Masks and Your Child — What we don’t know

Also Read: Great News About COVID-19

Normally, in an informational post, I try to focus only on what I know to be fact, what is widely accepted in the medical community, and what is supported in the literature. I also write posts based solely on opinion, and I hope I make it clear in the text when this is the case. Given that our most powerful leaders are making major decisions based on what we don’t know rather than what we do know, I hope you’ll indulge me in a fact/opinion combo post. I’ve been thinking a lot about my kids wearing masks in school. It is giving me high anxiety, and I imagine, if we were allowed to speak freely, I am not alone. I know it is the popular, acceptable opinion that forcing our kids to wear a mask should be a no-brainer. We are told it will save lives, and it is hard to argue a human life is less valuable than an education. Parents in underdeveloped nations who, each day, send their kids to walk miles through dangerous areas to reach a schoolhouse may make a compellingly different argument.

Here in the tri-state area, I have come to terms with the reality that covering their noses and mouths for hours each day is the only way my children will receive an education in person this fall, and likely this winter and spring, as well. In addition to worrying about the side effects of this (see below for my very abbreviated list of concerns,) I also wonder what will be the all-clear de-masking signal. Are there reasonable people in charge who will call off the mask mandate when it is deemed prudent to do so, or will we forever opt for safety above all else? Will we be forced to subject our kids to a novel, unproven vaccine for a disease which will not severely sicken them, in order for them to go to school and be able to speak clearly and breathe freely? I understand the requirement. I know it is in place because of the fear children will make adults sick. And, if there was a reasonable end game in place, I would accept it as a necessary evil, hope the effects wouldn’t be too harmful, and try to put it out of my head.

However, I worry mask wearing for hours each day, for months and maybe more, will be harmful for our kids. Again, as many live in fear and isolation because of what we don’t know about COVID-19, I think it also important to voice what we don’t know about how mask wearing will affect our kids. Nothing is without risk and side effect, including that which is dismissed as necessary, protective and socially responsible by the media.

Socially – How will mask wearing affect kids’ ability to socialize, something we accept is critical for growth and development at young ages and crucial for mental health in our older children? We have evidence of the deleterious effects phones have had on social maturity and communication skills. Will the inability to express emotion or see emotion in others further stymie our children’s ability to interact face to face?
Emotionally – The potential effects of mask wearing on emotional well-being are too many to name, but I’ll try to name a few that have me most concerned. We are sending the message to our children they are toxic and can kill someone with their breath. They understand the mask is also to protect them against an unseen enemy, and it will therefore serve as an ever-present reminder of their vulnerability to danger, subjecting them to fear of the unknown. This can be crippling. Mask wearing is more emotionally charged for some. Will children who already suffer from anxiety and depression spiral under the protection it offers? Those who experience panic attacks will likely see an increase in events, and those who have mild mental health issues will probably see a worsening of their symptoms. I don’t think it histrionic to assume children with no prior emotional or behavioral problems will struggle as well.
Physically – While we are being told there is no health downside to wearing a mask, do we really know that to be true anymore than we know how contagious an asymptomatic child is? A study reported in 2005 on health care workers wearing N95 and surgical masks for extended periods resulted in physical discomfort, increased fatigue, difficulty in taking in sufficient oxygen and changes in heart rate. There are, of course, many individual factors and mask features which will affect the severity of these side effects, but the authors found, “Therefore, it can be concluded that N95 and surgical facemasks can induce significantly different temperatures and humidity in the microclimates of facemasks, which have profound influences on heart rate and thermal stress and subjective perception of discomfort.” You can read the whole study here. I haven’t even touched upon how masks may affect kids with pre-existing respiratory or cardiac problems. What about the quality of the fabric itself? The fabric of uniforms has been blamed for causing various ailments in airline employees, including respiratory illness. The evidentiary supported claim is that breathing so close to certain fabrics for extended periods of time was harmful. Remember, these fabrics weren’t placed over employee’s faces, they were just clothing their bodies.

Perhaps masking our children is necessary to control the spread of coronavirus, and perhaps it will save lives. It would be short-sighted of us though, to only see the potential benefits to such a major cultural shift, and to not at least acknowledge the plausible adverse effects. For me, as a parent and a physician, the answer is not so simple as, “Just wear the mask. It can’t hurt.” Our children won’t just be running into the store in a face covering for 5 minutes. They will be wearing their masks for hours, and likely shamed and reprimanded if they need to remove it for a few moments.

Mask or no mask, I will send my kids to school in the fall for however many hours they are allowed, because I do believe their future is worth these risks. If covering their faces isn’t optional, they will be wearing masks, as my worries about mask-wearing are trumped by their need, and their right, to learn. If I didn’t think there was value to an in-person education, I wouldn’t have sent them to school during flu season, exposing them year after year to a virus which could actually kill them. I will be very careful about the kind of masks we choose, opting for maximum oxygen exchange and the safest fabric, made by trusted manufacturers. I will wash them frequently to avoid rashes and acne and to keep them clear of bacteria. I will also let my kids play with their friends after school, mask-free, and hope this is enough to boost their immune system against all the illnesses which can and will make children sick, and to which they need exposure when they are young. I am not anti-mask. I am anti the “it is no big deal” mentality.

UPDATE: Great News About COVID-19