Why toddlers shouldn’t wear masks in school

In these times of COVID, concerns have been raised over the need for mask-wearing in children under the age of 5. While stopping the spread is imperative, these specific and myopic concerns must be taken into perspective, and careful consideration is advised before enacting a harmful policy on our children.

Mask-wearing may have a negative and long-lasting effect on children within this age-group, while at the same time not being an effective transmission prevention method. Such policies may inflict damages to our children that far outweigh the risks of contracting or transmitting COVID-19.

To quote the WHO and UNICEF’s advice to policymakers[1]:

Based on the expert opinion gathered through online meetings and consultative processes, children aged up to five years should not wear masks for source control. This advice is motivated by a “do no harm” approach and considers:

• childhood developmental milestones

• compliance challenges and

• autonomy required to use a mask properly.

Points of Impact

Enforcing mask-wearing in children under the age of 5 is likely to disrupt the harmonious development through various points of impact. If true, this would be a violation of the Convention of the Rights of the Child.

1. Inhibited learning — Wearing a mask causes constant discomfort and irritation, as well as attenuates our senses of smell and taste — two significant sensory channels for a developing toddler. Further, it affects our ability to communicate and be understood. These challenges force the child’s mind inwards, maintaining focus on the excess stimulation, and increasing frustrations over communication difficulties. Furthermore, as others are also wearing masks, recognizing speech is now bound to the auditive channel alone, as lips and facial expressions are occluded. All this creates even more isolation between the child and their surroundings, increasing potential helplessness and decreasing the ability to interact and process surrounding events and stimuli.
2. Emotional recognition and social interaction with peers — An important part of a child’s development is in learning to interact with their peers, understand and accept their emotions. As we communicate a large part of our emotions through our faces, forcing all the children to wear masks is likely to impede their ability to learn how to read those emotions. This can impact the child’s ability to expect and show empathy towards peers.
3. Attenuation of expression — It’s common for children this age to have an inherent difficulty in expressing themselves verbally. Most have only recently learned how to participate in multi-sentence conversations, and describing their feelings and emotions is an even more difficult task. Wearing a mask can make expressing themselves even more burdensome, rendering some kids even more introverted and internalized than otherwise, if not laden with frustrations.
4. Teacher visibility and efficacy — Mask-wearing in children under the age of 5 requires constant vigilance by competent adults, with uninterrupted line-of-sight coverage to ensure the children’s safety and prevent any potential harm associated with mask-wearing [1]. These new safety concerns compound with the teachers’ new role in enforcing compliance, with all the points above as well as their non-trivial roles as teachers. Will the teachers be able to see and address my daughter’s needs if they’re overwhelmed with these safety concerns, they need to ensure correct mask-wearing compliance, they can no longer read children’s’ facial expressions, they need to overcome the challenges that their own masks impose, they need to help the children understand and communicate with each other, and they still need to be the teacher?
5. Unnecessary anxieties — The effects of social distancing and other COVID regulations are already creating a visible wave of anxieties in children, and likely impacting them in ways we don’t yet understand. In schools, children are exhibiting fear of touching, leaving their homes, and exceeded concern over the wellbeing of caregivers. Education researchers are only now starting to ask the questions, but it’s clear that this generation will be affected in the long-term. I fear that enforcing masks would make matters even worse, as the negative externalities now afflict the child’s physical self, confining them verbally and sensory in the already complex and frightening world of COVID.

Comparative Risks

While it’s clear that transmission of the disease and individual protections are necessary at a global scale, it’s important to account for the differences between the age group at hand and the whole population.

• Child-to-child transmission — Independent of other concerns, there’s evidence showing that this age group is not the main driver of COVID-19 transmission[2–7, 9]. Even investigations of cases identified in school settings suggest that child to child transmission in schools is uncommon and not the primary cause of infection in children [9].
• Effectiveness of masks in children — While masks can be an effective protective measure in the general population, there’s a question over how much of the risk is actually mitigated in children 5 and under. Achieving compliance from 3 and 4 year-olds is unlikely, as many children will often reposition the mask, take it off, and even throw tantrums over wearing things they don’t want to. Accounting for this, the and the hours spent eating and napping, already half of the school day is spent without a mask on. Further, a study conducted in laboratory conditions shows that they are less so for young children [8]. Children this young may not be dexterous or capable enough to wear a mask correctly[1]. I can clearly see how my own daughter (almost 3 y.o.) touches, fidgets and takes off her mask after just a few minutes of wearing it. This clearly renders the tool useless for both transmission prevention and personal protection.
• COVID affliction in children — As parents, we care deeply about the health and well being of our children, but luckily, the evidence shows that children suffer far less than adults from this pandemic[10]. Even the rate of hospitalization in children (18 and under) is lower than adults by nearly 2000% [10].

Conclusion

This is NOT the way!

Resources

1. WHO: Advice on the use of masks for children in the community in
   the context of COVID-19
2. CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children — United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422–6. Epub 2020/04/10
3. Joint IPA-UNICEF COVID-19 Information Brief. Epidemiology, Spectrum, and Impact of COVID-19 on Children, Adolescents, and Pregnant Women. (https://ipa-world.org/society-resources/code/images/HjNYEyfuM250.pdf accessed 20 August 2020)
4. Goldstein E, Lipsitch M, Cevik M. On the effect of age on the transmission of SARS-CoV-2 in households, schools and the community. medRxiv. 2020. (https://www.medrxiv.org/content/10.1101/2020.07.19.20157362v2 ).
5. Li X, Xu W, Dozier M, et al. The role of children in transmission of SARS-CoV-2: A rapid review. J Glob Health. 2020;10(1):011101. Epub 2020/07/03.
6. Ludvigsson JF. Children are unlikely to be the main drivers of the COVID-19 pandemic — A systematic review. Acta Paediatr. 2020;109(8):1525–30. Epub 2020/05/21.
7. Viner M, Mytton O, Bonnell C, et al. Susceptibility to and transmission of COVID-19 amongst children and adolescents compared with adults: a systematic review and meta-analysis. medRxiv. 2020
8. Van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One. 2008;3(7):e2618. Epub 2008/07/10.
9. European Centre for Disease Prevention and Control. COVID-19 in children and the role of school settings in COVID-19 transmission. 6 August 2020
10. Kim L, Whitaker M, O’Halloran A, et al. Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1-July 25, 2020. MMWR..