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Infants born during the COVID-19 pandemic have less interest in masked faces than unmasked faces
  1. Susan Byrne1,2,3,
  2. Eileen O'Flaherty1,
  3. Hailey Sledge2,
  4. Sonia Lenehan4,
  5. Norah Jordan1,
  6. Fiona Boland5,
  7. Ruth Franklin2,
  8. Sadhbh Hurley1,2,
  9. John McHugh1,
  10. Jonathan Hourihane1,2
  11. on behalf of the CORAL Study group
    1. 1 Children's Health Ireland, Dublin, Ireland
    2. 2 Department of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland
    3. 3 FutureNeuro SFI research centre, Royal College of Surgeons Ireland, Dublin, Ireland
    4. 4 INFANT Centre, University College Cork, Cork, Ireland
    5. 5 Division of Population Health Science, HRB Centre for Primary Care Research, Dublin, Ireland
    1. Correspondence to Dr Susan Byrne, Paedatrics, RCSI, Dublin, D02 YN77, Ireland; suabyrne{at}

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    The COVID-19 pandemic was managed with lockdown, social distancing, mask-wearing and vaccination. Babies experienced societal isolation and encountered mask-wearing. There was speculation about whether COVID-19 mitigation measures, including mask-wearing, would impact child development.1 Deficits were identified in early communication skills among babies aged up to 24 months assessed during the pandemic.2 3

    The CORAL Study is a longitudinal study of over 350 Irish infants born into the pandemic.4 We have previously demonstrated that CORAL infants had limited social circles and a reduction in social/communication skills relative to a historical cohort at 12 and 24 months of age.3 4 We used eye-tracking technology to determine where 18-month-old CORAL infants fixed their gaze when looking at unmasked and masked adults.

    Eye tracking (see online supplemental file 1):

    Supplemental material


    • Task 1 – unmasked/masked parent task: infants were presented with an image of their own parent with no mask, then an image of their own parent masked.

    • Task 2 – unmasked/masked stranger task: all infants were presented with the image of a stranger with no mask, then the same stranger, masked. The same stranger was used in images for all infants.

    Eye-tracking study: 71 of 365 CORAL families participated. Infants were 18.5 …

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    • Collaborators CORAL study group: Liam O’Mahony (APC UCC), Naomi McCallion, Martin White, Marguerite Lawler (Paediatrics and Child Health, RCSI), Aideen Byrne, John Fitzsimons (Children’s Health Ireland).

    • Contributors SB co-designed the developmental aspect of the CORAL Study, designed the eye-tracking study, collected data, analysed data and wrote the paper. EO’F designed the eye-tracking study, collected eye-tracking data and edited the paper. HS collated data, assisted in analysis and edited the paper. SL provided input on the eye-tracking study and eye-tracking data analysis, and edited the paper. NJ designed the eye-tracking study, provided expertise on data acquisition and analysis, and edited the paper. FB provided statistical input and edited the paper. RF recruited participants, collected data and edited the paper. SH recruited participants, collected data and edited the paper. JM designed the eye-tracking study, provided input on eye-tracking analysis and edited the paper. JH is PI of the CORAL Study. He conceived and designed the CORAL Study and the developmental substudy. He recruited participants, collected data, interpreted data and wrote the paper. He designed the eye-tracking study. He is the guarantor of the work.

    • Funding This work was supported by Temple Street Hospital Foundation in Dublin, Ireland and the Clemens Von Pirquet Foundation in Geneva, Switzerland. SL was funded through Irish Research Council (grant GOIPC/2020/309).

    • Competing interests JH is director of Clemens Von Pirquet Foundation. No other conflicts declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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