It’s all about the fit: Parents should focus on proper usage rather than mask type for children

Frenzied parents across Canada are scouring stores and online sites for child-sized respirator-type masks, like N95s or KN95s, as children return to school for in-person learning, but their efforts may be misplaced.

This purchasing frenzy comes on the heels of an updated recommendation from public health officials about the use of these respirator-type masks by the general public, as well as from concerns brought forth by parents in Alberta and Ontario about the ill-fitting masks provided to some students by schools in these provinces.

But correct mask usage is far more important than the mask model, says Jeannette Comeau, a pediatric infectious disease doctor at IWK Health in Halifax.

Each family needs to consider its child’s behaviour and developmental stage, as well as the school environment where masks come on and off to drink water, eat snacks and lunch and pant after recess or gym class.

The advantage of respirator-type masks is that they create a seal around the face, but the resulting discomfort needs to be carefully considered in children. The tight elastic bands and the rigid metal nose pieces are features that help them seal the face, but also make them more uncomfortable, require more supervision for proper placement and assistance with molding the nose piece, and make them more expensive.

And – surprise, surprise – children can be messy and slobbery and need new masks quite often, further raising the cost.

Comeau worries about a “logic flaw” in the new guidance when applied to children.

N95 masks – created 30 years ago for construction workers – were never made with children in mind. Hospitals adopted them for aerosol-generating medical procedures, such as endotracheal intubation, but until COVID-19 there was no pediatric use and it’s unlikely that children would generate similar quantities of aerosols in schools as high-risk procedures in hospitals.

Respirator-type masks work best when individually fit tested. Krista Stultz, a safety consultant at IWK Health in Halifax, says that fit testing of respirator-type masks is “absolutely necessary” to ensure the correct size to seal and work properly.

Fit testing takes about 15 minutes to complete, with six or seven steps. If the mask does not fit correctly and other masks need to be tried out, a session can stretch to an hour – a tough regimen for most children.

Far better, says Stultz, is to teach children how to wear masks properly. Like Comeau, Stultz says the focus in children needs to be on enforcement of mask wearing. With proper instruction about use, no matter the type, “they would be fine.”

And if they cannot handle an N95 or don’t understand how to wear it properly, they might be better off wearing a simple medical mask.

Meanwhile, Comeau says that some research before the COVID-19 pandemic found that N95 masks perform less well in infections transmitted by droplets, largely because users picked at the masks. Comeau pointed out that it’s not the mask itself that didn’t work, it’s that the seal was breached by touching, leading to concerns that this would more commonly happen with children since they are much more likely to be touching their faces with unclean hands.

There’s no problem if someone feels safer with an N95, say both Comeau and Stultz, but it must be worn properly and replaced when damaged, dirty or wet. Though in children, it seems it might be better and equally effective for them to wear a child-sized medical mask that fits properly or a three-layer non-medical mask with filter.

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Kirstin Weerdenburg


Kirstin Weerdenburg is a pediatric emergency doctor at IWK Health and pediatrician for newcomer children in Halifax, and is an assistant professor at Dalhousie University. She is currently a student in the Certificate of Health Impact program at the Dalla Lana School of Public Health, University of Toronto.

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