States, local governments, and schools have had to make difficult decisions during the coronavirus pandemic about how to best serve students while also keeping them — and adult school staff — as safe as possible from the risk of COVID. The debate about whether kids should be required to wear masks has become heated, and the facts have become skewed.

Everyone loves the party game “Two Truths and a Lie.” Can you identify which of the three following statements about masking children is a lie?

A. Young children are at relatively low risk of contracting and spreading COVID.
B. Young children in most European countries do not wear masks, even in school.
C. Masking kids has been studied in depth; no study shows any downsides to masking.  

A. True. It’s a great blessing that COVID doesn’t pose as serious a health risk to children as it does to adults. Despite hysterical headlines, this is also true for the Delta variant. Critically, young kids do not significantly spread COVID either. Several large studies have shown that young kids transmit COVID at a lower rate than adolescents and teens do, and a much lower rate than adults do. One epidemiologist who headed a kids-and-COVID study said kids “aren’t taking [the virus] home and then transferring it to the community. These kids have very little capacity to infect household members.” Furthermore, now that all adults who work in schools have had a chance to get vaccinated, the risk to adults of serious illness from COVID infection is even smaller

B. True. When it comes to masks on young children (meaning those below the age of about 10), the United States is an outlier. We are certainly extreme considering the CDC recommendation to mask children as young as age 2. The World Health Organization has held since August 2020 that no one under the age of 5 should be required to wear a mask. European countries, including the U.K., Ireland, all of Scandinavia, France, the Netherlands, Switzerland, and Italy, do not require masks on kids (with varying age cut offs). Experts in these countries seem to recognize that masking young children may impose risks and harms. Public Health England’s medical adviser Dr. Susan Hopkins said “It’s important that primary schoolchildren don’t wear face coverings,” because COVID infection rates are low among their age group and wearing face coverings “could affect their development.”

C. False. The American Academy of Pediatrics recently tweeted “Babies and young children study faces, so you may worry that having masked caregivers would harm children’s language development. There are no studies to support this concern.” The problem with this tweet, and with the AAP’s extreme pro-mask stance in general, is that, as the aphorism goes, “the absence of evidence is not evidence of absence.” Sadly, we don’t have strong evidence either way (to show that mask wearing does or does not impact language development). Some studies have indicated some other concerning associations with mask wearing in kids: increases in anxiety and depression; decreases in communication and socialization skill development; increases in headaches, face rashes and redness, and impaired facial recognition; and increases in tooth decay. This is an area that deserves further study, but it is not accurate to say there’s no reason for concern or potential downside of masking. 

In the absence of evidence that masking young kids causes significant harm or provides significant benefit, the questions surrounding mask mandates become purely political: Who should decide if children wear masks or not? Who decides which risk to take? Parents or politicians? Who faces the burden of proof, anti-mask parents or pro-mask administrators?

Ultimately, we believe that parents should always have the greatest degree of control when it comes to issues that affect their children. When we consider the relatively low rate of spread in schools, the wide availability of the vaccines for adults, and the low risk of COVID-related illness in young children, parents should have the choice to say no to masks on young children.