Just recently, the World Health Organization shared advice on the use of masks for children in the community in the context of COVID-19. In a nine-page document, the agency together with the United Nations Children’s Fund (UNICEF) detailed the use of masks to a risk-based approach, as part of a comprehensive package of interventions to prevent the transmission of viral respiratory diseases, including COVID-19. View the full WHO document here.
Here are some excerpts:
- Available evidence suggests that most reported cases among children have resulted from transmission within households, although this observation may have been influenced by school closures and other stay-at-home measures implemented by some countries.
- 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. So far, the effectiveness and impact of masks for children during play and physical activity have not been studied; however, a study in adults found that N95 respirator and surgical masks reduced cardiopulmonary capacity during heavy exertion.
Here are suggestions from WHO:
- Children aged up to five years. 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.
Based on the do no harm approach, if the lower age cut-off of two or three years of age is to be used for recommending mask use for children, appropriate and consistent supervision, including a direct line of sight supervision by a competent adult and compliance need to be ensured, especially if mask-wearing is expected for an extended period of time. This is both to ensure the correct use of the mask and to prevent any potential harm associated with mask-wearing to the child. Children with severe cognitive or respiratory impairments who have difficulties tolerating a mask should, under no circumstances, be required to wear masks.
Other IPC, public health, and social measures should be prioritized to minimize the risk of SARS-CoV-2 transmission for children five years of age and under; specifically maintaining a physical distance of at least 1 meter where feasible, educating children to perform frequent hand hygiene and limiting the size of school classes.
- Children between six and 11 years of age. For children between six and 11 years of age, a risk-based approach should be applied to the decision to use a mask. This approach should take into consideration: the intensity of transmission in the area where the child is and updated data/available evidence on the risk of infection and transmission in this age group; social and cultural environment such as beliefs, customs, behavior or social norms that influence the community and population’s social interactions, especially with and among children; the child’s capacity to comply with the appropriate use of masks and availability of appropriate adult supervision; the potential impact of mask-wearing on learning and psychosocial development; and additional specific considerations and adaptions for specific settings such as households with elderly relatives, schools, during sport activities or for children with disabilities or with underlying diseases.
- Children and adolescents 12 years or older. Advice on mask use in children and adolescents 12 years or older should follow the WHO guidance for mask use in adults1 and/or the national mask guidelines for adults. Even where national guidelines apply, additional specific considerations (see below) and adaptions for special settings such as schools, during sport, or for children with disabilities or with underlying diseases will need to be specified.
- Immunocompromised children. The use of a medical mask for immunocompromised children or for pediatric patients with cystic fibrosis or certain other diseases (e.g. cancer) is usually recommended but should be assessed in consultation with the child’s medical provider. View the full WHO document here.
