Kids and Masks

Emily Oster

9 min Read Emily Oster

Emily Oster

Kids and Masks

Emily Oster

9 min Read

The approval of vaccines for 5- to 11-year-old kids last week left a lot of parents (including this one; both kids had a first dose last Thursday) very relieved. It’s also given more attention to the ongoing conversation about when it makes sense to dial down some of the other COVID mitigation strategies — notably, masks. In recent weeks, a number of articles (here, here, here) have been written about the need to articulate “off-ramps” for masking in schools. These pieces recognize that while in-school masking provides some protection, with lower case rates and vaccines for kids and adults widely available, there will be a time to remove this layer. It goes without saying that the discussion is very fraught and generates a lot of anger.

A number of pieces have also been written about the evidence of the protective value of masks in schools. Not everyone agrees on that topic. But today I want to look at what we know about the other side of the coin, which is actually the question I get most frequently from parents: Are  there any downsides to mask wearing for kids in school or child care?

This feels important to consider, since it influences how we think about changes in masking policy. Here’s a simple thought experiment. Say that, instead of face masks, you protected against COVID-19 by wearing a friendship bracelet. Even still, some people would object to forcing children to wear one, claiming it infringed on freedom of expression, but most people would be willing to continue the practice as long as we believed it had some protective effect. On the other hand, imagine that the protection required kids to wear a blindfold at school. Again, some people would argue for continuing this indefinitely, at least until we reached “zero-COVID,” but most people would say that we’d need to be convinced of significant value to continue it.

All this is to say that as we contemplate off-ramps, or a move to “mask-optional” approaches in schools, the question of whether there are downsides to masks and, if so, how large they are matters. We will — and should — think about it differently depending on whether masks are more like friendship bracelets or more like blindfolds.

Interruption to say: By and large, kids have adapted extremely well to masks. They are able to wear them, and they don’t complain (much). Which is all great! But it doesn’t necessarily mean there are not some possible downsides.

When people discuss possible concerns with masks for kids, there are a few key issues that are raised:

  • Interference with breathing/respiratory health
  • Interference with social development (ability to read emotions and interact with friends)
  • Interference with intellectual development (learning to speak, learning to read, learning in general)
  • Concerns about students with disabilities

A TL;DR is that answering most of these questions precisely is extremely difficult or impossible. But by triangulating across different pieces of data, we can start to get a picture.

Respiratory function

In June, JAMA Pediatrics published a study in which the authors suggested that face masks cause children to inhale dangerous levels of carbon dioxide. This was based on laboratory measurements, and it really scared parents. Without going into details, the most important thing you should know is that the study was retracted. The calculations ignored some basic understanding of how breathing works. In fact, at least one other study (not retracted!) evaluated respiratory function in infants and young children while wearing masks and did not find any evidence of impacts.

There’s other work focused on the theory of whether face masking would impact respiratory function, even during exercise, that does not suggest impacts. The bottom line is that while you can certainly find anecdotal evidence of people claiming their child cannot breathe wearing a mask, this isn’t a claim that is well supported in the data.

Social and intellectual development

I’m going to lump these together, because the type of evidence we bring to bear on them is roughly the same.

Stepping back: the concerns here stem from the observation that the bottom half of the face is important for reading emotions, learning to speak, and learning to read. The theory behind this is compelling.

In the study of socioemotional development, the idea of facial expressions conveying emotions goes back to Charles Darwin (in one of his lesser-known books, The Expression of the Emotions in Man and Animals). As adults, it should be obvious from our own experience that we use facial expressions to understand the emotions of others.

This is a skill that develops over childhood (see, e.g., this paper on how kids get better at reading emotions from faces between the ages of 3 and 11). Kids differ in the speed at which they develop this ability; there is literature on how children’s reading of facial expressions correlates with their social skills. This starts early: Infants respond to faces, rapidly learning to distinguish between happy, sad, and other emotions, and can distinguish their mom’s face from others within a short period.

There is also a potential role for facial expressions in language development. Watching how mouths move is part of learning to speak (see, e.g., this paper). And when kids need help with speech issues, being able to observe the movement of their mouth and the mouths of others in pronouncing letters is crucial.

A final argument relates to hearing. There is direct evidence that masks make it difficult to hear the speaker, and that this may be exacerbated for kids in loud classrooms. It stands to some logic that if you are trying to teach a young child to read — or, really, do anything — it is valuable for them to be able to hear you. And social interactions are better if kids can hear each other and be heard by teachers.

Putting all this together, it is reasonable to think that some aspects of learning or social skills may be impacted by masks, and indeed others have argued this. But this isn’t quite the same as direct evidence that masking matters, and it doesn’t tell us about magnitudes. Maybe seeing half a face is almost as good as a whole face. The impacts of hearing on learning may be small.

Large-scale evidence on the particular question of masking in schools and development is lacking and is unlikely to ever appear. One could imagine exploiting differences across schools in mask policies to look at differences in learning outcomes, but you would rapidly realize in doing so that too many other things vary across these schools. There will never be anything convincingly causal.

What we can see is a bit of lab-based evidence on masks directly, especially on emotion-reading. There is, for example, this paper showing that children performed worse on a face-perception test when masks were involved versus without. There’s also this paper — co-authored by a researcher and a 9-year-old — which showed that children had trouble reading emotions from masked faces. Or this one, which showed that masks reduced kids’ ability to read emotions from pictures (though notably, not more than sunglasses).

This type of in-lab analysis for studying language development or learning evolution is less feasible, and there is therefore little we can say directly.

In the end, what we arrive at is a lot of theoretical reasons to think that masking could be somewhat detrimental to social learning and intellectual progress, with the evidence for the former being somewhat stronger. It is nearly impossible to be precise about magnitudes.

Students with disabilities

For students with disabilities — especially students who are deaf, or those with autism, for whom reading emotions is already more challenging — masks may be a particular barrier. There is some direct evidence among children with hearing impairment of masks impacting their word understanding.

A challenge is that these students are also, in some cases, at higher risk for COVID-19. There is a balance, then, between risk and benefit.

Summing up

It remains extremely difficult to make any concrete statement about possible risks or downsides of masks in kids. Perhaps the strongest evidence is on impacts on emotion-reading, but even there we have to ask: How much does it matter in practice? If kids are unmasked at home and when out at recess, is it a big deal to wear a mask while learning to subtract?

We expect variation in impacts across children. Those who are slightly hearing-impaired, or have more trouble paying attention, may be more affected by the muffled nature of voices through masks. Those kids who struggle more to read emotions may benefit more from getting “whole-face” information and, on the flip side, struggle more with masks.

None of this is intended to scare parents. Kids are resilient, kind of amazingly so. If your child is in school with a mask, you shouldn’t panic — and far, far better to be in person at school with masks than at home without.

So this isn’t a moment to be scared about yet another thing. But what seems quite clear to me in reflecting on this is that masks are not a friendship bracelet. The effects may be small, or mixed across kids, but in the absence of a disease risk, we would not have children mask at school or child care. And these effects are likely larger for younger kids. Which means that there are strong reasons to consider when we will feel the COVID risks are such that we can remove masks, probably even before the youngest kids are vaccine-eligible. Which, basically, means we need to design off-ramps.

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Updated CDC Guidelines for School and Child Care

NO QUARANTINES!!!

Emily Oster

Instagram

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The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
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It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
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Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor
...

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better.  Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough. 

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better. Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough.

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips
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When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips
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The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth
...

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata
...

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships
...

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles
...

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity
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What's in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you.

What`s in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you. ...

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport
...

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way. 

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way.

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes
...

Congratulations on making it through another year of panic headlines! We’ve had some doozies this year, like aspartame causing cancer and the perils of white noise, but these headlines are very often based on poor data. Correlation does not equal causation. There will certainly be more panic headlines in 2024, but ParentData is here to debunk them for you.

#emilyoster #parentdata #happynewyear2024 #panicheadline #datadriven

Congratulations on making it through another year of panic headlines! We’ve had some doozies this year, like aspartame causing cancer and the perils of white noise, but these headlines are very often based on poor data. Correlation does not equal causation. There will certainly be more panic headlines in 2024, but ParentData is here to debunk them for you.

#emilyoster #parentdata #happynewyear2024 #panicheadline #datadriven
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