Do Masks Harm Children?

Jan 28, 2022 | Covid-19

Many people strongly endorse universal masking in schools to protect students and staff from getting sick with Covid-19, and to keep schools open. Studies overwhelmingly support the efficacy of universal masking. And a growing body of Americans with Disabilities Act (ADA) case law has mostly upheld universal mask mandates in schools so immunocompromised children can access school.

At the same time, others question whether there are harms to requiring children to mask in school, and if so, how schools should balance different students’ competing needs. There are public health and legal considerations at play here.

Leading public health organizations, including the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) strongly recommend universal mask requirements in schools for all children older than 2 years, unless medical or developmental conditions prohibit use. (We’ll get back to this exception in a minute.) The AAP just updated its guidance today, and it put this recommendation in bold: Universal masking in school, with an emphasis on indoor masking.”

In a publication entitled Do Masks Delay Speech and Language Development?, the AAP and the American Speech-Language Hearing Association (ASHA) jointly answer: “While this is a natural concern, there is no known evidence that use of face masks interferes with speech and language development or social communication. Plus, children can still get plenty of face time at home with mask-free family members.”

ASHA states:

  • “When it comes to use of face masks, the bottom line is safety first! Masks reduce transmission of COVID-19 and can make in-person schooling possible.”
  • “Audiologists and speech-language pathologists (SLPs) can share current research findings with families, school boards, teachers, and others to make sure that policies regarding mask use in schools and for the public are informed by science, particularly data that demonstrate definitively that mask use reduces infection.”
  • “The benefits of mask use should outweigh any concerns about possible impact on speech and language development.”

The CDC emphasizes:

  • “Mask use has been found to be safe and is not associated with clinically significant impacts on respiration or gas exchange under most circumstances, except for intense exercise.”
  • “The limited available data indicate no clear evidence that masking impairs emotional or language development in children.”

“It’s the disruptions in learning opportunities and care routines that harm children, not the masks,” according to Yale professor of child psychiatry and psychology, Walter Gilliam. Professor Gilliam authored a study showing that universal masking helped minimize closures of child care centers.

These authorities answer the question for most children, at least based on the studies we have today. But getting back to that exception above, some children cannot or should not wear masks for disability or medical reasons, so how should their needs be handled?

The answer is not to get rid of universal masking because it has widely-recognized benefits and without it some children would not be able to access school at all. Instead, mask accommodations or exemptions for children who require them should be determined on a case-by-case basis, under an ADA analysis. The AAP, CDC, and the US Department of Education provide guidance here too:

  • In cases where lip reading is essential, the AAP recommends using face masks with transparent windows or augmentative communication devices. Individualized nursing care plans may need to be adjusted for suctioning or tube feedings.
  • The CDC recognizes that some children with disabilities may be unable to wear a mask at all. This could include children with high sensitivity to materials on their faces, difficulty understanding why wearing a mask is protective (such as those with an intellectual disability), or those who have problems controlling their behavior.
  • For the narrow subset of students with disabilities who cannot wear a mask because of their disability, the US Department of Education recommends the use of alternate mitigation strategies, including masking for all others and physical distancing.