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JAMA Pediatrics Patient Page
December 28, 2021

Why Wear a Mask?—Explaining Medical Masking to Children

Author Affiliations
  • 1Department of Pediatrics, University of Florida College of Medicine, Gainesville
  • 2Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
JAMA Pediatr. 2022;176(2):212. doi:10.1001/jamapediatrics.2021.5336

The best ways to reduce the risk of infection with COVID-19, in addition to vaccination, are properly using medical masks, frequent hand washing, and discouraging face touching.

Many parents have questions about proper mask use for their children. The safest masks for children are surgical masks and N95 respirators. Cloth masks offer less protection but are better than not masking at all. All children 2 years and older should wear one of these masks when indoors. Children younger than 2 years should not use masks because their small airways make it harder to breathe. They also cannot communicate breathing difficulties to parents and are less likely to keep the mask on. You should ensure that masks fit properly, especially for smaller children who cannot fit into adult-sized masks. Neck gaiters, scarves tied around the mouth, or any masks with valves are not recommended. Surgical masks should be discarded after 6 hours of use or if they become wet or damaged. Cloth masks should be hand or machine washed after every use with warm water and laundry detergent.

Masks prevent inhalation of airborne virus released while others talk, breathe, and cough. Children should keep their masks on even while coughing or sneezing. Parents should also emphasize the importance of frequent handwashing, hand sanitization, and avoidance of touching the nose, eyes, and mouth. Children should wash or sanitize their hands before wearing or removing masks and before eating. When in public or at school, a child should only remove their mask to eat or drink. When eating, they should stay at least 6 ft away from their classmates.

Younger children may not remember a time before the COVID-19 pandemic, while older children may be growing impatient with daily masking. Both groups will take cues from their parents. We suggest always wearing a mask in public and affirming routine use to your children.

For younger children, try offering this explanation about the importance of wearing masks: You want to play in the rain with your friends, but we will only let you go if you stay dry. If you use an umbrella, there is a good chance that you can remain dry, but what happens if your friend does not have an umbrella? When they get close to you, you could get wet. If you and your friends all have umbrellas, you can all play and still stay dry. The umbrella is like a mask. If used correctly, you will all be safe (dry), but if someone around you doesn’t have one on, you could still get sick (wet). That’s why you need to keep your distance from people who don’t have a mask on so that you can stay healthy!

Recently, the Delta variation of COVID-19 caused a 240% surge in pediatric infections. During the summer of 2021, the number of children younger than 4 years who were hospitalized because of COVID-19 increased 10-fold. As children return to in-person schools across the country, parents must do everything they can to reduce their own and their children’s risk of getting sick with COVID-19. Please encourage your children to wear their masks.

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The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, email reprints@jamanetwork.com.
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Article Information

Published Online: December 28, 2021. doi:10.1001/jamapediatrics.2021.5336

Conflict of Interest Disclosures: None reported.

1 Comment for this article
Masks for children
David Bell, MBBS, PhD | Independent consultant
The article overlooks that importance of medical interventions being based on risk versus benefit. It failed ot mention the very low risk of COVID-19 in healthy children (reviews of UK and US data have failed to confirm causal deaths among this age group without co-morbidities), though it may occur very rarely. It also overlooks post-infection immunity. So it remains unclear what actual overall benefit is achieved from masking, which will reduce communication (especially in hearing-impaired children), and will marginally reduce gas exchange. It also overlooks the lack of data on efficacy of masks with aerosolized respiratory viruses.
These issues
seem important to the overall argument.