provided several lists below from reputable sources which have tested tons of kids masks on the market with unbiased recommendations on the ones they found to be the “best”. 

Developed using patented (safe) nanotechnology at Stanford University and founded by a former US Secretary of Energy along with a world-class scientist, 4C Air’s Nano Mask for Kids has been recommended and used by thousands of people and trusted by top organizations worldwide. 

The next-generation face mask offers the breathability similar to a cloth mask with filtration efficiency greater than the N95 standard. 

These masks are also included on the two following lists and have been used and reviewed by several reputable sources (see below).

4C Air Nano Mask for Kids

Editors and writers at NY Times Wirecutter have tested many of the most popular kids masks and even had their own staff wear them around for review.

Their helpful article lists their top choices and provides a brief analysis of each one.

View the Times article here.

Aaron Collins, aka the “Mask Nerd” is an aerosol engineer who reviews and educates the public about masks via Twitter and his YouTube channel.

Aaron is collaborating with Professor Linsey Marr, a leading researcher in aerosol transmission and air quality to develop a list of masks they recommend for children which they update frequently on a shared Google spreadsheet.

You can view their google spreadsheet here.

Please note, this article is an on-going work in progress and we will continue to update it as more information becomes available. 

Did we miss something? Reach out to us in the comments below if there’s anything you feel would be important to add to this article. 

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