There are documented reports on the protective barrier effects of well-fitted facemasks in adults; however, there are no randomized controlled trials on the protection offered by facemasks to children of any age in any setting. Still, many countries continue to mandate facemasks for children, often as part of multi-layered mitigations, to prevent the spread of SARS-CoV-2 in educational settings.

Facemask recommendations, however, varies in different parts of the world. The World Health Organization (WHO) and UNICEF encouraged adolescents aged 12+ years to follow the same masking guidance as adults. At the same time, it recommended 6-11 year-olds to wear a well-fitting mask in areas where SARS-CoV-2 is spreading, in poorly-ventilated indoor settings, and in indoor settings where people cannot maintain defined physical distancing. Moreover, Children younger than six years were recommended not to wear a mask.

There have been debates in favor of and against wearing masks by children in educational settings. The lack of randomized controlled trials on the protective effects of facemasks in children in any setting makes us dependent only on observational studies. 

A recent study by Chandra and Hoeg described a significant association between school mask mandates and a lower risk of COVID-19 in educational settings. On using a larger, nationally representative dataset over a longer period and after replicating the original result, they failed to find a significant relationship between mask mandates and case rates in the expanded sample, even after controlling for differences across districts.

Other similar US observation studies reporting lower infection rates associated with mandatory masking policies have also been faulted for methodological biases.

The problem with such observational studies is that the mask mandates are usually accompanied by other mitigations, such as stronger public health messaging, increased household and community testing, different contact tracing policies, and COVID-19 vaccine requirements, which may all contribute to lower infection rates.

It is now crucial to accept that there is no robust evidence to recommend face masks for children. The studies must prove this intervention before recommending large-scale implementation. 

There is a need to focus on evidence-based interventions that help protect children against all infections. It could be facilitated by improving educational settings to provide a safer environment for staff and children. Larger premises, smaller class sizes, a cleaner environment, better ventilation, and improved outdoor facilities will all help reduce the risk of infections in educational settings and keep children healthy. 

Ladhania SN. Face masking for children - time to reconsider. Journal of Infection. 2022;85:623–624.