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Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic

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To identify the key insights or developments described in this article
Key Points

Question  Are surgical masks associated with episodes of oxygen desaturation or respiratory distress among children?

Findings  In this cohort study of 47 infants and young children in Italy, wearing surgical face masks for 30 minutes was not associated with changes in respiratory parameters or clinical signs of respiratory distress.

Meaning  These findings suggest that the use of surgical masks among children may be promoted during the coronavirus disease 2019 pandemic, especially in view of the reopening of schools.


Importance  Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older.

Objective  To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress.

Design, Setting, and Participants  This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged ≤24 months, and group B, aged >24 months to ≤144 months). Data were analyzed from May through June 2020.

Interventions  All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes while wearing a face mask. Children aged 24 months and older then participated in a walking test for 12 minutes.

Main Outcomes and Measures  Changes in respiratory parameters during the use of surgical masks were evaluated.

Results  Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (Petco2; 33.0 [32.0-34.0] mm Hg; P for Kruskal Wallis = .59), oxygen saturation (Sao2; 98.0% [97.0%-99.0%]; P for Kruskal Wallis = .61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min; P for Kruskal Wallis = .99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min; P for Kruskal Wallis = .69) or for group B in median (IQR) Petco2 (36.0 [34.0-38.0] mm Hg; P for Kruskal Wallis = .97), Sao2 (98.0% [97.0%-98.0%]; P for Kruskal Wallis = .52), PR (96.0 [84.0-104.5] pulsations/min; P for Kruskal Wallis test = .48), or RR (22.0 [20.0-25.0] breaths/min; P for Kruskal Wallis = .55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min; P < .02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min; P < .05).

Conclusions and Relevance  This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in Sao2 or Petco2, including among children aged 24 months and younger.

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Article Information

Accepted for Publication: January 11, 2021.

Published: March 2, 2021. doi:10.1001/jamanetworkopen.2021.0414

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Lubrano R et al. JAMA Network Open.

Corresponding Author: Silvia Bloise, MD, Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Ospedale Santa Maria Goretti, Polo di Latina, Via Albenga 56, Rome 00186, Italy (

Author Contributions: Drs Lubrano and Bloise had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Lubrano, Bloise, Marcellino, Dilillo, Martucci, Sanseviero, Del Giudice, Ventriglia.

Acquisition, analysis, or interpretation of data: Bloise, Testa, Marcellino, Dilillo, Mallardo, Isoldi, Martucci, Sanseviero, Del Giudice, Malvaso, Iorfida, Ventriglia.

Drafting of the manuscript: Bloise, Testa, Marcellino, Dilillo, Mallardo, Martucci, Sanseviero, Del Giudice, Iorfida, Ventriglia.

Critical revision of the manuscript for important intellectual content: Lubrano, Isoldi, Malvaso, Ventriglia.

Statistical analysis: Bloise, Marcellino, Dilillo, Isoldi, Martucci, Sanseviero, Del Giudice, Iorfida.

Administrative, technical, or material support: Testa.

Supervision: Lubrano, Marcellino, Malvaso, Ventriglia.

Conflict of Interest Disclosures: None reported.

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