{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:45:45Z","timestamp":1791222345448,"version":"4.1.0"},"reference-count":86,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T00:00:00Z","timestamp":1683072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Investigation"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Importance<\/jats:title><jats:p>Despite the high burden of respiratory infections among children, the production of exhaled particles during common activities and the efficacy of face masks in children have not been sufficiently studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the effect of type of activity and mask usage on exhaled particle production in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Healthy children were asked to perform activities that ranged in intensity (breathing quietly, speaking, singing, coughing, and sneezing) while wearing no mask, a cloth mask, or a surgical mask. The concentration and size of exhaled particles were assessed during each activity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010three children were enrolled in the study. Average exhaled particle concentration increased by intensity of activity, with the lowest particle concentration during tidal breathing (1.285 particles\/cm<jats:sup>3<\/jats:sup> [95% CI 0.943, 1.627]) and highest particle concentration during sneezing (5.183 particles\/cm<jats:sup>3<\/jats:sup> [95% CI 1.911, 8.455]). High\u2010intensity activities were associated with an increase primarily in the respirable size (\u2264 5 \u00b5m) particle fraction. Surgical and cloth masks were associated with lower average particle concentration compared to no mask (<jats:italic>P<\/jats:italic> = 0.026 for sneezing). Surgical masks outperformed cloth masks across all activities, especially within the respirable size fraction. In a multivariable linear regression model, we observed significant effect modification of activity by age and by mask type.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Similar to adults, children produce exhaled particles that vary in size and concentration across a range of activities. Production of respirable size fraction particles (\u2264 5 \u00b5m), the dominant mode of transmission of many respiratory viruses, increases significantly with coughing and sneezing and is most effectively reduced by wearing surgical face masks.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ped4.12376","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T08:02:01Z","timestamp":1683100921000},"page":"75-85","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The effect of activity and face masks on exhaled particles in children"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9664-5959","authenticated-orcid":false,"given":"Peter P.","family":"Moschovis","sequence":"first","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1391-3111","authenticated-orcid":false,"given":"Jesiel","family":"Lombay","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Rooney","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara R.","family":"Schenkel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilpreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Harvard T. H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Department of Mechanical and Aerospace Engineering Rutgers University School of Public Health  New Brunswick New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawheen J.","family":"Rezaei","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Salo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Gong","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine the University of California Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lael M.","family":"Yonker","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jhill","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Hayden","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia L.","family":"Hibberd","sequence":"additional","affiliation":[{"name":"Department of Global Health Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Demokritou","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Harvard T. H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Department of Mechanical and Aerospace Engineering Rutgers University School of Public Health  New Brunswick New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6927-258X","authenticated-orcid":false,"given":"T. Bernard","family":"Kinane","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab691"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-021-00535-6"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.abd9149"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.23698"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1716561115"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2007.10.007"},{"key":"e_1_2_7_8_1","unstructured":"WHO.Infection prevention and control of epidemic\u2010 and pandemic\u2010prone acute respiratory infections in health care. Accessed March 7 2022.2014.https:\/\/www.who.int\/publications\/i\/item\/infection\u2010prevention\u2010and\u2010control\u2010of\u2010epidemic\u2010and\u2010pandemic\u2010prone\u2010acute\u2010respiratory\u2010infections\u2010in\u2010health\u2010care"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0668.2007.00469.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ina.12465"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2021.106814"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/s42254-022-00506-7"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/02786826.2020.1829536"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2204593119"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piaa079"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1743-8977-10-12"},{"key":"e_1_2_7_17_1","unstructured":"International Organization for Standardization.Air quality\u2014Sampling conventions for airborne particle deposition in the human respiratory system.https:\/\/www.iso.org\/standard\/53331.html"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30323-4"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1003205"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab722"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab311"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.15973"},{"key":"e_1_2_7_23_1","unstructured":"CDC.National respiratory and enteric virus surveillance system. Accessed November 14 2022.https:\/\/www.cdc.gov\/surveillance\/nrevss\/index.html"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.100986"},{"key":"e_1_2_7_25_1","unstructured":"GBD 2016 Lower Respiratory Infections Collaborators.Estimates of the global regional and national morbidity mortality and aetiologies of lower respiratory infections in 195 countries 1990\u20102016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Infect Dis.2018;18:1191\u20101210. DOI:10.1016\/S1473\u20103099(18)30310\u20104"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0242302"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61901-1"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiab509"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-021-27120-y"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiab577"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2031915"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2021.26.15.2001695"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7117e3"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2020.25.49.2000725"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.06.062"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000003396"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000003460"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2020.12.007"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1088\/1752-7163\/ac1ea5"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0271517"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-020-03674-9"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1177\/21501319221131704"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1590\/1984-0462\/2023\/41\/2021164"},{"key":"e_1_2_7_44_1","unstructured":"CDC.Community Levels: A measure of the impact of COVID\u201019 illness on health and healthcare systems.2022. Accessed March 7 2022.https:\/\/www.cdc.gov\/coronavirus\/2019\u2010ncov\/science\/community\u2010levels.html"},{"key":"e_1_2_7_45_1","unstructured":"AAP. AmericanAcademy of pediatrics offers new masking recommendations for families following updated CDC guidance. Accessed March 7 2022.http:\/\/www.aap.org\/en\/news\u2010room\/news\u2010releases\/aap\/2022\/american\u2010academy\u2010of\u2010pediatrics\u2010offers\u2010new\u2010masking\u2010recommendations\u2010for\u2010families\u2010following\u2010updated\u2010cdc\u2010guidance\/"},{"key":"e_1_2_7_46_1","unstructured":"WHO.Advice on the use of masks for children in the community in the context of COVID\u201019. 2020. Accessed October 13 2021.https:\/\/www.who.int\/publications\u2010detail\u2010redirect\/WHO\u20102019\u2010nCoV\u2010IPC_Masks\u2010Children\u20102020.1"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25330"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.buildenv.2021.108020"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.buildenv.2021.108293"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1098\/rsfs.2021.0078"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.01.022"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-72798-7"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/ina.12452"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaerosci.2014.05.007"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1093\/annhyg\/meu111"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006577"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2016.12.002"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1750\u20102659.2011.00318.x"},{"key":"e_1_2_7_59_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0843-2"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7039e1"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7039e3"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7110e1"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2211029"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.3205\/dgkh000380"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.1080\/23744731.2021.1944665"},{"key":"e_1_2_7_66_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-6817"},{"key":"e_1_2_7_67_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.abi9069"},{"key":"e_1_2_7_68_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7106e1"},{"key":"e_1_2_7_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cis.2021.102435"},{"key":"e_1_2_7_70_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens9090762"},{"key":"e_1_2_7_71_1","doi-asserted-by":"publisher","DOI":"10.1111\/jebm.12424"},{"key":"e_1_2_7_72_1","doi-asserted-by":"publisher","DOI":"10.1021\/acsnano.0c10146"},{"key":"e_1_2_7_73_1","doi-asserted-by":"publisher","DOI":"10.1021\/acsnano.0c05025"},{"key":"e_1_2_7_74_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0245688"},{"key":"e_1_2_7_75_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0258191"},{"key":"e_1_2_7_76_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000563"},{"key":"e_1_2_7_77_1","doi-asserted-by":"publisher","DOI":"10.1080\/15459624.2012.684582"},{"key":"e_1_2_7_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaerosci.2008.11.002"},{"key":"e_1_2_7_79_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-38808-z"},{"key":"e_1_2_7_80_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202005-569RL"},{"key":"e_1_2_7_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2020.10.008"},{"key":"e_1_2_7_82_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17239088"},{"key":"e_1_2_7_83_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-021-02872-7"},{"key":"e_1_2_7_84_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2466-12-11"},{"key":"e_1_2_7_85_1","doi-asserted-by":"publisher","DOI":"10.1111\/josh.13033"},{"key":"e_1_2_7_86_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17082893"},{"key":"e_1_2_7_87_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2020.12.123"}],"container-title":["Pediatric Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ped4.12376","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T03:05:26Z","timestamp":1692500726000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ped4.12376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,3]]},"references-count":86,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1002\/ped4.12376"],"URL":"https:\/\/doi.org\/10.1002\/ped4.12376","archive":["Portico"],"relation":{},"ISSN":["2574-2272","2574-2272"],"issn-type":[{"value":"2574-2272","type":"print"},{"value":"2574-2272","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,3]]},"assertion":[{"value":"2022-05-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}