Naturally, it is hard to show that mask-wearing alone is responsible for lower rates of sickness in schools, since there are many other measures in place, like hand-sanitising stations, pods, physical-distancing, staggered break times or specified play areas, which may also be important variables in reducing Covid numbers in schools.

Even where parents accept that mask-wearing is needed, they naturally can have concern about how it will affect their child psychologically. Unfortunately, there is a real lack of research about the psychological impact, for children, of wearing masks. There are a lot of assumptions, and stark warnings, being made about mask-wearing being bad for children’s emotional well-being. As yet, however, the research doesn’t back up those claims.

One concern parents may have is that if a child wears a mask it impacts on their ability to form social connections and “read” emotions of others. A US study of 81 children (aged 7-13 years) found that children were able to infer another person’s emotions even when parts of the face were covered (they showed pictures of faces uncovered, eyes covered by sunglasses and mouths covered by surgical facemasks).

Other concerns may be about emotional distress or upset. A Chinese study of over one million children has shown that students who only wore masks occasionally had higher likelihood of self-reported psychological distress than students who wore masks at all times in school and community settings. Rates of mask wearing in China are much higher, and it is more of a cultural norm.

In France, a study shows, conversely, that four in five children reported being embarrassed wearing a mask. A German study (of over 25,000 children) indicated that the greatest difficulties reported by children wearing masks in school (for an average of over four hours a day) were of physical discomfort and headache, with less happiness also reported. What those authors couldn’t prove, however, is that these reported impairments were just from mask-wearing.

This, in fact, is the constant difficulty in interpreting the very limited amounts of research that has been carried out. There are so many other factors that could be leading to any distress in children, that we really can’t tell if masks, themselves, are the problem.

For example, I hear regularly about children who are stressed and anxious about the disease itself. Or they are distressed by getting stuck in a pod with other children they don’t really like. Or they find it hard to be limited to certain areas to play at breaks, unable to be with friends.

It is only when we can study the same children, measured over time, that we can identify if it is masks themselves that cause the problems, or if it is other factors related to the changes within schools, or even changes in those children’s lives outside of schools, that are causing any observed difficulties.

We also have the dilemma of what happens if schools close again. We know from our own experience that it was a struggle for children and families. Does it create more hardship for children to be out of school, with, perhaps, limited access to educational materials? Will children miss the chance to be in social contact with their peers more than they would miss being able to see their friends’ full faces? Will parents be more stressed if their children are off from school, returning to home-schooling while also trying to work, which in turn might lead to more tension or conflict in families?

While no public health measure will suit every child or every family, it seems clear that masks are effective in reducing transmission of the virus. There isn’t conclusive evidence that mask-wearing is bad for children and I think schools having to close would be more harmful to them.