As mask mandates lift in schools around the United States, many people – parents, children, educators, and family service providers included – continue to have worries and concerns regarding the on-going COVID-19 pandemic. Despite waning infection rates, anxieties about getting sick are likely to last for some time, regardless of whether another variant significantly increases cases locally again.
YCSC Assistant Professor Yann Poncin, MD says of the recent endings to school mask mandates in Connecticut and many other places, “This is a stress for parents, kids, teachers and all school staff. There is a particular challenge for families that have immunocompromised members at home or conditions that put them at risk.”
How do you talk to children about these concerns and ease anxieties, whether about the choice to continue to wear a mask or about others who are not masking?
First, it’s important to note that there is no research showing that masks harm children. As YCSC Professor Walter Gilliam, PhD said in a recent National Geographic article on this topic, “When you have an ache and a pain, it’s the cut on your arm not the Band-Aid that went over it that’s causing the problem. The purpose of the mask is to reduce all the other traumas—traumas that we know for an absolute fact harm children.”
A study conducted by Gilliam and colleagues (via Yale CARES, an interdisciplinary research team) with data from childcare programs across the U.S. found that masking made a significant difference in keeping programs open, especially when used as part of a layered approach and toolkit for preventing infection. Gilliam and Associate Professor Thomas Murray, MD talk about this in a “Famly” video interview.
YCSC Associate Research Scientist Megan Goslin, PhD agrees and adds that community risk factors – in addition to individual factors such as having an immunocompromised household member – should also be considered when determining approaches to mitigate and prevent illness. “Such considerations are essential given the disproportionate impact that COVID-19 has had on black, indigenous, and other communities of color and on individuals with disabilities,” Goslin added.
Nonetheless, mask mandates are being lifted around the country, so children and adults alike may have worries and anxieties regardless of individual choices around continued masking. Some guidance follows from Gilliam, Poncin, and Goslin regarding a variety of related concerns.
Protecting ourselves and our families from COVID-19 going forward:
This is a stress for parents, kids, teachers and all school staff. There is a particular challenge for families that have immunocompromised members at home or conditions that put them at risk.
YCSC Assistant Professor Yann Poncin, MD
- Getting vaccinated and boosted is still the best protection from serious illness in adults and children. Vaccination also provides some protection from transmission within the family, the most common form of transmission.
- Masking can provide an important layer of protection, especially for unvaccinated children and adults.
Talking to children about COVID-19 concerns and family or household members who are immunocompromised or otherwise at higher risk:
- Often, the most important thing that parents and caregivers can do for children expressing worries about COVID-19, masking, or other mitigation strategies is to listen.
- Listen to the concerns that children are raising and answer questions directly, using age-appropriate language.
- Acknowledge how a lack of control and uncertainty about the pandemic can contribute to worries and encourage children to focus on things they can control to keep themselves and family members safe.
- Maintain an “open door” policy for new questions and worries as the pandemic continues to evolve.
- To jumpstart discussions, parents might ask their children if classmates have been talking about changing guidance, which may be easier for some children to acknowledge than their own worries and questions.
- Be careful not to discuss matters with a child in a way that they fear infecting their own family members, as feelings of guilt and worry may set in easily. Instead, focus on actions the child can take to protect themselves and their loved ones.
- Although it may be appropriate to share information with children about different perspectives that adults have on masking, children should generally not be exposed to contentious debates about masking or vaccination. Children (especially very young ones) are easily frightened when the adults around them argue or otherwise don’t seem to have their act together. Children turn to adults for stability, particularly during uncertain times.
- Discussions with children about changing mask guidance can provide a good opportunity to teach empathy – being a kind and caring person often means choosing not to exercise a freedom just because one can, and instead choosing to do all we can to protect others. This is also an opportunity to teach children that there are times when we need to follow rules or guidance with which we don’t always entirely agree.
Responding to concerns about masking in children:
- Masking & Mental Health Difficulties
- There is no peer-reviewed research that shows masks or mask mandates causing mental health concerns.
- Although children’s mental health concerns have increased during the pandemic, experts attribute these increases to disruptions such as school closures and resulting isolation, increased parental substance misuse, economic stressors, increased exposure to domestic violence, community violence, and child maltreatment, food insecurity, loss of loved ones, and similar impacts of the pandemic.
- Keeping schools safely open for in-person instruction addresses many of these concerns by providing familiar routines and predictability, reducing isolation, allowing children to access school-based meals and physical and mental health resources, and providing the opportunity for identifying children impacted by violence or other traumas at home.
- Masking and Developmental Delays
- There is no peer-reviewed research that shows masks or mask mandates causing speech/language or other developmental concerns.
- While a few studies have shown that children have a harder time identifying some emotions in pictures of masked people, any effects are small, and in some cases the findings are mixed, with children having difficulty identifying some emotions, but they are actually better identifying other emotions in a picture of a masked face. Most children identified most emotions correctly anyway. In real life, children do not interact with still pictures. They interact with real humans who also show emotion with their upper faces, words, gestures, vocal inflection, and within a context – emotion recognition is not limited to mouths.
- There is no science showing speech deficits due to masking; despite one headline that speech clinic referrals increased significantly after the shutdowns, it cannot be assumed that masks caused this increase.
- Masking & Breathing or Communication Difficulties
- Overall, research shows that most children are able to breathe well while wearing a mask.
- In a review of 10 studies on the effects of masking with children and adults, the results consistently showed no negative effects of masks on breathing.
- One study that suggested masks may cause breathing difficulties for children was later discredited and retracted because of problems with the study’s methods and findings.
- One study showed that most children can typically hear well through a mask, and when they cannot, the adults simply talk a little louder.
- Children with underlying medical conditions that do not allow them to wear masks safely should be accommodated, consistent with CDC recommendations and the Americans with Disabilities Act.
- Masking Considerations for Certain Populations
- For children with speech and language needs or deafness, standard masks (for them or for the adults around them) can be problematic.
- Many deaf children read lips. Clear masks have been developed to meet these children’s needs.
- Some children with developmental disabilities or tactile sensitivities may have a very hard time being masked. Parents and caregivers are encouraged to consult with special education professionals, pediatricians, and mental health specialists to develop individualized plans to address these concerns.
- Some children with moderate to severe asthma or other diagnosed breathing challenges may have difficulties wearing masks for longer periods of time and may need more breaks from the mask. It is best to consult your child’s health care provider.
- Conversely, there are children who are immunocompromised or have comorbidities that would place them at higher risk of COVID-19 complications. Masking may be essential for these children even after mandates are lifted.
As we shift our public health strategies to an endemic approach, it is normal to experience a range of reactions, including relief and joy as well as fear, anger, and worry. It is important to acknowledge these reactions in ourselves and our children and to stay informed in order to make healthy decisions. Parents are encouraged to talk with their health care providers about concerns and to be compassionate with themselves and one another as we all attempt to navigate this next phase of COVID-19 together.