Pediatricians Answer Top 10 Questions 
Regarding Masks in Children

Content from the New York State American Academy of Pediatrics

Why is it important for my child to wear a mask in school?

A significant number of individuals with Covid‐19 have no symptoms and can transmit the virus through respiratory droplets. These droplets are released when coughing, sneezing, loud speaking or singing. A mask acts as a barrier and can decrease the amount of respiratory droplets released into the air. While

it is not a perfect barrier, it is one of the best tools we have to prevent the spread of Covid‐19 along with social distancing.

What kind of mask is best for my child?

Children can wear homemade or purchased cloth face coverings or surgical masks. The right fit is important for children. Masks should cover the nose and mouth without any gaps on the sides. Pleated face coverings with elastic are likely to work best for kids. Adult cloth face coverings are usually 6x12 inches, and even a child‐sized 5x10 inch covering may be too large for small children. Try to find the right size for your child's face and be sure to adjust it for a secure fit. Masks should be washed daily. It might be helpful to have a small supply of masks on hand so they can be replaced daily. Masks with vents or exhalation valves are not recommended as they can allow exhaled respiratory droplets to reach others.

What is the safest way to put on and remove a mask?

Hands should be washed before placement of a mask. Cloth face coverings can then be placed securely over the nose and mouth and stretched from ear to ear. Touching the face should be avoided while wearing a mask. Wash hands before removing the mask and avoid touching the front of the face covering by taking it off from behind. Wash hands after the mask has been removed.

Are there any medical contraindications to wearing a mask in children?

Children under 2 years old should not wear masks. Children older than 2 years old can safely wear masks throughout the school day. Medical contraindications to mask wearing are exceedingly rare. Children with severe cognitive or respiratory impairment may have a hard time tolerating a mask.

Is it unsafe for my child with asthma to wear a mask?

It is completely safe for a child with asthma to wear a mask. If your child is having difficulty wearing a mask and has a history of asthma, please discuss with your pediatrician as their asthma may not be controlled. A mask should not be uncomfortable when worn by a child with well‐controlled asthma. Please consult your pediatrician for specific recommendations regarding your child’s asthma care.

When should children be allowed to remove their masks?

Schools and teachers should structure in times when students can take off masks and have a break. These mask breaks would preferably be outdoors whenever possible with social distancing in mind. If children are indoors it is preferable that windows be open whenever possible particularly during mask breaks. These breaks can occur hourly ideally during quiet reading time or study when students are not speaking. Teachers might consider having alternate rows remove masks at the same time during a break and then switching. Children may also remove their masks while eating, playing outdoors and during gym activities requiring physical exertion provided children can remain 6 feet apart from each other.

Masks are too uncomfortable and hard to breathe in. How can I help my child?

A mask can sometimes feel strange the first time a child wears one. It is helpful to try to find a mask that fits comfortably, that is not too tight and is made out of a soft non‐ irritating material. If a mask feels comfortable a child should have no difficulty breathing while it is on.

Is it possible for my child to have carbon dioxide poisoning from wearing a mask throughout the school day? Will my child get enough oxygen with a mask?

Carbon dioxide and oxygen particles are much smaller than viral particles and can flow freely through a mask while viral particles may be trapped. Cloth masks worn by the general public are not air tight and allow for air flow, in comparison to the more sealed N95 masks that healthcare professionals wear. Periodic mask breaks throughout the day are also recommended. It is nearly impossible for a child to have decreased oxygenation or increased carbon dioxide levels from wearing a cloth mask.

If desks are already set 6 feet apart in the classroom, why should children still wear masks all day during instruction?

In order to make the indoor classroom setting as safe as we possibly can, mask wearing is advised at all times. It may sometimes be difficult for children to stay 6 feet apart. Masks can help prevent the spread of the virus in respiratory droplets released when coughing and sneezing. In addition, masks will also help prevent children from spreading germs by touching their nose and mouth. Mask wearing is a simple and effective measure we can take to help keep our children and families safe.

What are ways to increase my child’s ability to wear a mask all day?

Some children may need help getting used to wearing masks all day. Mask endurance is a new term used to describe the ability to wear a mask for prolonged periods of time. Start working on mask endurance with children a few weeks before school begins. Find a fun design or pattern that is interesting to your child. Initially have children practice wearing their masks for small increments of time. Try wearing a mask with your child for 10 minutes once a day and slowly build up to longer periods three or more times a day. Parents are encouraged to wear their own masks to help model the behavior. Parents should keep it relaxed and fun. Children can adapt to new situations easily and should be praised for helping to keep their classmates and community safe.