Risks and benefits of face masks in children

Kai Kisielinski^1*Claudia Steigleder-Schweiger²Susanne Wagner³Stephan Korupp⁴Stefan Hockertz⁵Oliver Hirsch^6,7

• ¹Independent researcher, Smart medical solutions, scientific and technological services and research work, clinical medicine, orthopedic and trauma surgery, emergency medicine, social medicine, 40212 Düsseldorf, Germany
• ²Department of Paediatrics, University Hospital of Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
• ³Non-clinical expert, veterinary medicine, Wagner MSL Management, 15831 Mahlow, Germany
• ⁴Surgeon, Emergency Medicine, Private Practice, 52070 Aachen, Germany
• ⁵tpi consult AG, Haldenstr. 1, CH 6340 Baar, Switzerland
• ⁶FOM Hochschulzentrum Siegen, Siegen, Germany
• ⁷Department of Psychology, FOM University of Applied Sciences, 57078 Siegen, Germany

Introduction: Children, a significant and vulnerable portion of the global population, are particularly susceptible to environmental factors. Methods: We conducted a systematic search and scoping review of 3,144 articles, including 107 publications from medical literature, to assess mask use in children during the 2020–2023 pandemic. We examined expected viral protection versus scientific evidence and side effects, synthesising findings with SWiM and GRADE frameworks for evidence certainty and the Cochrane adverse effects approach. Results: Masking children lacks ecological validity, with high-quality studies showing little real-world effectiveness against viruses. On the other hand, side effects can clearly be identified. Masks contain hazardous materials (carcinogens, heavy metals, organic compounds, microplastic), impacting children´s health by altering inhaled air (including elevated carbon dioxide) and causing many physical symptoms and bio-psychosocial issues (MIES syndrome), akin to sick building syndrome. Toxicological assessments highlight risks to biology of the young. Evidence certainty is high for non-effectiveness, moderate for risks and side effects, and low to very low for viral protection or benefits in children. Conclusions: With a negligible COVID-19 mortality rate in children (0.0003%) and no evidence of child-to-child or school-based transmission, masks offered little benefit during the pandemic. The documented adverse effects — respiratory impairment, toxicity, and health risks — outweigh any justification for their mandatory use. An individual risk-benefit analysis is essential (individual medical advice), but this review suggests avoiding this intervention in children due to its numerous downsides and lack of proven efficacy. It is the responsibility of political leaders to address our findings.