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School mask mandates have become something of a political lightning rod in the United States during the COVID-19 pandemic--and, in recent weeks, the dominos have started to fall as one state after another has announced plans to lift their mandates.

Some parents and teachers have cited concerns that masks harm kids by impairing their ability to breathe, slowing their social and emotional development, and causing them anxiety. But experts say that the science doesn't back up those worries.

It's understandable why there might be confusion, says Thomas Murray, a pediatrician at the Yale University School of Medicine. There's no question that masking reduces the spread of disease, but the evidence is less cut and dry about how masking affects kids emotionally and developmentally over the age of two. To answer that definitively would require that researchers asking people to shed their masks for a randomized trial, the gold standard in science, which would be unethical. So, most masking research is based on retrospective real-life observations that can be more easily cherry-picked to argue one side or the other of the debate over mask mandates.

"But we do have this human experiment that's been going on with kids wearing masks at school, and we know that we haven't seen those fears of health risks realized," says Theresa Guilbert, a pediatric pulmonologist who is a member of the American Academy of Pediatrics Section on Pulmonary and Sleep Medicine.

She and other experts say most evidence suggests that masking doesn't harm children--and that it benefits them in more ways than one. Not only do masks protect kids from COVID-19 and other respiratory diseases, but studies show that schools with mask policies in place are more likely to stay open, which decades of research show is particularly critical for kids' mental health and development. [...]

How masks affect mental health

Similarly, while some argue that school masking mandates are harmful to a child's mental health, experts say the evidence suggests the opposite. Guilbert says the most significant signal of the pandemic's toll on mental health came early in the pandemic. Back then children who were doing remote learning experienced increased levels of anxiety and depression because they weren't at school with their peers.

Gilliam and Murray, the Yale researchers, were also concerned about how school shutdowns were affecting the mental health of kids and their stressed-out parents alike. With that in mind, they decided early in the pandemic to investigate the most effective strategies for keeping schools and early childcare programs open.

In May 2020, the researchers surveyed 6,654 childcare professionals in all 50 U.S. states to find out which COVID-19 mitigation tactics they were using, including social distancing, symptom screening, and masking. Then, a year later, they followed up to see if those programs had been forced to close. Their resulting analysis shows that childcare facilities with mask requirements for kids older than two were 13 percent more likely to have remained open than those where kids were not masked.

As with many of the other studies on masking in schools, Gilliam and Murray concede that their study is limited: It's based on real-world observations and could not control for other factors--like, say, whether the adults and children who masked also avoided travel throughout the same period. But it still provides more compelling evidence that masking policies have more potential to help rather than hurt a child's mental health.

"We can't wear masks forever, but you can't have kids missing 10 days of school every so often because of quarantine," Murray says.

Gilliam says blaming masks for the depression and anxiety in kids stems from a natural desire to protect them. But he suspects it's not the masking that causes stress in classrooms. "It's the trauma of COVID that the masks were intended to prevent," he says. "When you have an ache and a pain, it's the cut on your arm not the Band-Aid that went over it that's causing the problem. The purpose of the mask is to reduce all the other traumas--traumas that we know for an absolute fact harm children."

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