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By Elesha George

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The Ministry of Health has amended its mask-wearing guidelines for children under the age of five, reflective of new research carried out by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).

The local health authority has now said that children under the age of five are not required to wear masks. Previously the ministry took the decision that all children above the age of two should wear masks, according to the WHO recommendations at that time.

However, in a document dated September 3, the WHO and UNICEF recommended that children under the age of two should not wear masks and those between two and five years old should “not wear masks for source control”.

Chief Medical Officer (CMO), Rhonda Sealey-Thomas, told Observer that means that children under five should not wear masks at all, unless it’s for medical purposes.

The WHO and UNICEF advise that the age categories be adapted to the national/local education level structure to facilitate the new guidelines in school settings.

The decision takes into consideration childhood developmental milestones, compliance challenges and the autonomy required to wear masks correctly.

The decision, the WHO says, is motivated by a “do no harm approach”.

“Based on the do no harm approach, if the lower age cut-off of two or three years of age is to be used for recommending mask use for children, appropriate and consistent supervision, including direct line of sight supervision by a competent adult, and compliance need to be ensured, especially if mask wearing is expected for an extended period of time. This is both to ensure correct use of the mask and to prevent any potential harm associated with mask-wearing to the child,” the document reads.

The rationale included consideration of the fact that by the age of five, children usually achieve significant developmental milestones, including the manual dexterity and fine motor coordination movements needed to appropriately use a mask with minimal assistance.

Children with severe cognitive or respiratory impairments who have difficulties tolerating a mask should also, under no circumstances, be required to wear them, the guidelines say.

Face shields, the WHO said, may be considered as an alternative to masks as respiratory droplet protection or as source control, based on availability, improved feasibility and better tolerability but the organisation warns that research into the transmission of Covid-19 using only a face shield needs to be further researched and monitored.

Both WHO and UNICEF advise that face shields may be used when physical distance cannot be maintained, and in special situations where it is not practical to wear a mask.

The face shield should however cover the entire face, be wrapped around the sides of the face and extend to below the chin. Reusable face shields must be properly cleaned (with soap or a detergent and water), disinfected and stored after each use. Face shields that will withstand the use of disinfectants without damaging their optical properties should be selected.

Furthermore, children should maintain physical distance of at least one metre (3.3 feet) where feasible, with ongoing promotion of frequent hand hygiene and respiratory etiquette.

Mask wearing, the bodies advised, should also not be mandatory for children with developmental disorders, disabilities or other specific health conditions.

The use of a medical mask for immunocompromised children, or for paediatric patients with cystic fibrosis or certain other diseases such as cancer, is usually recommended but should be assessed in consultation with the child’s doctor.

 “They should be assessed on a case by case basis by the child’s educator and/or medical provider,” the document states.

In order to reduce the transmission of Covid-19, other Covid protocols, public health and social measures should be prioritised; specifically maintaining physical distance of at least one metre where feasible, educating children to perform frequent hand hygiene and limiting the size of school classes.

Meanwhile, children and adolescents 12 years or older are advised to follow the WHO guidance for mask use in adults and/or the national mask guidelines for adults.

Experts from WHO, UNICEF and the International Paediatric Association jointly reviewed the available evidence to develop guidance on the use of masks for children in the context of the current pandemic.

Five international expert meetings were held between June and August. In the absence of strong scientific evidence, consensus among these groups forms the main basis for this guidance. The draft guidance was also reviewed by a multidisciplinary group of additional external experts prior to finalisation.

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