Protecting Your Child’s Lungs From Smoky Air

Pediatric pulmonologist Esmeralda Morales, MD, answers the most common questions she gets from parents.

Fire season is unfortunately here again, and with it comes a host of questions about how to protect your child’s lungs from smoky air. Esmeralda Morales, MD, a pediatric pulmonologist and director of the Stanford Medicine Children’s Health Asthma Program, answers some of the most common questions she gets from parents.

Q: What’s the biggest misconception parents have about air quality and protecting their children’s lungs?

A: I think a lot of parents jump to “What kind of mask should my child wear?” when I would first say, if the air quality is unhealthy (AQI 151 or more), try to keep your child inside whenever possible. I realize this is difficult, especially if it is very hot and you don’t have air-conditioning, like many of us in the Bay Area, but the best protection is to stay inside. There are no perfect masks to help stop smoke and particulates from getting into your child’s lungs, especially if your child is young.

Q: If a child has to go outside when the air quality is unhealthy, what are the best mask options?

A: If your child is old enough and you can find a well-fitting N95 mask, this can decrease smoke exposure by about 80%. When I say an N95 mask, I’m talking about a NIOSH-approved N95 mask, not a KN95 that many people wear to protect against COVID-19. There are no child-sized NIOSH-approved N95 masks, but they make a “small adult” size that might work for older children and teens. Be sure to test the fit by having your child blow out and suck air in, and make sure nothing is getting in or going out the sides of the mask. A medical mask, like the kind that can protect against COVID-19, can decrease smoke exposure by about 20%. A cloth mask provides no protection against smoke. And even if you have a well-fitting NIOSH N95 mask for your child, I still recommend limiting time spent outside.

Q: It seems like everyone is hyper-aware of the air-quality levels—good, moderate, unhealthy for sensitive groups, etc.—now. What can they tell us?

A: The air-quality levels range from good to hazardous. The different levels match up to different health effects for certain groups. For example, some extraordinarily sensitive people may have symptoms in the moderate range, though most people will feel fine. Children can experience health effects at lower levels than healthy adults. At AQI above 100, the air quality is called “unhealthy for sensitive groups.” All children up to age 18 are in the “unhealthy for sensitive groups” range, and kids with lung or heart conditions, like asthma, may be extra-sensitive.

Q: What can parents do to improve the air quality inside their home when there is a lot of wildfire smoke in the air?

A: Get to know your central HVAC unit, if you have one. If it has a fresh-air intake, this should either be closed or turned to recirculation mode. A MERV 13 or higher air filter is recommended. A portable air cleaner may be helpful, and if cost or availability is an issue, the EPA has a resource for creating a DIY air cleaner using a filter and a box fan that can be a temporary solution.

Q: What symptoms should parents look for if they are worried their child has been exposed to too much smoky air?

A: The lung symptoms of smoke exposure include coughing, wheezing, chest tightness/pain, and shortness of breath.

If you have questions or concerns about your child’s lung health, please call (844) 724-4140 to schedule an appointment with our team of pediatric lung specialists.

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