{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T16:04:48Z","timestamp":1774022688870,"version":"3.50.1"},"reference-count":440,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Children, a significant and vulnerable portion of the global population, are particularly susceptible to environmental factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u20132023 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 childre\u0144s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2014respiratory impairment, toxicity, and health risks\u2014outweigh any justification for their mandatory use. An individual risk\u2013benefit 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1679586","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T06:48:44Z","timestamp":1773384524000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risks and benefits of face masks in children"],"prefix":"10.3389","volume":"14","author":[{"given":"Kai","family":"Kisielinski","sequence":"first","affiliation":[{"name":"Clinical Medicine (Surgery), Emergency Medicine and Social Medicine, Private Practice","place":["D\u00fcsseldorf, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Steigleder-Schweiger","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University Hospital of Salzburg, Paracelsus Medical University","place":["Salzburg, Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Wagner","sequence":"additional","affiliation":[{"name":"Non Clinical Expert, Veterinarian, Wagner MSL Management","place":["Mahlow, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Korupp","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Private Practice","place":["Aachen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Hockertz","sequence":"additional","affiliation":[{"name":"Toxicology, Pharmacology, Immunology, TPI consult AG","place":["Baar, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Hirsch","sequence":"additional","affiliation":[{"name":"FOM University of Applied Sciences","place":["Siegen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"B1","first-page":"1","article-title":"Assessing the risk of chemicals to children\u2019s health: OECD-wide survey 2021 survey report","volume-title":"Series on Testing and Assessment, No 376","year":"2023"},{"key":"B2","volume-title":"Face Covering Policies During the COVID-19 Pandemic","year":"2023"},{"key":"B3","year":""},{"key":"B4","doi-asserted-by":"publisher","first-page":"e2317358","DOI":"10.1001\/jamanetworkopen.2023.17358","article-title":"Association of COVID-19 government-instituted mask mandates with incidence of mask use among children in Alberta, Canada","volume":"6","author":"Hahn","year":"2023","journal-title":"JAMA Netw Open"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1093\/pubmed\/fdab057","article-title":"Adapting to the culture of \u201cnew normal\u201d: an emerging response to COVID-19","volume":"43","author":"Corpuz","year":"2021","journal-title":"J Public Health (Oxf)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/josh.13099","article-title":"Dynamic masking: a proposal of burden-based metrics for masking in K-12 schools during the COVID-19 pandemic","volume":"92","author":"Rowland","year":"2022","journal-title":"J Sch Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1007\/s00431-020-03674-9","article-title":"To mask or not to mask children to overcome COVID-19","volume":"179","author":"Esposito","year":"2020","journal-title":"Eur J Pediatr"},{"key":"B8","year":"2020"},{"key":"B9","year":""},{"key":"B10","volume-title":"WHO - Advice on the use of Masks for Children in the Community in the Context of COVID-19: Annex to the Advice on the use of Masks in the Context of COVID-19, 21 August 2020","year":"2020"},{"key":"B11","author":"De Brouwer","year":"2020"},{"key":"B12","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1055\/a-1199-4525","article-title":"Die maskierte Gesellschaft [The masked society]","volume":"74","author":"Ewig","year":"2020","journal-title":"Pneumologie"},{"key":"B13","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1055\/a-1174-6591","article-title":"Mund-Nasen-Schutz in der Offentlichkeit: keine Hinweise fur eine Wirksamkeit [Face masks in public: no evidence of effectiveness]","volume":"15","author":"Kappstein","year":"2020","journal-title":"Krankenhaushygiene up2date"},{"key":"B14","doi-asserted-by":"publisher","first-page":"100138","DOI":"10.1016\/j.tine.2020.100138","article-title":"Masked education? 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