Abstract
Background: Mask mandates for children during the COVID-19 pandemic varied in different locations. A risk-benefit analysis of this intervention has not yet been performed. In this study, we performed a systematic review to assess research on the effectiveness of mask wearing in children...
Results: We screened 597 studies and included 22 in the final analysis. There were no randomised controlled trials in children assessing the benefits of mask wearing to reduce SARS-CoV-2 infection or transmission. The six observational studies reporting an association between child masking and lower infection rate or antibody seropositivity had critical (n=5) or serious (n=1) risk of bias; all six were potentially confounded by important differences between masked and unmasked groups and two were shown to have non-significant results when reanalysed. Sixteen other observational studies found no association between mask wearing and infection or transmission.
Conclusions: Real-world effectiveness of child mask mandates against SARS-CoV-2 transmission or infection has not been demonstrated with high-quality evidence. The current body of scientific data does not support masking children for protection against COVID-19...
Discussion: In this systematic review, we fail to find any evidence of benefit from masking children, to either protect themselves or those around them, from COVID-19. Harms of masking may include affected speech, language and emotional development, and physical discomfort contributing to reduced time and intensity of exercise and learning activities, and the long-term effects are too early to be measured. Adults who work with children should be educated about the lack of clear benefits and the potential harms of masking children, and there is no scientific evidence supporting a recommendation for masking in these professions.
In summary, child mask mandates fail a basic risk-benefit analysis. Recommending child masking to prevent the spread of COVID-19 is unsupported by current scientific data and inconsistent with accepted ethical norms that aim to provide additional protection from harm for vulnerable populations."
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