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As the debate over masks in schools continues, parents and educators raise concerns over the impact such mandates may be having on the physical and mental health of children. FluxFactory/Getty Images
  • As we learn about the mental and physical impact COVID-19 has had on children, parents differ in their opinions about lifting restrictions.
  • The need for in-person learning and desire to eliminate mask mandates in schools brings contention across the U.S.
  • Children continue to show lower risk of severe symptoms from COVID-19 compared to adults.

Amelia is a 16-year-old junior at a high school in suburban Chicago. She only had one “normal” semester during her high school years, in which she learned in school without a mask or physical distancing.

The lack of normalcy has been most difficult for her to deal with, especially when her school went remote for much of her first 2 years of high school as a result of Illinois Governor J.B. Pritzker’s orders and efforts to slow the spread of COVID-19.

“Not having to get up and get ready for school made it really hard to actually focus during school,” Amelia told Healthline. “Sitting at home, not having to pay attention to what we were learning has affected me this year [now that we’re back in school], and made it hard to readjust to normal studying and doing my work.”

She likes in-school learning better than remote but says that having to wear masks in school makes it hard for her to stay in touch and communicate with teachers and peers, “when we can’t see each other’s face expressions.”

During sports, she says that the communication between coaches and teammates — as well as simple breathing — is a challenge.

“We are missing our experiences as teenagers and young adults: concerts, dances at school, sporting events, going to restaurants, seeing our family,” Amelia said.

Her experience is that of many children and teens across the nation, which has gotten experts and parents concerned about the mental health of America’s youth.

In October 2021, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association declared a national emergency in child and adolescent mental health, naming stress brought on by COVID-19 and racial injustice as the causes.

Dr. Willough Jenkins, inpatient medical director of psychiatry at Rady Children’s Hospital-San Diego and child psychologist, said that before the pandemic, the rates of children’s mental health issues were on the rise, and the pandemic amplified and worsened an already existing problem.

“Children’s mental health needs to be prioritized at all levels, but particularly on a national level with more funding and legislation to support mental health initiatives,” she told Healthline.

During the pandemic, she said mental health professionals have seen rates of depression, anxiety, eating disorders, and suicidal ideation increase.

“More children are accessing tertiary and emergency care for mental health. We have had record numbers of children seeking mental health care at Rady Children’s Hospital in San Diego,” said Jenkins.

Data collected by states that report COVID-19 cases in children shows:

  • 0.00–0.02 percent of all child COVID-19 cases resulted in death
  • 0.1–1.5 percent of all child COVID-19 cases resulted in hospitalization

Parker L. Huston, PhD, pediatric psychologist and owner of Central Ohio Pediatric Behavioral Health, said that there are two ways to look at this data.

“By percentage, children continue to show lower risk of severe symptoms. It is logical to think that they can relax some of the restrictions with the intention of helping their mental well-being,” Huston told Healthline.

“However, from a population level view, even 1 percent suffering severe complications is a huge number of children, and the healthcare system is not equipped for a significant increase in patient need for intensive services.”

There’s also the concern that children spread viruses more than adults do. “Anything that children catch tends to spread in the home to siblings and parents,” he said.

Still, the debate on how the country should prioritize normalcy for children as it balances the safety of the general public and the operation of hospitals is a heated one with much to consider. In-person learning and unmasking kids are hot topics among parents.

On January 28, 2022, the American Academy of Pediatrics stated in updated guidance that in-school learning should be prioritized, with diligent adherence to safety measures, such as vaccination, universal masking, and physical distancing.

Huston said that there are demonstrated negative outcomes for children who don’t have consistent access to education or peer interaction.

“Virtual education is preferable to a full closure, but there are difficulties for large parts of the country to have stable access to required technology and the support students need to be successful,” Huston told Healthline.

“Having children physically present in the building is really important. For some students, these are the best meals, the safest places, and the most support they get in their lives.

Jenkins agreed and noted the importance of academic catch-up.

According to a report by Curriculum Associates, fewer elementary and middle school students started the 2021 school year reading and doing math on grade level than in the 3 years before the pandemic.

However, not all students were affected in the same way. The report also found:

  • Students who were behind in reading and math before the pandemic experienced the most unfinished learning.
  • The percentage of students in 4th to 8th grade who were on grade level is close to pre-pandemic levels.
  • Unfinished learning is greater for Black and Latino students in both reading and mathematics than for white students.

“All students have been affected in some way, and because of this, the academic catch-up will be somewhat universal although disproportionately affecting disadvantaged families who may not have had the resources to support remote learning,” said Jenkins.

Laura Fagan has been vocal about the burden COVID-19 mitigation in San Francisco has put on her three children, ages 6, 5, and 3. She believes that schools are safe for in-person learning and feels that the benefits of in-school learning far outweigh the risk that COVID-19 presents to them.

From the beginning of the pandemic in early March 2020, she never worried about keeping her kids physically safe from COVID-19. She continued to ride the bus to work and daycare with her kids until the city went into lockdown.

“Now we know kids’ risk is much lower than risks we’ve always accepted without terrifying our kids, like car accidents, flu, drowning, and heart disease,” Fagan told Healthline. “To this day, there hasn’t been a single death under the age of 20 in San Francisco, and only a handful of pediatric hospitalizations.”

She prioritized keeping her kids mentally well and unafraid by avoiding broadcast news in her home and assuring them that they’re healthy and don’t need to be scared.

“[Two] of my kids recently had an asymptomatic positive because of required testing, and as a result, they all had to stay home from school for the required period of time. In hindsight, I’m not even sure if they realized they ‘had COVID.’ We just didn’t make a big deal out of it,” said Fagan.

Liz Beaver, host of the Dam Well Better podcast and mother of two teenagers and a 10-year-old in Utah, takes a different approach. She has prioritized keeping her kids and community safe from COVID-19 while trying to balance their mental well-being.

“We have always been very honest with our kids about the world and have raised our kids to be science-minded,” Beaver told Healthline.

“We have always talked to them, at every stage, about current events and had discussions about the choices other people make (in age-appropriate ways, of course.) This was true with fashion, gender, music, guns, religion — you name it.”

Because of this, she believes that her kids have the capacity to understand that the public won’t always behave in a way they agree with.

In Utah, there’s a battle between health experts and the legislature to implement safety protocols. But Beaver explained to her kids her and husband’s choices, such as why they chose to participate in the 2020–2021 school year online, why they felt it was OK for them to go back in 2022, and why they pulled them back out for a week during the latest surge that ended up shutting down a few school districts.

“We presented the evidence. I honestly think my kids feel empathy towards all the kids whose parents refuse masks and vaccination. They are very confident and knowledgeable.”

Still, she agonizes over whether to let her kids hang out with certain friends who live with a family that doesn’t take safety precautions.

“Because out here, people aren’t being measured in their approach. This creates a need for more safety on the part of the people who must compensate for the recklessness,” she said.

While not many people would argue that masks are fun for kids to wear, the Centers for Disease Control and Prevention (CDC) references three studies on its website as evidence that there are more COVID-19 cases in areas without school masking policies.

“There is no evidence showing that wearing masks has impacted kids’ mental health. There are a small minority of children that might struggle with mask-wearing, and these are typically children with sensory sensitivities or developmental differences,” Jenkins said.

Huston added that the risk to mental health for children isn’t likely to be lessened simply by telling them they don’t need masks anymore.

“There are many other factors in the world that are negatively impacting children’s mental health, such as the mental well-being of the adults around them, expectations placed on them, and how we teach children (or not) to understand and manage their emotions,” he said.

Beaver agreed, noting that the most distressing part for her kids isn’t wearing a mask or having their facial expressions covered by a mask, but rather that adults are unable to cope.

While her kids struggled during the pandemic, she said that they were most distressed by the fighting within the U.S. government, fistfights at grocery stores, screaming moms, men waving assault rifles, and people saying, “We have to just let people die so we can move on.”

“We were out there telling our kids, and everybody else, that it is essentially okay to lose old people, overweight people, disabled people, and people with underlying conditions,” said Beaver.

“One of my kids was really worried about her friend with diabetes because no one was going to keep her safe. All of my kids were terribly worried about their grandfather because he is over 80 with a heart condition.”

She believed that if there were a consistent mask mandate in schools, society could be more confident that it could also protect the teachers, who bear the brunt of the risk.

Huston pointed out that the greatest impact on mental health is likely the feeling that mitigation measures are inconsistent, out of control, or that safety can’t be guaranteed.

“This can increase mental health symptoms because school, for most children in the U.S., is traditionally something stable and a safe place,” he said.

Fagan sees it differently, though. She’s a proponent of eliminating masks from schools and points to Britain’s approach with masking. In the spring/summer of 2021, the British government didn’t require elementary school students or teachers to wear masks in classrooms and instead focused on widespread quarantining and rapid testing.

In an op-ed she wrote, she also cited a not yet peer-reviewed study that explored individual and population-level trends in infant and early child neurodevelopment and the developmental impact of the COVID-19 pandemic.

Comparing yearly mean scores since 2011, and controlling for age, gender, demographic, and socioeconomic indicators, the researchers found “striking evidence of declining overall cognitive functioning in children beginning in 2020 and continuing through 2021.”

“The data was always there and children should have always been the priority. The false premise that kids were a danger to themselves or a danger to others has caused a landslide of harms, from school closures to speech delays due to masks,” said Fagan.

She calls for the prioritization of children’s mental health. “I’m so tired of people debating it while kids continue to suffer every single day. Where is the urgency? The harms are piling up. At this point, even if kids were lethal weapons, it’s still their turn to be put first,” she said.

She hopes that soon the country will return to pre-pandemic normal. However, she believes that parents who want their kids to still wear masks should have that choice.

From Huston’s perspective, practices to prevent the spread of germs is something that shouldn’t be controversial at this time. “The more normal [kids] see these practices, the less intrusive they will seem. If we focus on how annoying they are or constantly talk about wishing for things to ‘go back to normal,’ it draws negative attention,” he said.

Because children are resilient, Jenkins said that the majority of children will recover from the effect of this pandemic. One reason she pointed to is that the situation is universal shared adversity, which is different from the often alienating experience of individual trauma.

“We can openly talk about the pandemic as opposed to other adverse childhood events, which remain stigmatized. I do believe that with a continued focus on the issue and support for those that need it, our children will be able to overcome this period,” Jenkins said.