Risks and benefits of face masks in children

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 vs. scientific evidence and side effects, synthesizing 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, and microplastic), impacting childreńs health by altering inhaled air (including elevated carbon dioxide) and causing many physical symptoms and bio-psychosocial issues (MIES, mask-induced exhaustion 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 because of its numerous downsides and the lack of proven efficacy. It is the responsibility of political leaders to address our findings.