What are masks doing to our children? In recent months, as frustration with the ongoing pandemic increases, this question has felt particularly relevant.
Everyone from hematologists and veterinarians to New York Times
columnists have pointed to children’s development when suggesting that it’s time to drop the precautions of the early phases of the pandemic. The frustration is understandable: After all, parents and children were promised a mask-free existence once they got the shots. Can you blame them for asking when this bargain will be kept?
Many calling for an end to mask mandates point to vague “downsides” and “harms” from masking children. “Masks can interfere with young children’s brain development,” one recent article stated, citing no studies whose findings actually showed this. Others say masks cause “disruption to their social and emotional learning, to literacy and speech,” again with no studies or evidence. Even a piece titled “The downsides of masking young children are real” failed to offer research showing actual documented downsides. What these articles cite, if anything, is studies showing that masks sometimes muffle speech and make it slightly harder to judge emotion from facial expressions alone. The articles then infer that, given these findings, there must be some kind of damage to children’s development.
The problem is, so far there is no evidence to support these claims. I talked to several speech therapists, developmental psychologists, and pediatricians, and no one has seen evidence for delayed or changed development in children because of masks. Masks probably aren’t the culprit when it comes to changes in children’s mental health, either. And about two-thirds of Americans support wearing masks, including in schools, according to several polls.
Of course, as with all science, the absence of evidence is not evidence of absence; just because there is no research showing something exists doesn’t mean it’s not happening. And there are few long-term studies on masks and development because we’ve only been wearing them widely in the United States for two years or so (and some places never fully adopted them). But it’s striking that, two years in, early fears about developmental issues from masks have still not materialized into delays. The pandemic itself has made kids and parents more stressed and made it harder for families to access effective services for children who already had delays, childhood development experts say. But masks are not what’s hurting kids.
“There really isn’t any research to back up that claim at all,” Dr. Ashley Ruba, a developmental psychology researcher at the University of Washington, told me, referring to the commonly repeated concern about masks affecting child development. One study Ruba co-authored, in fact, found 7-to-12-year-olds’ ability to recognize emotions persists, despite concerns that partially covered faces make kids unable to understand emotions or less empathetic. “Our study suggests that it’s not a founded concern,” she said. “Kids are able to determine from facial expressions alone the emotion that someone is likely to feel even when they’re wearing a face mask.”
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Kids were most accurate at judging emotions in the photos with no face coverings at all, but their accuracy was the same with covered faces whether someone was wearing a mask or a pair of sunglasses. And that was with a still photo. “In everyday life, we have a variety of other information, other than the face, to determine how someone else is feeling,” Ruba said—like body language or eye movement or tone of voice, which can be even more powerful than facial expressions in conveying emotion.
This finding isn’t some kind of isolated fluke. In December 2021, the Centers for Disease Control and Development reported that “limited available data indicate no clear evidence that masking impairs emotional or language development in children.” And that makes intuitive sense: Face coverings are common in societies around the world, even when there’s not a pandemic—for reasons ranging from faith to air pollution—and children don’t suffer from delays because of it.
Seeing isn’t a prerequisite for learning to speak, Peter J. Smith, associate professor of developmental and behavioral pediatrics at the University of Chicago Medicine, pointed out. “For instance, children who have visual impairments don’t have to be socially delayed or language delayed, and they can’t see mouths or things like that because they have a visual impairment.”
The argument for school masking affecting children’s language development is particularly puzzling, because the majority of language development usually happens before the age of two, and masks are not recommended for children under that age. Even among young kids at preschools and daycares, who regularly interact with masked adults, no delays have been discovered.
“Babies and young children study faces intently, that’s true,” Dr. Diane Paul, director of clinical issues in speech-language pathology at the American Speech-Language-Hearing Association, told me. “But children can tune in to other cues when an adult’s mouth isn’t visible.” One study shows that 2-year-olds can still recognize words through masks. Another study from before the pandemic found that children aged 3 to 8 have no trouble identifying expressions through masks. Perhaps most fascinating of all, a study on preschoolers found that they made more complex speech sounds when wearing masks.
Even if masked in school, children still get plenty of face time at home with family and outside with friends, experts said. In fact, in the first months of the pandemic when they spent more time with family and caregivers, children may have seen a leap forward in vocabulary acquisition, compared to before the pandemic. As for the time in school or out in the world around masked people, anyone who has spent more than a minute with young children knows that they’re not staring at adults all of the time. “They’re running around. They’re looking at their toys,” Paul said. “They’re listening to voices, they’re looking at gestures, they’re looking at your eyes, they’re not just looking at a masked face.”
At the beginning of the pandemic, some developmental experts had a more specific worry: They thought masks might impede children who already had developmental delays. But even this group of kids seems to be doing OK. “I’ve been surprised,” Smith said. “It’s been remarkably not affecting them.” Children with speech delays, who sometimes need to see how sounds are formed physically, can work with speech therapists who wear clear masks, and they can also look at videos of unmasked faces. (Clear masks can also help students with hearing loss.) Therapists “don’t always have to provide the direct demonstration, for instance of a sound, with their own mouths. There are other ways that they can provide the same information,” Paul said.
There is one small but important group that may struggle with wearing masks and communicating through them: Children with special needs and strong sensory sensitivities may not tolerate masks as well. “Physically, it upsets them,” Smith said. And kids who have some difficulties interpreting emotions to begin with, such as those on the autism spectrum, may face challenges interpreting masked expressions.
But this is a reason for, not against, universal masking and other precautions during times of high Covid transmission. When others wear masks, it protects those who can’t do it well or consistently—and this is especially true for immunocompromised children (and adults) who wouldn’t be safe in an unmasked classroom during high transmission.
If schools stop masking over unfounded fears of how masks are affecting children without special needs, Smith said, that might mean high-risk kids, such as those with disabilities that include a weakened immune system, would be compelled to stay home. “I would be strongly against any argument that takes people with disabilities and removes them from society,” he said, pointing out that this would also violate these children’s rights. “That’s always a bad idea. It’s bad for them, and it’s bad for society.”
“Everybody has to make sacrifices right now,” Becca Shreckengast, a New Mexico–based mother of two kids with developmental delays, told me. (Shreckengast is also my husband’s cousin—she volunteered when I asked a group of parents of kids with developmental delays whether they’d be willing to speak to me for this piece.) Masking, she believes, is an acceptable one: “I would make the sacrifice of [my daughter] becoming better at facial recognition or continue to be delayed in that area,” she told me, if it means protecting vulnerable classmates.
The drawbacks to wearing masks in school are minor and compensable: They muffle sound, they may irritate skin. But there are easy fixes: Make sure you have the child’s attention and it’s not too loud; speak a little more clearly and slowly; use your hands and body language, Paul suggested. (I would add my own, to avoid “maskne”: a little facial moisturizer goes a long way.)
The drawbacks to unmasking, it turns out, are much greater. In schools that have abolished mask mandates or never had them at all, some have had to go to virtual because of staff shortages. These closures hurt kids immediately and demonstrably in ways that masks don’t, the experts all told me. This is also the reasoning behind a Twitter thread from the American Academy of Pediatrics on January 28, urging schools to keep masking. According to the organization, 3.5 million children tested positive for Covid-19 in January alone.
“Being separated from their peers, especially adolescents separated from their peers at a developmental time where peer relationships are so important, that’s what concerns me more,” Ruba said. “Schools that are able to keep being open with mask wearing in place—that’s ultimately going to be more beneficial.”
Masking can help schools stay open. But it also helps individual children avoid other risks. Some of those are clear—missing school because you’re sick, passing the virus to vulnerable family members or school staff—while others are still being understood.
Even with measures like making learning virtual and using masks, more than 800 children are estimated to have died from Covid in the U.S., compared to much lower fatalities from the flu and other respiratory illnesses in this time. Having Covid may also affect early brain development. “Mask wearing has not been linked to any sort of negative developmental outcomes,” Ruba said, “but other aspects that would result from not wearing the mask have been.”
Schools are more than three times more likely to have outbreaks if they don’t have mask mandates, and counties with school mask requirements had significantly lower spread than those without them, studies from the CDC found. Wearing masks also helps prevent daycare closures. A randomized controlled trial—the gold standard of research—in Bangladesh found that surgical masks help significantly to control the spread of Covid. (Cloth masks didn’t work as well, but higher-filtration masks like N95s and KF94s likely work even better than the medium-filtration surgical masks.) While some people have called for a child-specific trial, this would mean withholding masks from certain kids for the purposes of the study—and given that masks are known to have some benefit, it’s unlikely such a study would pass an ethical review.
The more widely masks are adopted, the better; when only vulnerable people wear them, they don’t work as well as when everyone does. Masking will also help, by slowing transmission, to bring the pandemic to a true end, meaning that kids and society at large can avoid the social problems from a prolonged pandemic, which include violence, abuse, child labor, education loss, widened disparities, and food insecurity. Masks also help keep other respiratory viruses from sweeping through schools and causing absences.
Children should not bear disproportionate burdens, wearing masks and distancing in schools while adults make merry in bars and restaurants. But the fact that adults are socializing mask-free while kids mask up is an indictment of how grown-ups are mishandling the pandemic, not an argument for relaxing kids’ precautions as well. We should have clear, data-driven policies for when the masks come off—and when they go back on again—as well as other precautions based on vaccination rates, cases, health vulnerabilities, and hospital capacity in each locality. With only 22 percent of 5- to 11-year-olds fully vaccinated nationwide, though, we’d currently be very far from hitting any such data-driven markers.
Masks are a stark visual reminder that the pandemic is still a threat. And perhaps that’s partly why parents dislike them: Who hasn’t looked at a child playing with friends and thought about how different the past two years have been for them? What parent hasn’t yearned for a simpler time?
But while masks are a symbol of how the pandemic has changed our lives, they’re not the cause. The virus, and the way we’ve failed to control it, is the real culprit. Yes, kids are stressed by the pandemic—which is one of the reasons we should end it as quickly as possible. But unmasking prematurely in this and other surges will only prolong the havoc this virus is wreaking on children’s lives.