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      The impact of face masks on children—A mini review

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          Abstract

          Aim

          Face masks are essential during the COVID‐19 pandemic, and the United Nations Children's Fund and the World Health Organization, recommend that they are used for children aged six years and older. However, parents are increasingly expressing concerns about whether these might be physically harmful. This mini review assessed the evidence.

          Method

          We conducted a narrative review on the effects of mask wearing on physiological variables in children, using PubMed, the Cochrane Library and the World Health Organization COVID‐19 Database up to 7 November 2020. The lack of paediatric studies prompted a second search for adult studies.

          Results

          We only found two paediatric studies, published in 2019 and 2020. The 2020 study was not related to COVID‐19. Only one study, performed with N95 respirators, collected medical parameters, and this did not suggest any harmful effects of gas exchange. The eight adult studies, including four prompted by the pandemic and one on surgeons, reported that face masks commonly used during the pandemic did not impair gas exchange during rest or mild exercise.

          Conclusion

          International guidelines recommend face masks for children aged six years and older, but further studies are needed to provide evidence‐based recommendations for different age groups.

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          Most cited references29

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          Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population

          Background Governments are preparing for a potential influenza pandemic. Therefore they need data to assess the possible impact of interventions. Face-masks worn by the general population could be an accessible and affordable intervention, if effective when worn under routine circumstances. Methodology We assessed transmission reduction potential provided by personal respirators, surgical masks and home-made masks when worn during a variety of activities by healthy volunteers and a simulated patient. Principal Findings All types of masks reduced aerosol exposure, relatively stable over time, unaffected by duration of wear or type of activity, but with a high degree of individual variation. Personal respirators were more efficient than surgical masks, which were more efficient than home-made masks. Regardless of mask type, children were less well protected. Outward protection (mask wearing by a mechanical head) was less effective than inward protection (mask wearing by healthy volunteers). Conclusions/Significance Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence, personal respirators providing most protection. Masks worn by patients may not offer as great a degree of protection against aerosol transmission.
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            Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity

            Background Due to the SARS-CoV2 pandemic, medical face masks are widely recommended for a large number of individuals and long durations. The effect of wearing a surgical and a FFP2/N95 face mask on cardiopulmonary exercise capacity has not been systematically reported. Methods This prospective cross-over study quantitated the effects of wearing no mask (nm), a surgical mask (sm) and a FFP2/N95 mask (ffpm) in 12 healthy males (age 38.1 ± 6.2 years, BMI 24.5 ± 2.0 kg/m2). The 36 tests were performed in randomized order. The cardiopulmonary and metabolic responses were monitored by ergo-spirometry and impedance cardiography. Ten domains of comfort/discomfort of wearing a mask were assessed by questionnaire. Results The pulmonary function parameters were significantly lower with mask (forced expiratory volume: 5.6 ± 1.0 vs 5.3 ± 0.8 vs 6.1 ± 1.0 l/s with sm, ffpm and nm, respectively; p = 0.001; peak expiratory flow: 8.7 ± 1.4 vs 7.5 ± 1.1 vs 9.7 ± 1.6 l/s; p < 0.001). The maximum power was 269 ± 45, 263 ± 42 and 277 ± 46 W with sm, ffpm and nm, respectively; p = 0.002; the ventilation was significantly reduced with both face masks (131 ± 28 vs 114 ± 23 vs 99 ± 19 l/m; p < 0.001). Peak blood lactate response was reduced with mask. Cardiac output was similar with and without mask. Participants reported consistent and marked discomfort wearing the masks, especially ffpm. Conclusion Ventilation, cardiopulmonary exercise capacity and comfort are reduced by surgical masks and highly impaired by FFP2/N95 face masks in healthy individuals. These data are important for recommendations on wearing face masks at work or during physical exercise.
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              Return to training in the COVID‐19 era: The physiological effects of face masks during exercise

              COVID‐19 outbreak has a profound impact on almost every aspect of life. Universal masking is recommended as a means of source control. Routinely exercising in a safe environment is an important strategy for healthy living during this crisis. As sports clubs and public spaces may serve a source of viral transmission, masking may become an integral part of physical activity. This study aimed to assess the physiological effects of wearing surgical masks and N95 respirators during short‐term strenuous workout. This was a multiple cross‐over trial of healthy volunteers. Using a standard cycle ergometry ramp protocol, each subject performed a maximal exercise test without a mask, with a surgical mask, and with an N95 respirator. Physiological parameters and time to exhaustion were compared. Each subject served his own control. Sixteen male volunteers (mean age and BMI of 34 ± 4 years and 28.72 ± 3.78 kg/m2, respectively) completed the protocol. Heart rate, respiratory rate, blood pressure, oxygen saturation, and time to exhaustion did not differ significantly. Exercising with N95 mask was associated with a significant increase in end‐tidal carbon dioxide (EtCO2) levels. The differences were more prominent as the load increased, reaching 8 mm Hg at exhaustion (none vs N95, P = .001). In conclusion, in healthy subjects, short‐term moderate‐strenuous aerobic physical activity with a mask is feasible, safe, and associated with only minor changes in physiological parameters, particularly a mild increase in EtCO2. Subjects suffering from lung diseases should have a cautious evaluation before attempting physical activity with any mask.
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                Author and article information

                Contributors
                martin.eberhart@kages.at
                Journal
                Acta Paediatr
                Acta Paediatr
                10.1111/(ISSN)1651-2227
                APA
                Acta Paediatrica (Oslo, Norway : 1992)
                John Wiley and Sons Inc. (Hoboken )
                0803-5253
                1651-2227
                21 February 2021
                : 10.1111/apa.15784
                Affiliations
                [ 1 ] Department of Paediatrics and Adolescent Medicine LKH Hochsteiermark Leoben Austria
                Author notes
                [*] [* ] Correspondence

                Martin Eberhart, Department of Paediatrics and Adolescent Medicine, LKH Hochsteiermark, Standort Leoben, Vordernberger Straße 42, 8700 Leoben, Austria.

                Email: martin.eberhart@ 123456kages.at

                Author information
                https://orcid.org/0000-0001-8435-8349
                Article
                APA15784
                10.1111/apa.15784
                8014099
                33533522
                36d732a9-0db3-4760-92a6-f10b09455849
                ©2021 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 28 January 2021
                : 09 December 2020
                : 28 January 2021
                Page count
                Figures: 0, Tables: 1, Pages: 6, Words: 9511
                Categories
                Mini Review
                Mini Reviews
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.1 mode:remove_FC converted:01.04.2021

                Pediatrics
                coronavirus,covid‐19,face masks,gas exchange,pandemic
                Pediatrics
                coronavirus, covid‐19, face masks, gas exchange, pandemic

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