This year’s back-to-school supply list has an important line item: masks. With a rise in the Delta variant, school mask mandates and recommendations from major medical groups that all children two and older should be masked in indoor group settings have sent parents into a mask-buying scramble.
With a dizzying variety of choices around not only brands, but types of face masks and how to care for them, parents have largely been left to fend for themselves as they try to protect their children and others. We asked infectious-disease specialists, pediatricians and other experts how parents should parse the mask questions.
What kind of mask offers the best protection for kids?
There is a short answer and a long answer. The short answer is: A mask your child will tolerate. "The most effective mask is a mask a child will wear and fits them properly. That's much more important than the filtration characteristics between the three different kinds of masks," says Eric Toner, an internist and senior scholar with the Johns Hopkins Center for Health Security.
The three types of masks that Toner referred to are cloth masks, surgical masks and N95s (plus their cousins, KN95s and KF94s).
Finding a mask your child will keep on during the school day was a point of common emphasis among all experts we spoke to. Yvonne Maldonado, a pediatric infectious-disease specialist at Stanford University and chair of the American Academy of Pediatrics' Committee on Infectious Diseases, says the "bottom line" is that "the best mask is the mask the child will actually wear."
The longer answer is that, compliance across mask types being equal, there are differences but not tremendous ones. Toner says all three types of masks are effective at what is known as "source control," or stopping the spread of the virus outward if your child is the one infected. In terms of blocking incoming particles, all masks greatly reduce inhalation of virus-laden particles, with N95s blocking the most.
Even with the differences in filtration, though, all the experts we spoke to agreed that - even in the face of the delta variant - either a double-layered cloth mask or a surgical mask offer the best balance between wearability and protection. (To check if a cloth mask is double-layered, you should be able pull the separate layers of fabric toward opposite ends as if it were a double-layered blanket.)
Should kids wear N95 masks?
It is probably not necessary for kids to wear N95 masks, and it could actually backfire. "A well-fitted N95 is uncomfortable to wear, and I am very doubtful that most kids would tolerate them for very long," Toner says, adding that "they are at great risk for not being used properly."
Emily Levy, a pediatric infectious-disease specialist at the Mayo Clinic, concurred. Levy noted that even health care professionals treating active covid-19 patients only wear N95 masks during procedures such as intubation; otherwise, they are in surgical masks. "An N95 is a medical grade mask. It has never been tested in children for safety or efficacy," Levy says. "We don't have much safety or efficacy data for children with different facial structures and respiratory patterns [than adults]." This includes the KN95s and KF94s. Although there are many masks that appear to fit children and are called KN95 or KF94, they often have not been regulated by a governing body in the United States.
Are cloth masks with filters the best option for kids?
It is something of a grab-bag. "Filters are a bit controversial because it's a bit unclear what kind of filter it is," says Levy. "So in general we recommend staying away from filters."
Aaron Prussin and Linsey Marr of Virginia Tech's Department of Civil & Environmental Engineering, who have created a public spreadsheet of child mask recommendations, write that they only recommend filters that "spans the mask. Smaller filter inserts are less effective because it is easier for air to flow around them rather than through them."
How do I get my child to wear a face mask all day?
Helping your child build good mask-wearing habits is generally more important than the materials the mask is made of. Several experts suggest including the child - particularly if they are younger - in the mask selection process. "If children have a role in picking out a mask or decorating it, that can be really helpful in keeping the mask on their faces," says Maldonado.
Bergen Nelson, a pediatrician with the Virginia Commonwealth University Health Systems, talked about practicing and making a game out of it. “Say, ‘This your superhero costume you’re a superhero, wear your mask! Superheroes wear masks!’ " she says. “Depending on the age and developmental level of the child, you can get them motivated in different ways. Some kids are very motivated to know that they’re helping prevent the spread, some kids like to be the superhero, some kids might need an incentive: ‘If you can go the whole time with your mask on, you can get a reward at the end of the day.’”
Despite conventional wisdom, Nelson adds that in her experience, children have overall "done really well" with mask-wearing. "They've been amazingly flexible and resilient and willing to do their part."
How bad is it if my child has a tendency to wet their mask by licking or chewing on it?
This turns out to somewhat depend on the mask type. It is not ideal for any mask to get wet, and you should work with your child to limit wetting, but Toner explains that surgical masks (and N95s) lose an enormous amount of their protective ability when wet. Surgical mask material, he said, "depends on electrostatic charge to catch the particles, and if it's wet, it loses the charge, and the efficiency goes way down." If your child is prone to having a wet mask, going the cloth route is probably advisable.
How often should I change or wash my child’s mask?
Fairly frequently. Levy says her rule of thumb is, "If you can see that the mask is soiled - markings externally or internally - it's probably time to wash it, and if it's disposable, it's probably time to get rid of it."
Changing masks is especially important for younger children who tend to get close to each others' faces, as respiratory droplets of covid or other germs can sit on the mask. While surface transmission of covid is rare, Nelson noted that a child who touches their germy mask and then touches an orifice in their face could increase their risk of getting sick.
If a disposable mask is not soiled, it may be ok to reuse a couple times. The concern with reusing disposable masks is the loss of shape and a tight fit. "If your goal is source control - to keep from spreading the virus to other people - even if you wore them 100 times, you'd still have good source control," Toner says. "They just start losing their efficacy for protecting you."
Where should I get my child masks?
The good news is that masks that meet the bar the experts laid out - minimum of double-layered cloth - are widely available, and the message from experts is to not stress about finding the perfect mask.
If you are trying to be more discerning, the spreadsheet put together by Prussin and Marr, as well as one put together by mechanical engineer Aaron Collins, offer specific recommendations.
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