No Signs of Respiratory Distress in Children Who Wear Masks

Children who wore face masks did not have any respiratory distress even after a walking test, according to an original investigation published in JAMA Network Open.

Investigators from Rome monitored 47 healthy children every 15 minutes during a period of wearing and not wearing a mask in order to determine whether the use of surgical face masks in children is linked to episodes of oxygen desaturation or respiratory distress. The investigators identified the cohort and examined their mask wearing during May and June 2020 at a secondary-level hospital pediatric unit and further categorized the children by age. Group A was made up of 22 children under the age of 2 years, of which half were boys. Group B was made up of 25 children aged 2 to 12 years and there were 13 boys.

The study authors noted that 2 Group A children dropped out due to mask intolerance, adding that their intolerance may have been associated with a possible bias, which they evaluated in a post-intervention debrief. When the parents of these children conducted the training instead of the doctor, the study authors observed better compliance, they said.

The investigators said that the children were monitored every 15 minutes for changes in respiratory parameters for 30 minutes while not wearing a surgical face mask and then the following 30 minutes while they were wearing a face mask. Additionally, they noted, children aged 2 and older participated in a 12-minute walking test.

For both groups of children, the investigators observed no significant change in terms of partial pressure of end-tidal carbon dioxide, oxygen saturation, pulse rate, or respiratory rate during the study period.

The study authors did note that there was a significant increase in median pulse rate after the walking test for Group B:

• First 15 minutes: 90 pulsations/min
• First 30 minutes: 91 pulsations/min
• First 45 minutes: 90 pulsations/min
• First 60 minutes: 90 pulsations/min
• After walking test: 105 pulsations/min

The mean distance traveled by the children in the walking test was 808 meters, according to the study authors.

Respiratory rate also jumped after the walking test for Group B:

• First 15 minutes: 20 breaths/min
• First 30 minutes: 21 breaths/min
• First 45 minutes: 22 breaths/min
• First 60 minutes: 24 breaths/min
• After walking test: 26 breaths/min

The study authors said that no child showed clinical signs of respiratory distress throughout the duration of the study, including among measures of oxygen saturation and partial pressure of end-tidal carbon dioxide. That remained true for children aged 24 months and younger, they added.

In light of more widespread school reopenings, the study authors said, their findings may help promote the use of surgical masks among this population. Children should be educated on how to use face masks by parents and school personnel, the authors said, which can increase mask compliance, especially among younger children.

“We do not know how long the present emergency will last, but we must prepare in case new lethal viruses should appear, possibly associated with increased adverse clinical outcomes among children,” the authors concluded.