Mask use in children has been shown to cause no respiratory distress
In a recent study published in Environmental researchresearchers investigated whether surgical masks and N95 caused respiratory distress in children.
In a recent article published by Walach et al., they said that the use of face masks in children increased carbon dioxide (CO2) accumulate in inhaled air so rapidly to a high level that even under resting conditions they would cause serious health hazards. The authors of the current works have pointed out several methodological limitations of the Walach et al. study so that parents do not consider masking as harmful and dangerous for their children.
Walach et al. considered to be 2000 parts per million (ppm) of CO2 as CO threshold value2 toxicity. This value applies to indoor air quality, while the environment created between the face and the mask is not comparable to a closed environment. Additionally, according to the US Centers for Disease Control and Prevention (CDC) website, exposure to approximately 50,000 ppm CO2 for 30 minutes causes the first symptoms related to respiratory distress. Walach et al. reported CO2 levels between 13,120 and 13,910 ppm, well below the CO threshold2 toxicity.
Second, Walach et al. the study could not prove the alleged link to hypercapnia because they did not measure blood CO2 levels. The main physiological compensation mechanism for hypercapnia is the increase in respiratory and heart rates. Study subjects did not show any of these symptoms and they did not show a decrease in oxygen saturation (SaO2). Finally, the measuring device used by Walach et al. in their study could not adjust to the level of CO2 the changes therefore gave unreliable results.
About the study
In the current study, researchers assessed respiratory distress in children using several parameters, including end-tidal partial pressure of carbon dioxide (PETCO2), heart rate, respiratory rate and clinical signs. They monitored changes in respiratory parameters in all study subjects every 15 minutes. For the first 30 minutes, these children did not wear face masks, but were asked to wear face masks later. The masked sessions consisted of a 12-minute walk test in a 40m-long corridor.
Results and conclusion
During rest and physical activity, the use of a surgical mask did not lead to significant changes in the respiratory parameters of children. Use of the N95 mask, especially during physical activity, increased PETCO2, but remained within the normal range. Overall, none of the children evaluated in the present study showed clinical signs of respiratory distress throughout the duration of the study. In support of these findings, another recent study in adults with severe lung failure showed that surgical masks did not influence their gas exchange abilities.
In addition, several studies have shown the efficiency and accuracy of methods involving the assessment of PETCO2 to show changes in respiratory distress parameters, including venous pCO2 and arterial pCO2. The implications of mask use in the pediatric age require particular attention as it is the only non-pharmaceutical intervention measure that could reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 ). In addition, it could help contain many common pediatric diseases, which, in turn, could reduce healthcare system expenses.
More importantly, there is enough clinical evidence to support the safety of masks in the pediatric age. Thus, parents should not doubt that using the mask is dangerous for their children or increases carbon dioxide in the inhaled air. In fact, it prevents the spread of multiple pathogenic infections, including SARS-CoV-2, for the good of public health.