This piece originally appeared on the Health Feed blog. 

Face masks have been identified as one of the crucial tools to help stop the spread of COVID-19 yet the debate over whether they work or are necessary has been ongoing since the beginning of the COVID-19 pandemic. The Center for Disease Control and Prevention (CDC) strongly recommends universal indoor masking for all teachers, staff, students and visitors to K-12 schools, regardless of vaccination status.

Are masks effective for children at school?

The short answer is, “Yes.” “In settings of very high mask use, the in-school transmission of the coronavirus is less than 1%,” says Adam Hersh, M.D., a pediatric infectious disease specialist at University of Utah Health and Intermountain Primary Children’s Hospital. “The best way to protect health and safety—particularly of those that are not vaccinated—is to wear a mask.”

Children under the age of 12 are currently not eligible for the COVID-19 vaccine, most schools will be offering in-person learning this school year and right now, intensive care units (ICUs) across the country are filling up. With many families and caregivers grappling with the decision of whether or not to send their children to school with a mask, the evidence clearly shows that wearing a mask is the right decision.

Despite that, some people think children don’t need to wear masks because of a misconception that they can’t spread the COVID-19 virus to adults. According to the CDC, this is untrue. “Children and adolescents can spread SARS-CoV-2 to others when they do not have symptoms or have mild, non-specific symptoms and thus might not know that they are infected and infectious.”

Children can become infected with Sars-CoV-2 and transmit the virus to their parents, caregivers, grandparents and so on. With limited space in hospitals to care for COVID-19 patients, this becomes an issue.

“We don’t have the same number of health care workers as we did last year to do the same amount of testing. We have a significant workforce issue. The best thing we as a community can do for our health care workers, is to get vaccinated and wear masks,” says Richard Orlandi, M.D., associate chief medical officer of ambulatory health at U of U Health.

“The best thing we as a community can do for our health care workers, is to get vaccinated and wear masks.”

Richard Orlandi, M.D.

Does wearing a mask affect your mental health?

“The evidence that we have does not point us to any concern that masks affect mental health negatively,” says Jeremy Kendrick, M.D., assistant professor of psychiatry, Huntsman Mental Health Institute.

We are experiencing a mental health crisis on top of a pandemic, and for children, this can be even harder. “It is a fact that kids are more anxious and depressed right now. Parents want to do everything possible to reduce that anxiety and depression. However, let’s fall back on data,” Kendrick says. “There is no evidence that a child wearing a mask causes depression or anxiety.”

When it comes to anxiety, school children do not like to feel different from their friends. “One of my concerns about an environment with one child doing something different than the other is it could lead to some kids feeling anxious. One of the benefits of all kids wearing masks is everyone is on a level playing field.” Kendrick says.

“There is no evidence that a child wearing a mask causes depression or anxiety.”

Jeremy Kendrick, M.D.

Masking in children

Masks can be worn safely by children all day. However, fit and material matter. Look for masks with multiple layers, something that is comfortable and that fits your child’s face. If there are gaps on the sides, choose a different size. If a KN95 mask is available for your child, that is the best option.

There is misinformation circulating that children breathe in carbon dioxide when they wear masks. “When you exhale, you exhale carbon dioxide molecules. Fortunately, carbon dioxide molecules are tiny, and they are smaller than the pores in our mask,” Hersh explains. “So, the concerns that have been raised about carbon dioxide building up in a mask and leading to carbon dioxide retention in children, or others, are fortunately unfounded.”

Research done by the Utah Hero project found that children are very successful at wearing masks all day while participating in normal school activities and in an environment where mask use is promoted, children succeed.