Kids and masks during the COVID-19 pandemic: 7 questions, answered

Wearing a mask when out in public is one of the easiest ways to help curb the spread of the novel coronavirus, COVID-19, especially by those who may be infected and not yet realize it.

But it’s not just adults who need to wear masks during the COVID-19 pandemic. Kids do, too.

So, how young is too young to wear a mask? Why do some children resist it so fiercely? And how can parents get their kids more comfortable with wearing a mask during the COVID-19 pandemic?

We spoke with Nicole Rosburg, manager of our Child, Adolescent and Young Adult Life Program, who works with our pediatric cancer patients to get them to wear masks. Here’s what she had to say.

Why is it important for children to wear masks during the coronavirus pandemic? What should parents tell their kids about wearing a mask?

It’s important to help kids understand that wearing a mask helps protect the people around us. We know that wearing a mask provides more protection for others than it does for ourselves. But we also know that children can be asymptomatic carriers of COVID-19. So, if they’re masked, they’re less likely to transmit the virus to others.

Children have a lot fewer inhibitions than adults. So, if they see something interesting, they’re much more likely to run at it. Kids aren’t worrying about the risks. They just think, “Oh, it’s so exciting to see Aunt Cathy! I’m going over there right now.” They don’t have that internal locus of control to put on the brakes, before somebody else says, “Stop!”

Wearing a mask protects others a bit when they overstep that boundary. It can also be a tangible reminder of, “Oh, right. I’m supposed to be more careful.”

At what age should children wear masks?

Right now, the recommendation is any child over the age of 2, if they can tolerate it and don’t have any breathing difficulties.

Young children aren’t as capable as older children of consistently following rules, such as don’t touch your face, cover your cough, and use a tissue. Developmentally, they’re just not there yet. So, wearing a mask reinforces that message, because it’s a tangible reminder of the things they’re supposed to be doing — and not supposed to be doing.

Most kids start to get better at following rules by about age 6. But even then, they aren’t entirely reliable. I know some older children who think absolutely nothing of wiping their noses with their sleeves and then coming over to hug you.

Why is it important for children younger than age 2 not to wear a mask?

The main reason is that infants and toddlers may not be able to get the mask off of by themselves, if they’re in distress. Most haven’t mastered speech yet, either, so they also can’t reliably tell you if they’re having problems — or, at least, not in the same way that an older child might.

Experts still don’t understand how sudden infant death syndrome (SIDS) happens, but they do know that breathing is involved. And very young children breathe in a less regular and measured pattern than adults do. That’s why parents are always warned not to use blankets or crib bumpers. Those items can restrict air flow and potentially cause suffocation, should a child become tangled up or pressed tightly against a surface.

It’s the same thing with masks. An infant could get tangled up and not be able to get out of one. Or, the elastic could become a choking hazard when it slips over a baby’s head and tightens around the neck.

Why is it so difficult for some children to tolerate masks?

Some kids have sensory processing issues, so they can’t stand the sensation of the fabric against their skin. Others feel stifled or suffocated, particularly if they already have difficulty breathing, due to a chronic health condition such as asthma.

Small children simply don’t like to be restricted. Developmentally speaking, preschoolers especially are just starting to realize that they are separate from their parents. So, they’re wanting to go out and explore the world. Anyone who’s ever tried to restrain a young child who’s upset or excited knows how difficult that can be. It can feel very frustrating for the child, too.

For older children, resistance can stem from a form of claustrophobia. That fear is not just about being confined to a tight space. People can also start to feel panicky and hyperventilate when they’re constrained or restricted in some other way. Adults experience it, too.

How can parents help younger children get more comfortable with the idea of wearing a mask to prevent the spread of COVID-19?

The key is familiarity. As Child Life specialists, we do all sorts of things to get kids familiar with medical materials, whether it’s fun activities or medical play. The idea is to make the item in question non-threatening. This is no different.

For instance, you might put a mask on yourself and play peekaboo. Or put one on a favorite stuffed animal, and then say, “Oh! Teddy looks so silly, doesn’t he? But, can we tell it’s still Teddy?”

Allowing the child to manipulate the mask, wear it, decorate it, or put it on someone else can be helpful. Let them touch it, feel it and really experience it. When they figure out it’s not going to hurt them, and it’s still you under the mask, it’s not a scary thing anymore.

Imaginative play can also get children to act out any misconceptions they may have. That helps you understand what they still don’t understand, so you can provide a better explanation.

What else can parents do to encourage their children to wear masks?

Set a good example by wearing a mask yourself. It’s important to practice what you preach, so it’s not a case of “do as I say and not as I do.”

Kids can sniff out hypocrisy pretty quickly, and it seriously dilutes the message when parents don’t lead by example. This is especially true for younger children.

Anything else you want parents to know about having kids wear masks during the coronavirus pandemic?

Our pediatric patients experience masking on a daily basis since they’re immunocompromised, but every child over the age of 2 needs to be doing this, to protect both themselves and others around them.

The reality right now is there’s no effective, identified treatment for COVID-19 and no vaccine yet, so people of every age have some level of risk. I know it might seem like an extra effort to get your child to wear a mask, but it’s worth it – and it sets a great example.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.