Making Kids Wear Masks Isn't Child Abuse

This transcript has been edited for clarity.

My evidence-based and hopefully mostly vaccinated colleagues: According to the new Centers for Disease Control and Prevention (CDC) guidelines, a lot of us can finally get rid of these masks in the public setting. However, many of my colleagues, friends, and patients have been asking about kids. What about their unvaccinated children? Do they still have to wear masks? Well, the answer is yes, and not everyone's happy about this.

Recently, Tucker Carlson went on primetime news and compared mask wearing in children to child abuse. Now, I found this comparison egregious, so I made an Instagram post about it saying it's not child abuse and children should still be wearing masks. Well, the response to my Instagram post was a combination of ridiculous but also thought-provoking, and it had me thinking about where we need to go with respect to mask recommendations in kids.

Many parents and health professionals agree with me, but I was surprised at how many people outright said, "You know what, masks and children is child abuse." No matter what, they would never make their kids wear a mask. I'll skip all the angry, profanity-laden comments and the usual anti-mask rhetoric about masks causing hypoxia and bacterial pneumonia, or how doctors are paid off by Big Pharma and want to harm children. Instead, I'll focus on the civil comments I got from people saying, "Hey, I'm not anti-mask, but no matter what I do, my 2- to 3-year-old's not going to wear one, and it seems abusive for me to force them to."

This got me thinking. There are plenty of reasons why children should be wearing masks, and a lot of kids have gotten used to it. Parents have done a great job in helping them, such as practicing mask wearing at home or decorating your own mask. I've seen kids as young as 2 safely wear a mask — happily, no issues. But then on the other hand, there are a lot of kids who absolutely cannot tolerate mask wearing or can't wear one without constantly messing with it, especially kids with sensory issues or underlying medical conditions. The struggle will continue as long as we're still in a pandemic, there are still mask requirements, and we're still waiting for a vaccine to be approved for young kids.

While the CDC recommends that all kids above the age of 2 wear a mask, the World Health Organization (WHO) differs and has more age-based guidance. According to the WHO, kids under the age of 5 shouldn't be wearing masks. Age 6-11 is more of an individualized risk-based approach, and kids above the age of 12 should all be wearing masks. Also, according to the WHO, kids should not be wearing a mask while they're playing sports, and the CDC kind of says the opposite. Now, I know this discrepancy is old news, and we've talked about data regarding transmission, disease severity in kids, reopening schools, and all that jazz. But this debate isn't going away anytime soon. As businesses and schools reopen, there's bound to be a tug of war between mask guidelines and frustrated parents.

Businesses, schools, daycares, and even Disneyland require masks for young kids now and for the foreseeable future. Now, both Moderna and Pfizer have trials underway for kids as young as 6 months, but it's going to be a while before they can get their vaccines. Pfizer is expected to submit an emergency use authorization in September. That's at least 5 months before kids as young as 2-11 years old can get their shots. Before then, a lot of kids might be off to summer camp, and I'm sure their parents are ecstatic about this. But the recent CDC mask guidelines for summer camps maintain that all kids at summer camps need to be wearing a mask except for when they're swimming or eating. That seems a little strict to expect 2- to 3-year-olds to keep a mask on while playing outside.

Last, let's talk about travel because I feel like every week there's a different video or headline about a family being removed from a flight or an airport dispute because a 2-year-old doesn't want to wear a mask. Now, I know air flight is different because you're in an enclosed space with other individuals, but I feel like as travel re-enters our lives, we're going to hear more and more of these stories. I made my own fancy Twitter poll and I asked people if they actually thought 2- or 3-year-olds should be required to wear a mask on planes. And 63% of people said they absolutely should, but 35% of people said no.

https://twitter.com/AlokPatelMD/status/1390011919910641665

I want to know what you all think. We know older kids and teens can still catch and spread the virus. When appropriate, they should still be wearing masks. But it's a completely different story for those younger kids, especially when they're outside. Hopefully, all this becomes a topic of the past once we get more vaccines out there and we finally get out of this pandemic. But for now, do you think we should stick with the CDC's guidance — require masks in all kids above the age of 2? Or should we lean more into the World Health Organization's model?

Comment below, and please don't send me any hate mail, although I'm kind of expecting somebody to because that's what happens every time I talk about masks.

Alok S. Patel, MD, is a pediatric hospitalist, television producer, media contributor, and digital health enthusiast. He splits his time between New York City and San Francisco, as he is on faculty at Columbia University/Morgan Stanley Children's Hospital and UCSF Benioff Children's Hospital. He hosts The Hospitalist Retort video blog on Medscape. Follow Alok Patel on Twitter.

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