The day care that Kathy Franklin's 3- and 4-year-old daughters attend recently started requiring face masks. And the first day did not go well.
"It's impossible to keep a face mask on them. They rip them off and throw them on the ground when they get hot, frustrated or tired of wearing them. My oldest tries to be funny and pulls it over her eyes," the Baltimore mom says. "The teacher said they had a really hard time getting all the kids to wear their masks. They were taking them off a lot and dropping them. It was a big challenge."
Adjusting to face masks has been a challenge for many children - and it's a problem that's only going to intensify as more and more kids and teens head back to in-person day care, child care and school. Here are some tips to make the process a little easier.
Who should wear a mask?
The U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics (AAP) recommend that children 2 and older wear face coverings indoors or out anytime they can't stay six feet or more away from others.
"For safety reasons, a mask should never be placed on any child who is unable to remove it themselves, for example children under 2 years of age and children with neurologic issues or developmental delays," explains Nipunie Rajapakse, a pediatric infectious diseases doctor at the Mayo Clinic in Minnesota. "But otherwise children should wear masks in public settings and especially in situations where they are indoors around other people or where maintaining physical distancing is difficult."
What kind of masks do children need?
Health experts say the cloth variety is generally all that's necessary for children - but not any cloth mask will do. The fit matters. "Children are unlikely to keep a mask on if it is very uncomfortable for them," Rajapakse explains. "If it does not fit properly, they will likely touch their face and mask frequently to make adjustments, which could also run the risk of increasing their chance of infection."
To ensure a proper and comfortable fit, experts recommend getting face coverings specifically sized for children. A good fit happens when a cloth mask covers the nose and mouth and secures under the chin. Ear loops can be easier for young children than ties, and the AAP says pleated masks often fit little ones best. The organization of pediatricians recommends more than one layer of fabric, too.
"Three layers seems to be the sweet spot that does a good job of blocking most of the respiratory droplets you produce while also still allowing you to breathe through it. Three layers is also what is recommended by the World Health Organization," Rajapakse says.
Practice the 3 Ps: Prep, plan and patience
Rebecca Schrag Hershberg, a clinical psychologist, parenting coach and author, says it's also helpful to prepare children for this new reality in any way you can. For younger children, she says, that might involve showing them what different facial expressions look like while wearing a mask so they get used to reading emotions and picking up on social cues when they can only see people's eyes and foreheads. Rajapakse also recommends showing kids how to place their mask on a clean paper towel or in a paper bag or plastic container to keep it clean while eating or drinking or at other times when they take it off.
Beyond that, experts say, be patient, provide positive reinforcement whenever possible and praise small victories. "If you find out from the teacher that your child did a good job wearing their mask for part of the day, focus on that rather than criticizing the part of the day that they struggled," Hershberg says. "We all need to remind ourselves that this is new and it's a process. It's not always going to go smoothly the first day, the first week or even the first month."
Managing face-mask feelings
Beyond the logistics of wearing a mask, there are emotions it may trigger in children, too. "For younger children, the issue with masks can be related to discomfort, unfamiliarity or just general fear. It can be uncomfortable for kids to wear them. It's hot and sweaty. Older kids may complain they get mask breath or it exacerbates acne. But we have to teach our children to focus on the greater good," says Ghassan N. Atiyeh, a pediatrician with Children's Medical Associates in Northern Virginia. "When they are alone or separate from others, kids can take the mask off, but in general they should keep it on for their safety and to protect others."
In addition to calmly and clearly explaining why we wear masks, Hershberg says validating children's feelings is important, too. "It's not helpful to say things like, 'It's not that bad,' or 'Come on, what's the big deal?' It's far better to acknowledge that this is different and does feel weird, but that it's also important and something we need to do for the health of our community," she says.
You also need to figure out where their defiance, if they have any, comes from, Hershberg says. "Are they anxious or afraid? Do they not like how they look? Is it uncomfortable or are they afraid they won't look cool? Whatever it is, explore that and then problem-solve, focusing not only on what they can't control, but also on what they can."
If young kids are apprehensive, Atiyeh suggests parents model good mask-wearing and incorporate masks into imaginative play. "Put masks around their toys. Put one on with them and pretend you are doctors or superheroes. Let them personalize a mask or decorate it. All of those things can gradually make them feel more at ease," the pediatrician suggests.
To-wen Tseng, the mother of two young boys in San Diego, says that in Taiwan, where she has many family and friends, children have been wearing masks for a while, and the successful messaging revolves around superheroes. "All of my children's cousins, aged 3 to 16, have been wearing masks to school since last semester there. It's totally doable. All the kids now know Spider-Man is the true hero because he covers his nose and mouth and protects himself and others. Batman is not the hero we need right now because he covers only his forehead and ears."
In the end, Franklin came up with a "mom hack" to solve her problem. She bought beads and clasps at a craft store and had the girls make necklaces that clip to either side of their masks to keep them from falling to the ground if they take them off and to allow teachers to easily change out masks if necessary. She says it is helping.
"The girls are doing great with their mask necklaces," Franklin says. "It felt like a fashion accessory for them, and the teachers seemed excited, too. I have mixed emotions about all of this. It's still kind of hard for me to picture my girls wearing a mask all day and the challenges that brings with seeing facial expressions and learning language and social skills. But at the same time I want them to be safe, and I want their teachers to be safe, so I need to figure this out to protect them all."
Face mask Dos and Don'ts
- Do teach children to properly take face masks on and off by touching ear loops, not the front of the mask.
- Do have children clean their hands using soap and water or alcohol-based hand sanitizer before and after handling their mask.
- Do have children remove masks to eat, drink and nap.
-Do have extra face masks on hand because they need to be changed if they become wet or visibly soiled. "Children should always have a clean backup mask handy in their desk or backpack at school. They should be taught never to share or trade masks with other children at school," says Nipunie Rajapakse, a pediatric infectious diseases physician at the Mayo Clinic in Minnesota.
- Do clearly label your child's mask with their name and make sure they can easily tell which side is the front.
- Do launder or wash masks with soap and water after each use.
- Don't worry that masks impact your child's oxygen levels. "There is no truth to that whatsoever. Kids can absolutely wear masks for long periods of time," explains Ghassan N. Atiyeh, a pediatrician with Children's Medical Associates in Northern Virginia who says so many parents are asking about this that his practice just shared a post on the subject on its Facebook page.
- Don't make children wear a mask in their own home or in the car as long as they're only with people from their household. But Rajapakse says physical distancing is still recommended while wearing a mask. "Since no single preventative measure provides 100 percent protection from exposure to or transmission of the virus, using a combination of strategies to reduce risk like physical distancing, wearing a mask and cleaning your hands frequently is the recommended approach," she explains.