Very few people would choose to wear a mask in public if they didn’t need to. We all enjoy being out in the open, exposing our face, and seeing the full faces of others. But like or not, masks are the word these days. The CDC is recommending them, and many cities are enforcing the mask-wearing rule. You don’t need to wear a surgical mask, an N95 mask, nor a scuba mask when you’re out and about, but you need to wear a mask. Cloth will do. And they’re getting trendy. You can go bare-bones basic with a bandana and a few rubber bands, as demonstrated by Dr. Sanjay Gupta here:
Or you can go all-out bougie and get a designer one. French designer Isabel Marant is selling a lovely Spring three-piece mask set for $110. But fashion statement or not, masks are becoming a necessity. Some have cool designs, clever political slogans, sports team logos, and school mascots. While most people, especially those not accustomed to wearing face covering, are rightly bothered by masks being a bit uncomfortable and cumbersome, there is no evidence that they are anything but a bit of a nuisance. They will not cause you to suffocate. They will not cause you to retain the carbon dioxide you exhale and lead to life-threatening re-breathing of your every exhalation. They are not toxic. In Victoria Forster’s recent Forbes article, she explains why you will not become “toxic” from carbon dioxide inhalation. In short, these tiny carbon dioxide molecules, each 232 picometers (232 trillionths of a millimeter) in length, will pass through any mask you’d wear, even an N95. As a reference for size, a coronavirus particle is 125 millionths of a millimeter. Remember, healthcare professionals, including surgeons, intensive care unit specialists, and emergency room physicians, to name a few, “double mask,” wearing a regular surgical mask over an N95 mask for up to 12 hours at a time. Oftentimes this is topped off with a plastic face shielf or goggles. This makes for horrible facial abrasions, irritation, and feeling overall awful, but mask-wearing is not leading to carbon dioxide poisoning.
Cloth masks, which are recommended for just being out and about in the world these days, don’t cause such a beating to one’s skin. And like it or not, it is the socially right thing to do these days. Is wearing a mask going to offer 100% protection from Covid-19 for you and those around you? Not even close. But it can help by reducing respiratory droplet spread, especially if you’re also keeping at least six feet of physical distance from those around you. And the more people in a group that wear a mask, the more overall protection there will be for that group. It’s hardly the herd immunity we talk about for a vaccinated population, but it’s the best we can do right now.
The one group of individuals who should NOT wear any face covering at all, including cloth masks, surgical masks, face shields, and certainly not N95’s, is infants and toddlers under age two years. Both the CDC and the American Academy of Pediatrics (AAP) advise against mask-wearing in individuals under age two years. Yes, those babies we see on social media wearing masks and shields sure do look cute, but there are several dangers when it comes to infant mask wearing. First, there are the practicalities, which are not necessarily dangerous in and of themselves, but are certainly not helpful:
- Ever try to keep a hat on a toddler that won’t wear a hat? Ever try to keep socks on a baby in a stroller? If your answer is “no,” you’ve never taken care of a baby or a toddler. Most toddlers will rip that mask off as fast as you try to put it on. This will make for more face touching, which we all know leads to viral-coated baby fingers.
- Ever see an infant or toddler try to remove their laced-up snow boot? They will work at it, but it’s not easy. Most of them will fail, and just get frustrated. And maybe kick you. So the solution to point #1 above is not to tie a mask on so tightly that your young charge can’t remove it. That leads us to the dangerous stuff.
Beyond the impractical issues regarding toddler-under-two mask wearing are the dangers:
- If a mask is too tight, an infant or toddler may not be able to vocalize breathing difficulties.
- Really tiny infants, under age four or five months, can’t breathe through their mouths yet. They are what we call “obligate nasal breathers.” So if a young infant gets a bit of a stuffy nose while wearing a mask, having not yet developed the reflex to open their mouth to breathe, they will quickly develop breathing difficulty.
- If an infant falls asleep while wearing a mask, they can, indeed, suffocate in a manner very similar to what happens to a baby suffering from Sudden Infant Death Syndrome, or SIDS.
Covering a baby’s face while sleeping, even in pre-Covid-19 days, puts them at much higher risk for SIDS.
So what can you do to minimize not only your baby’s exposure to others, but also minimize other’s exposure to them?
- For smaller infants, baby carriers are a great way to go these days. Even if they are facing forward, you can literally steer them away from people getting too close as you walk.
- If your stroller has an option for forward- or rear-facing, this may be the time to keep your child facing you, not the crowd on the street.
- If you have a thin netting or an awning to cover your stroller, and it won’t get tangled in your child’s limbs or face, and you can see through it or around it, this creates a reasonable barrier for a child when you’re out for a stroll.
If all of this maneuvering, especially with a young child, sounds too onerous, then for now it’s best to do what most of us have been doing for the past two months: Stay home.