Student Well-Being What the Research Says

Face Masks and Kids: Separating Fact From Fiction

By Arianna Prothero & Sarah D. Sparks — August 18, 2021 8 min read
Image of a face mask on school notebook.
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The fight over whether schools should require face masks to help slow the pandemic shows no signs of dying down, but in the science community, there’s little debate.

“Vaccination is number one, but masking is number two and is therefore the most effective way to reduce spread of COVID in settings where people [including children less than 12] cannot be vaccinated,” said Dr. Mike Smith, a professor of pediatrics at Duke University School of Medicine. He co-authored the ABC Science Collaborative study published in Pediatrics, which tracked the effectiveness of mitigation efforts in 100 school districts across North Carolina.

The American Academy of Pediatrics has consistently supported universal masking for all vaccinated and unvaccinated children and adults in schools, even when the Centers for Disease Control and Prevention briefly suggested earlier in the spring that vaccinated individuals could go without masks.

Both groups now urge universal masking because it could be months before a vaccine is available for students under 12, and few schools have systems in place to monitor vaccinations for adults and the students on campus who are eligible for them. With no ability to create herd immunity and amid highly contagious new strains of the coronavirus, “universal masking is the best and most effective strategy to create consistent messages, expectations, enforcement, and compliance without the added burden of needing to monitor vaccination status,” the AAP says.

The AAP also says masks could help schools avoid outbreaks of other respiratory illnesses in what are expected to be especially bad cold and flu seasons.

Even so, policies on masking now vary significantly state by state and district to district.

School Mask Mandates at a Glance

This information is no longer being updated. The last data update was on May 23, 2022.

  • MASK MANDATE BAN IN EFFECT


    1. Florida

    On Sept. 22, Florida's surgeon general instituted a rule that gives parents and legal guardians "sole discretion" over masking in schools. On Nov. 5, a judge sided with the state health department in a legal challenge to rule. On Nov. 18, Gov. DeSantis signed a bill that allows parents to sue school districts that require masks.

    2. Georgia

    On March 29, Gov. Kemp signed the “Unmask Georgia Students Act” which allows parents to exempt their child from a school mask requirement. The law went into effect immediately.

    3. Iowa

    On Sept. 13, 2021, a federal judge ordered Iowa to halt enforcement of its law banning mask mandates in schools. On Jan. 25, 2022, a federal appeals panel narrowed that injunction. Iowa’s attorney general announced the state is not enforcing the ban while awaiting further action from the court. On May 16, 2022 a U.S. Court of Appeals lifted the injunction.

    4. Oklahoma

    On Sept. 1, an Oklahoma judge temporarily blocked the state law banning school mask mandates, but students or their parents can still opt out of school mask mandates if they choose.

    5. Utah

    In Utah, local health departments can issue 30-day school mask mandates with approval from the state or county government, according to the state’s top education official.

    6. Virginia

    On Jan. 15, Gov. Youngkin issued an executive order allowing parents to opt their child out of any school mask mandate. It effectively rescinded the state's school mask requirement that had been in place since August. That executive order was later halted by a judge. On Feb. 14, the Virginia legislature passed a measure that bans school mask mandates. That bill was signed by the governor on Feb. 16 and went into effect on March 1.

    MASK MANDATE BAN BLOCKED, SUSPENDED, OR NOT BEING ENFORCED


    1. Arizona

    On Sept. 27, a judge in Arizona blocked the state laws banning mask mandates that were set to take effect on Sept. 29. On Nov. 2, the Arizona Supreme Court upheld that ruling. On April 25, Gov. Ducey signed HB2616, which prevents schools from requiring a student to wear a mask without first getting parental consent. The ban, which replaces the one blocked by the courts, will go into effect 90 days after the legislature adjourns.

    2. Arkansas

    An Arkansas judge ruled on Dec. 29, that a law signed by the governor in April that prohibited local officials, including school boards, from setting mask mandates was unconstitutional. School districts have been able to set their own mask requirements since August when the judge put the law on hold.

    3. South Carolina

    On Sept. 28, a federal judge suspended South Carolina from enforcing the rule that banned school districts from requiring masks for students.

    4. Tennessee
    5. Texas

    On March 17, an appeals court upheld an injunction that blocked Gov. Abbott's executive order banning mask mandates in schools, finding it is unlawful and exceeding the governor's authority. This is not the first time the state's ban has been halted by a judge.

    MASK REQUIREMENT IN EFFECT


    1. Hawaii

    Although Hawaii's state-wide indoor mask mandate ended on March 25, indoor masking will still be required in public schools at least through the summer.

    PREVIOUSLY HAD MASK REQUIREMENT


    1. California

    On Feb. 28, the governors of California, Oregon, and Washington issued a joint announcement that mask requirements would end in their states effective March 12.

    2. Connecticut

    On Feb. 7, Gov. Lamont announced that the school mask rule would expire Feb. 28. He signed a bill on Feb. 15 that made the expiration date official.

    3. Delaware

    On Feb. 7, Gov. Carney amended his emergency order to allow his state-level school mask requirement to expire March 31. On Feb. 28, he announced that masks would no longer be required effective at 6:00 p.m. on Tuesday, March 1.

    4. District of Columbia

    On March 8, the department of health released updated guidelines that recommend universal masking only when community COVID-19 levels are high.

    5. Illinois

    On Feb. 5, a judge issued a temporary restraining order on the governor's statewide mask requirement. On Feb. 25, the state supreme court vacated that order. On the same day, the governor announced he would lift the requirement on Feb. 28.

    6. Kentucky

    Kentucky's school mask mandate ended in September, when the state legislature voted to limit the governor’s emergency powers.

    7. Louisiana

    According to a State of Emergency proclamation issued Nov. 23, which was extended on Jan. 19, students were required to wear masks in schools, but districts could opt out of the mandate if they adopted an isolation and quarantine policy consistent with the state's department of health protocols. On Feb. 16, Gov. Bel Edwards extended the order without requiring masking in schools.

    8. Maryland

    On Jan. 5, the mask mandate was extended for 180 days, but allowed school districts to opt out if certain vaccination rates were met. On Feb. 22, the state board of education voted to rescind the mandate. On Feb. 25, a state legislative committee gave final approval to lift the mandate effective March 1.

    9. Massachusetts

    On Sept. 27, the state began allowing schools to apply for a waiver from the face covering rules for vaccinated individuals if certain vaccination rates were met. On Feb. 9, officials announced the statewide mask requirement for K-12 schools would be lifted on February 28.

    10. Nevada

    On Feb. 10, Gov. Sisolak announced the immediate suspension of the school mask requirement. The previous mask requirement had only applied to counties with populations of 100,000 people or more.

    11. New Jersey

    On Feb. 7, Gov. Murphy announced plans to end his state’s school-mask requirement on March 7.

    12. New Mexico

    On Feb. 17, Gov. Grisham announced the end of the mask requirement, effective immediately.

    13. New York

    On Jan. 24, a judge struck down the state's mask mandate. A day later, an appeals judge restored the mandate. On Feb. 27, Gov. Hochul announced the mandate would be lifted on March 2.

    14. Oregon

    On Feb. 7, health officials said the state would drop its school mask requirement no later than March 31. On Feb. 24, the Oregon Health Authority announced the requirement would lift on March 19. However, on Feb. 28, the governors of California, Oregon, and Washington issued a joint announcement that mask requirements would end in their states effective March 12.

    15. Pennsylvania

    A statewide mask mandate for Pennsylvania schoolchildren was thrown out by the state Supreme Court on December 10.

    16. Rhode Island

    On Feb. 9, Gov McKee announced the school mask mandate would only remain in effect until March 4. On Feb. 15, he signed an executive order specifying that the order would take effect at 5 p.m. on March 4.

    17. Virginia

    On Jan. 15, Gov. Youngkin issued an executive order allowing parents to opt their child out of any school mask mandate. It effectively rescinded the state's school mask requirement that had been in place since August. That executive order was later halted by a judge. On Feb. 14, the Virginia legislature passed a measure that bans school mask mandates. That bill was signed by the governor on Feb. 16 and went into effect on March 1.

    18. Washington

    On Feb. 17, Gov. Inslee announced the state's school mask requirement will end effective March 21. However, on Feb. 28, the governors of California, Oregon, and Washington issued a joint announcement that mask requirements would end in their states effective March 12.

  • NOTES
    In January 2022, the Missouri attorney general, Eric Schmitt, sued some school districts that required masks, citing a November ruling by a county judge that said local health orders tied to COVID-19 were illegal. (The ruling was interpreted differently by different districts.) The state’s treasurer announced he would also crack down on schools with mask mandates. In mid-March, Schmitt began dropping lawsuits against school districts that no longer required masks. On May 19, 2022 Schmitt announced new lawsuits against several districts that had reinstated mask requirements.
    On Feb. 23, 2022, New Hampshire’s governor announced the state was no longer recommending universal indoor masking and therefore schools have to end mask mandates, arguing they violate state education department rules. Soon after, the department advised districts that the mandates “are inconsistent with” their rules. There’s disagreement over whether districts still have the authority to require masks, but at least one district changed its policy in response. A bill that would have banned mask mandates was vetoed by Gov. Sununu in May 2022.
    Updated 5/23/2022 | Sources: Local media reports, Education Week reporting | Learn more here

“What we want is for teachers, staff, and students to be safe. If they want to go to in-person learning, [masking] has nothing to do with the politics. It has everything to do with public health and safety,” said Dr. Tina Tan, a pediatric infectious disease doctor at Lurie Children’s Hospital in Chicago and a coronavirus expert with the Infectious Disease Society of America.

“You know, one of the major impacts of virtual learning has been that kids have not actually had social contact with other individuals. But when you’re talking about going back to school, you are at least having some social interaction so that socially and emotionally you’re able to develop, so maybe you have to be able to wear a mask because that is the only way you’re going to be able to do in-person school,” she said.

But misinformation about masks for children abounds. Here’s what experts have to say about some of the most common myths.

Myth: Children don’t need masks in schools because they don’t get COVID-19.

Fact: It’s all relative. For most of the pandemic, children under 10 have had both lower rates of illness and fewer symptoms than older adolescents or adults. However, studies have found that even when asymptomatic, a child could contract the virus and carry as many or more infectious viral particles as an adult. One new study also finds toddlers and children ages 4 to 8 had higher odds of transmitting the coronavirus to others in their homes than teenagers did, even though teenagers were more likely to get infected in the first place.

“Masking does offer some protection to the student wearing the mask, but masks are really effective because they reduce the likelihood of children with asymptomatic infection spreading disease,” said Smith, from Duke University’s medical school. “COVID is spread via respiratory droplets, which masking contains and keeps from spreading. This is why universal masking is a much more effective strategy and the safest option for the school setting.”

Myth: Carbon dioxide and other toxins build up in masks during the day, causing breathing problems.

Fact: Oxygen and carbon dioxide molecules are significantly smaller than even the smallest viral particles and droplets captured by face masks. Both gases easily pass through face masks and do not build up within them. Nor do masks build up mold (unless they’re left wet and unwashed).
However, a mask that protects against viral particles must fit closely against the face, and studies have found that over hours of wear, pressure against the face and humidity can cause minor headaches and skin irritation. Allowing students breaks to remove their masks in outdoor, physically distanced spaces every few hours or if they show signs of discomfort can help.
The type of masks children wear do matter. While they might be associated with greater protection from the coronavirus, school leaders should caution parents and teachers not to opt for the highest-grade medical masks for daily wear.
“Not N-95,” Tan said, “it makes it very difficult to breathe. It is almost impossible, if an N-95 mask is fitted correctly, to wear it all day.” Internationally rated KN-95 masks may also have this issue. She said schools should suggest cloth or disposable two-ply or greater masks for school wear.

Myth: Young children aren’t capable of keeping masks on all day.

Fact: “Younger children are capable of wearing masks and have adjusted very well,” said Smith.
In Smith’s study on the effects of masking in North Carolina schools, there was 90 percent compliance in the two districts that kept track of adherence to the masking requirement.
If anything, younger children are better at masking than older ones, said Tan.
“We’ve learned over the past year that even though people said younger kids would not be able to do it, it’s really more the teenagers that forget to wear the mask or forget to put it back on after they’ve taken it off; it’s not the younger kids,” she said.
Researchers in France surveying parents and pediatricians about mask wearing found similar results: 6-year-olds were more accepting of wearing masks than 10-year-olds. The researchers said that could be because parents and teachers took more time to explain the reasons for mask requirements to younger students. It could also be because 10-year-olds are on the cusp of adolescence and starting to rebel more.
Overall, the researchers found that children in the study had become accustomed to wearing masks. Children, and parents, who did not understand the reasons for wearing face masks were less tolerant of it.
Key to getting children to wear their masks is setting an example, said Tan.
“If you start modeling mask-wearing, we know that these younger children are able to keep the masks on,” she said. “They don’t pull them off.”

Myth: Masks are too uncomfortable or distracting for students with sensory issues.

Fact: “Children who have severe underlying medical problems—if they are very developmentally delayed; if they have respiratory issues where they might be on a ventilator or they have a trach; or they have other serious medical problems—these individuals may not be able to keep a mask on or it might make it difficult for them to breathe,” Tan said, “but for normal, healthy children, there’s absolutely no medical indication that they can’t wear a mask.”
That includes many children with sensory impairments, such as autism spectrum disorders. Mask-wearing can be challenging for students who have extreme sensitivity to touch and who avoid eye contact, or are having a more difficult time interpreting facial expressions generally. However, one international study found students with autism could be taught to choose and wear face masks correctly, even via a video conference, particularly if family helped model mask wearing at home. Separate studies suggest students may tolerate soft cloth masks better, particularly if they are allowed to choose the masks themselves.

Myth: Children shouldn’t wear masks because it hurts their social and emotional development.

Fact: There is no hard yes or no answer to this one.
There doesn’t appear to be any research specifically on whether masking is detrimental to children’s social and emotional development, said Justina Schlund, senior director of content and field learning at the Collaborative for Academic, Social, and Emotional Learning, or CASEL.
One claim that has come up repeatedly in debates over masks in schools is that when children can’t see people’s faces, they can’t learn to read and respond to other’s emotions.
While there’s no doubt wearing a mask makes it harder to see how people are feeling, said Schlund, there are tradeoffs and workarounds that educators and parents should consider.
“There are lots of ways that students’ social and emotional well-being is impacted in school and that includes their physical health and their families’ physical health,” she said. “There are a lot of challenges with learning through virtual platforms. And masks allow for more in-person learning and in-person relationship building.”
It’s a common misconception that SEL is only about learning emotions. That’s only one part of social-emotional learning, which includes a lot of other skills such as how to build relationships and make responsible decisions, said Schlund.

There are also many ways to express emotions beyond using our mouths, she added. We do it through our eyes, our body language, and our tone of voice. Schlund said educators in situations where students and teachers are masking should use the opportunity to expand students’ emotional vocabularies.

Myth: Students learning English (and their teachers) shouldn’t wear masks because they can’t learn language skills without being able to see mouth movements.

Fact: It’s true that masks, if properly worn, cover the entire lower half of the face from the nose down, obscuring facial expressions and the shape of teachers’ students’ mouths as they speak. Educators have found that students do have a harder time following directions, phonics lessons, and social cues when masked.

However, it’s not clear yet from research whether students learn phonics and other language skills better from a teacher in person with masks or via online lessons without masks, or a combination of the two.

Health and education researchers alike have been developing strategies to bolster communication for students while wearing masks, such as slowing down speech, using gestures to mimic what is being said, and providing detailed written explanations for daily lesson concepts to children and their families. Some companies have begun to manufacture face masks with clear panels over the mouth; however, face shields which are open at the sides and bottom do not protect against airborne viruses.

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A version of this article appeared in the September 01, 2021 edition of Education Week as Face Masks and Kids: Separating Fact From Fiction

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