In general, the thicker and more occlusive the better.  The best homemade options are triple layered cloths or clothes with filter inserts which have a bendable nasal bridge and fit snug.  Try a few materials.   A mask that is so thick that a child pulls it down is not a very good mask, even though it filters well.   Chose a mask the child will actually leave on.

What is the best possible mask?

N-95s (14) remain the gold standard.   Surgical masks (1) are also excellent.  Adult sized N-95 and surgical masks are not generally advised for school children because of availability as well as the healthcare access needs.  So for most children, layered or filtered cloth is best.  

What is the bottom line on neck gaiters and neck fleeces (11)?

A recent non-peer reviewed study at Duke indicated that gaiters and bandana’s (12) may not perform as well as other multilayered textiles.   Not every product, however, is made the same.   Use common sense.   While the science is still early and not proven, there are things to consider.   Most gaiters are designed to reduce UV exposure and be extremely breathable and porous.   But some gaiters or neck fleeces may be better than others or offer layers.  Do your research or test it out yourself.  If you child loves the gaiters but they seem thin, consider making a pocket and inserting a MERV 13 air filter cutout to improve filtration.  Remember, the best mask is the one your child will keep wearing!

Bandana’s (12)?

Bandana’s with open bottoms are better than nothing, but still leave a lot of room for access of exhaled droplets onto surfaces below the wearer.  

Masks that seem great but maybe aren’t

Good mask function to filter both inhaled air and exhaled air.   Many folks arrive in our office with masks that have a one-way filter on them (2, below examples).   Exhaled air bypasses the mask filter and goes out to the room.  This makes for comfort for the wearer, but doesn’t reduce risk as well for others around them.   These are seen in both cloth and N-95 variants.   Check your mask for a valve and consider covering valves if your child must wear them.

Mask Age and Science

While the governor mandated masks down to 10 years, we have found that most kids can wear them well down to 2 years, consistent with AAP and CDC recommendations.   Each school will balance the benefit of facial cues with benefits of masking in their policy.  This is typically based on age, development, and each child’s individual needs.   Kids with special needs will often need modifications.

    There is not a mound of definitive data yet for the benefits of masking to mitigate school coronavirus spread.   As with most pediatric medicine, we make reasonable assumptions based on adult data.   Masks clearly reduce COVID-19 spread in adults and are reasonably expected to reduce spread in schools and children.   The extent of that benefit may be unclear, but we believe it is important to be reasonably cautious for now.  Also, please be kind and avoid judgement of mask choices.  There are many reasons that some masks may be chosen over others, and we rarely know all the factors. 

Practical

Ok, I get the basics.  Now what do I buy?   Check out Nurse Monica’s post on mask reviews and purchases here.