Students wearing masks attend class at a school, in Jammu, February 14, 2022. Photo: PTI
- Multiple expert bodies and the WHO are agreed that children younger than 2 years should not wear face masks.
- However, some of their guidelines differ over whether children older than 5 years should wear masks.
- Some studies have found among children of this age group that masking can hamper cognitive development and their ability to read emotions.
New Delhi: Do you have a child younger than 5 years? Are you making her wear a mask?
If yes, you’re dealing with something not so straightforward, and need to take a look at different guidelines on this issue.
The WHO, the Indian, American and European Academies of Paediatrics and UNICEF all say children younger than 2 years must not wear masks. According to them, masks offer them no advantage and could in fact make the children feel suffocated.
The latest guidelines of India’s Union health ministry also say that children younger than 5 should not use masks.
The WHO has said as well that children younger than 5 may not be adequately equipped to handle masks. This is because they don’t usually achieve the requisite “dexterity and fine motor coordination” by that age.
Masks are one of the most effective ways to keep SARS-CoV-2 at bay – but not for every child.
“Children aged 6-11 years may wear a mask depending on the ability of [the] child to use a mask safely and appropriately under direct supervision of parents/guardians,” the ministry guidelines say.
For children older than 12, the ministry recommends “masks under the same conditions as adults”.
This guidance is in line with the WHO’s recommendations:
“Several studies found that factors such as warmth, irritation, breathing difficulties, discomfort, distraction, low social acceptability and poor mask fit were reported by children when using masks.”
The body also said that the evidence on benefits and harms of children using masks to mitigate transmission of COVID-19 is limited.
At least one study has found that face masks for those aged 6-14 years could hamper cognitive development among children who depend on nonverbal communication.
Another study reported that children aged 9-10 years “showed extreme problems in reading the emotion disgust, strong effects on fear and sadness, and only mild effects on happiness, but also even better performances for emotional states [like] anger when faces were masked.”
So there are trade-offs when it comes to very young children wearing masks.
Protecting children
Nonetheless, the question of protecting children against COVID-19 still exists. The WHO recommends three strategies: maintaining a physical distance of at least 1 m, educating children to have good hand hygiene and limiting the size of school classrooms.
But while various bodies agree on precluding masks for children younger than 2, UNICEF and the Indian Academy of Paediatric (IAP) differ vis-à-vis those older than 5. According to the IAP, “children above the age of 2 to 5 years can be trained to use a mask”. It has also asked adults to mask up around children.
The American Academy of Paediatrics (AAP) “strongly” recommends that children older than 2 years should wear a well-fitted mask, regardless of their vaccination status.
The term “well-fitted” is key. If a mask is smaller than a child’s face, it could restrict their breathing. A bigger mask would defeat the purpose of masking. Parents have to be very mindful of this factor.
The European Academy of Paediatrics has said so as well: “The masks that fit the size of children’s heads are lacking. This issue is particularly important due to different age groups having different head and shape dimensions.”
The body also advised against N95 for very young children for bad fit and because researchers have studied their efficacy only among adults.
Reopening schools
Schools have reopened in most states, highlighting the need for clear masking guidelines for young students.
The IAP’s guidelines for the occasion are silent on masks. The Wire Science’s attempts to reach IAP president Dr Remesh Kumar went unanswered.
The Union education ministry issued standard operating procedures for schools on February 2, but they’re missing the word ‘mask’.
The AAP recommends that all staff and students (older than 2 years) wear masks unless medical or developmental conditions prohibit their use.
The WHO has said “age-appropriateness” must be central to schools’ requests to children to wear masks inside classrooms. This is in addition to teacher and support staff staying at least a metre away from students at all times and adequate ventilation.
Finally, the WHO has said, while young students and children could be asked to maintain distances, they shouldn’t be expected to wear masks while running around on the playground.