The CDC recognizes there are specific instances when wearing a mask may not be feasible. In these instances, consider adaptations and alternatives. The following categories of people are exempt from the requirement to wear a mask:
- A child under the age of 2 years.
- A person with a disability who cannot wear a mask, or cannot safely wear a mask, for reasons related to the disability.
- A person for whom wearing a mask would create a risk to workplace health, safety, or job duty.
General Mask Guidance:
- All children should wear a mask at school unless physical, developmental or behavioral impairments make wearing a mask unsafe.
- Masks should not be worn by anyone who is having trouble breathing, is unconscious or incapacitated. If a student desires a mask to attend school and is unable to remove the mask on their own, s/he should be supervised by a caregiver who is able to immediately assist if needed.
The physical, developmental and behavioral conditions that may make wearing a mask unsafe for children are very rare. They include the following:
- Developmental Disability
- Limited physical mobility
- Severe autism
- Structural abnormalities of the head or neck, however, some of these children may be able to wear bandanna style coverings.
In most cases, a child who is unable to wear a mask safely for medical reasons should not attend school in person.
Guidance for specific conditions:
- Allergies: There is no medical reason that allergies should prevent children from wearing masks. If a child is suffering from allergy-associated nasal congestion, over-the-counter or prescription steroid nasal sprays may provide relief.
- Anxiety: This is a difficult time for children who suffer from anxiety. Parents can support them by modeling appropriate mask wearing and providing factual, reality-based information about COVID19. For children with mask related anxiety or distress who are going to school, please refer to information provided at the end of this document. Anxiety is not a medical reason for not wearing a mask.
- Asthma: Children with asthma should not be exempt from wearing masks, nor should masks cause asthma symptoms. It is always important for children to follow their prescribed asthma action plan, including their maintenance medications. Masks should be removed if a child experiences active asthma symptoms. If the asthma symptoms prevent wearing a mask, then the family should see their physician to work together to improve their asthma care.
- Communication Differences: Students who are deaf, deaf-blind, hard of hearing or speech impaired may require the use of face shields to promote adequate communication to access their education.
- Cardiology: There are no cardiology conditions that make wearing a mask unsafe for children who are well enough to attend school.
- Developmental Pediatrics: Some children with limited physical and/ or mental capacity may not be able to wear masks safely. Masks may agitate some children with autism, behavioral challenges or intellectual disability. However, with consistent positive reinforcement and gradual desensitization, most children can get used to wearing a mask. Support
should be provided at school to continue to encourage students in this category to wear masks, without excluding them from school if they cannot.
- ENT: Children who have structural abnormalities of the head, neck or face may not be able to wear a traditional mask safely, but may be able to use a bandanna-style mask. These may also be helpful for children with tracheostomies.
- Hematology/oncology: If cancer and blood disorder patients are well enough to attend school in person, they should wear masks.
- Neurology: There are no neurological conditions that make wearing a mask unsafe for children who are well enough to attend school.
- Physical Medicine and Rehabilitation: Some children with limited physical mobility may not be able to wear masks safely and/or require an individual to monitor their facial covering at all times.
- Pulmonology: There are no pulmonology conditions that make wearing a mask unsafe for children who are well enough to attend school.
Our pediatricians are happy to work in conjunction with the pediatric sub-specialists, parents, and schools to determine whether children qualify for mask exemptions. We believe that these
criteria will limit the need for additional medical documentation.
Resources to help children adapt to the use of masks:
National Child Traumatic Stress Network (NCTSN)
Lots of good resources for kids, CYSHN
Coronavirus (COVID-19): Helping Kids Get Used to Masks