Child mask mandates for COVID-19: a systematic review

• Published in: Archives of disease in childhood Vol. 109; no. 3; pp. e1 - e7
• Main Authors: Sandlund, Johanna, Duriseti, Ram, Ladhani, Shamez N, Stuart, Kelly, Noble, Jeanne, Høeg, Tracy Beth
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01-03-2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adults; Age groups; Antibodies; Auditory Perception; Bias; Child; Child Health; Children; Children & youth; Cohort analysis; Counties; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; Disease control; Disease transmission; Evidence; Humans; Infections; Infectious Disease Medicine; Listening Comprehension; Masks; Meta Analysis; Observational studies; Original Research; Pandemics; Pandemics - prevention & control; Pediatrics; Public health; Risk assessment; SARS-CoV-2; Scandals; School districts; Severe acute respiratory syndrome coronavirus 2; Speech; Systematic review; Teaching Methods; Word Recognition; Young Children; United States > US; Covid-19; Infectious Disease Medicine; Child Health
• ISSN: 0003-9888; 1468-2044; 1468-2044
• DOI: 10.1136/archdischild-2023-326215

BackgroundMask 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.MethodsWe performed database searches up to February 2023. The studies were screened by title and abstract, and included studies were further screened as full-text references. A risk-of-bias analysis was performed by two independent reviewers and adjudicated by a third reviewer.ResultsWe 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.ConclusionsReal-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.