To mask or not to mask? That is the question parents may be facing when it comes to traveling with their young, unvaccinated children. Photo / 123rf
‘To mask or not to mask?’; that is the question regulators and parents around the world have been asking when it comes to protecting young children against Covid-19.
On one hand, masks are one of the best ways to protect children from contagious variants like Omicron, while they are too young to be vaccinated. On the other, some experts have suggested mask-wearing can challenge young people’s ability to communicate and socialise.
That’s even before considering the challenge of actually getting them to mask up.
In the wake of Aotearoa’s new mask mandates in schools, the conversation around children and face coverings has focused on weighing the health advantages against the cost of wearing a mask in a social, educational environment for hours at a time.
But, what about on flights, ferries or other domestic transport, where mask-wearing would be brief and outside of a social or educational context? Would the health benefits outweigh the costs?
It’s a question more parents may ask as they embark on domestic travel while Omicron is in the community.
What does the data say?
Due to the logistical and ethical challenges, few studies have been able to investigate mask-wearing in children. Studies that have been done focused on the physical impact of masks on children’s ability to breathe and did not find harmful effects.
Due to the limited evidence, the World Health Organization gathered a group of international and multidisciplinary experts to review the data they did have.
The results, in combination with children’s psychosocial needs and developmental milestones, led WHO and UNICEF to advise that, under some circumstances, children aged 6 to 11 should wear masks.
Factors include level of transmission in the area, mask accessibility, availability of adult supervision, impact on psychosocial development and whether they would be interacting with high-risk individuals such as the elderly or unwell.
Evidence about mask-wearing and adults, however, is far from limited. Dozens of studies from Cambridge to Bangladesh to real-world data has found the practice reduces the risk of adults contracting Covid-19.
As a result, many regulatory bodies around the world have enforced mask-wearing for children as young as two years old in a bid to protect them.
What are other countries doing?
Recent advice from the US Centers for Disease Control and Prevention states that people aged two years and older and not fully vaccinated “should wear masks in indoor public spaces.”
The US has enforced this advice and federal law requires all people aged 2 years and older to wear a face-covering in airports, planes, trains and other forms of transportation.
From January 27, the UK government dropped its mask mandate for planes, trains, buses and other forms of transport.
However, when face coverings are required by individual operators such as the London tube, Traveline and National Rail, those under the age of 11 are exempt.
The CDC stated those younger than two years old should never wear a mask due to the risk of suffocation, while the UK Health Security Agency sets the recommended minimum age as three.
Current mask mandates for travel in New Zealand
In New Zealand’s red traffic light setting, those aged 12 years and older must wear a face mask on domestic flights, public transport, ferry terminals, airports, taxis and other locations.
From February 4, all school students from Year 4 (aged 8 to 9) and up must wear a face mask on public transport and Ministry of Education funded school transport services in level red.
In other words: traveling families don’t have to pack a mask for their young kids on planes, trains and buses. It’s another question as to whether they should.
Is there a benefit for children wearing masks?
As mentioned, science indicates that, aside from vaccination, a well-fitting face mask is one of the best ways to reduce the risk of contracting and spreading Covid-19 amongst adults.
It makes sense then, that for those who cannot yet be vaccinated (such as young children) or are not yet fully vaccinated, face masks become one of the primary forms of protection.
Other tactics include ensuring nearby adults are vaccinated and masked, social distancing, and minimising time indoors with lots of other people.
The issue is, these practices become very difficult whilst sitting on a plane or catching a train.
What do the experts say?
According to epidemiologist Dr Amanda Kvalsvig, who has a background in clinical paediatrics, masks offer children effective protection against Covid-19.
“If kindergarten-age children want to wear a mask then they can – it is protective,” said Dr Kvalsvig, who works as a senior research fellow in the University of Otago, Wellington’s Department of Public Health.
“If children aren’t comfortable with the idea, no-one will insist,” she added but has previously noted that information from overseas shows Omicron triggers “an avalanche of child cases”.
Otago University epidemiologist Professor Michael Baker similarly believes masks are “one of the few ways you can actually give children an individual level of protection in indoor environments”. In line with the CDC, Baker recently told the Spinoff that “children down to the age of two years can wear a mask quite well.”
Advice for young children who want to try masking up
In New Zealand, masks are not mandatory for travelers under the age of 12 on domestic flights, public transport, ferry terminals, airports and taxis (unless it’s a school-related transport).
However, for parents and caregivers who want to encourage their children over the age of two to try masking up for travel, there are ways to make it easier.
According to psychotherapist and author of several parenting books Tina Payne Bryson, PhD, preparation is key in helping kids get on board.
“Don’t wait until the day of your flight to put the mask on your 2-year-old,” Dr Bryson told the New York Times. “Because our brains are wired to protect us, anything that is novel that doesn’t feel good can activate a big reactive response.”
Try it at home
Being in a foreign environment like a train station or an aeroplane can be stressful for little ones without the addition of masks. If they are younger and haven’t worn a mask before, practice a few times at home.
“You want to start with a minute or two at a time,” paediatrician Jennifer Shu told the Washington Post.
Parents can also provide simple distractions during this time, like stickers or coloring pens. “It doesn’t have to be anything fancy,” Shu said.
Talk about it
Few people like having to do something without understanding why. For this reason, Unicef recommends engaging your child in honest yet age-appropriate conversation about why wearing a mask is important and how it can keep people safe, including older and more vulnerable members of society.
Dr Bryson also encouraged talking about what the child can expect on the day of travel; how other people will be wearing masks, how they can be uncomfortable or when you can take them off.
Make it playful
Play is also a great tactic, Dr Bryson added. Pop a mask on their favorite stuffed toy, involve them in the process of buying or decorating their mask. Just make sure it fits well.
The Ministry of Health recommends a three-layer material mask or medical disposable mask that covers their nose, mouth and chin without gaps above, below or on the sides.
Model the right behavior
Kids are quick to spot inconsistencies between what adults tell them to do and what they do themselves. Be a great role model and mask up to show them how easy it is.
Stay up to date
Information and advice from the Government and the Ministry of Health changes constantly. Get up-to-date information on mask rules and mask exemptions on the Covid-19 website.