This daycare policy doesn’t care for children. It raises risks for all ages.

Research shows that consistently wearing masks reduces COVID-19 transmission. This includes children wearing masks in childcare and school settings to prevent passage of the virus to themselves, other children, teachers and families. The American Academy of Pediatrics (AAP), Centers for Disease Control and Prevention (CDC), and N.C. Department of Health and Human Services strongly recommend that children ages 2 years and older wear masks in childcare settings.

This is why we, as pediatricians, have been alarmed to learn that Bright Horizons, a large national childcare corporation with 11 centers in in North Carolina has not only declined to mandate mask wearing, but has even gone so far as to prohibit their use for children under 6 years old unless families provide a doctor’s note of medical necessity. We strongly recommend against such policies.

Children can safely wear masks beginning at age 2 years. Claims to the contrary are unfounded and erroneously excuse daycare centers from investing in the training and education of their staff on how to effectively promote mask-wearing. Social media myths that suggest that masks make it difficult to breathe, interfere with lung development or trap carbon dioxide have all been debunked by the CDC and AAP. Concerns that young children might touch their masks, touch a classmate’s mask, or take their mask off and throw it across the room are valid, but so are concerns that unmasked children may rub their noses and then touch their classmates’ faces, which is arguably a much higher risk for COVID-19 transmission.

Wearing masks keeps us all from touching our (and our friends’) noses and mouths as much as we would otherwise. Younger children need education and encouragement from their caregivers, the same way they do for handwashing, eating vegetables and wearing bicycle helmets. Over six months into the pandemic, we have seen the success of mask-wearing in the majority of our local daycares following public health recommendations as well as in states which have mandated masks for younger children.

Masks are particularly important because young children are often asymptomatic or have very mild symptoms that can go unnoticed. Temperature checks and increased surface cleaning are not sufficient for a highly transmissible virus that can aerosolize indoors with the usual squealing, laughing and singing in children’s play areas. Masks are the only means of consistently mitigating transmission.

The requirement of a doctor’s note for a child to wear a mask is deeply misguided, cumbersome for families and healthcare systems already struggling with the inordinate demands of the pandemic and sends the wrong message. Wearing a mask is to protect those around you.

Daycare providers are also put at risk when masks are not mandated. They are essential workers who serve on the front lines by caring for our children. They deserve the same protections that we pediatricians have in our medical offices where masks are mandated for children 2 years and older. Work exposures put them, their families and their communities at risk.

In this pandemic we consistently have to weigh the risks and benefits of interventions, and the benefit of mask-wearing in children far outweighs the risk, just as in adults. As leaders in the health care of children, we want families to know that it is medically necessary for every child 2 years and older to wear a mask in public settings, including daycare or preschool.

Families, physicians, childcare providers and government leaders should partner together to prioritize safety, leading with scientific evidence and heeding expert advice.

This story was originally published October 25, 2020 at 12:00 AM.