As with adults, the Centers for Disease Control and Prevention advises children 2 years and older to wear cloth face coverings when in public settings. Face masks are one tool being used to protect the spread of the coronavirus, which can be transmitted by carriers who don’t always show symptoms. This makes masks particularly important for all of us – kids included – where social distancing is hard to maintain.
“By and large, children with COVID-19 who do have symptoms have mild ones and they’re not being tested,” says Brad Feldstein, MD, associate medical director of pediatrics for Einstein Healthcare Network. “The mask helps prevent that child who could be infectious from spreading the infection to someone else.”
It’s hard enough to make sure kids wash their hands properly – and avoid touching their face. So how can you get your kid to wear a mask, keep it on, and wear it safely? We talked to local pediatric experts, and checked the latest guidance from American Academy of Pediatrics.
Even if you’re not going out in public together, mask-wearing may be a practice you want to start exploring now. While it’s not yet clear whether or not schools will reopen next fall, Philadelphia Superintendent William R. Hite Jr. says students will almost certainly need to wear masks when they do. And as restrictions start to lift, it’s likely they’ll still be required elsewhere, too, beyond essential businesses.
“It’s definitely a strain on everyone, but it’s one way that we can keep more people from becoming infected, and as a result, I think it’ll become more of a norm in our culture into the future,” says Craig A Shapiro, MD, pediatric infectious diseases specialist at the Nemours/Alfred I. duPont Hospital for Children.
Experts recommend a standard cloth mask like that for adults – only smaller.
“The fit of the mask is just as, and if not more, important than the material of the mask,” says Shapiro. “You want a snug and comfortable fit so that the kid isn’t constantly readjusting it and touching their face. The biggest risk of transmission is through touching the mask.”
You can find child-sized masks online, like Etsy, or search online for “child mask template” to make your own. Just keep in mind, you may need to go through a trial and error process to find the right fit. “Even a child-sized, 5-x-10 inch mask may be too large for young children,” notes the American Academy of Pediatrics.
If you’re in a place where it’s hard to stay six feet away from other people, like a supermarket, everyone in the family (two years and older) should wear a mask. However, experts recommend avoiding those situations altogether, if possible.
Kids will rarely need a mask when playing in places like the backyard.
“There’s no risk if they’re in an open environment away from other people, but they should still wash their hands when they come inside,” says Shapiro.
This applies to parks that aren’t crowded, too. But if your kid has a tendency to touch everything in sight, like water fountains and benches, a mask may be helpful to prevent them from touching their face.
Wearing a mask properly means not touching it when it’s on. Even with a proper fit, that can be one of the biggest challenges with kids.
Start by practicing together indoors. “Adults are the role models, so especially for the child who’s hesitant or fearful, it’s important to practice wearing it together to show that it doesn’t have to be a fearful thing,” says Feldstein. “Show them pictures of other families wearing masks, too. Kids don’t want to feel like they’re different.”
For younger kids, try using a favorite stuffed animal to model the practice. Encourage them to decorate their mask with stickers. And if they’re feeling particularly nervous, wear masks while looking in the mirror and talking about it.
Many experts also recommend using a reward system – avoid touching your face, get a piece of candy.
Or turn it into a game.
“With my two kids, we pretend we’re superheroes who can’t touch their face – it’s part of our superpowers, and I let them make up some of the story with me,” says Dr. Julia Sammons, hospital epidemiologist and medical director of the department of infection prevention and control at Children’s Hospital of Philadelphia.
Simple and constant reminders about not touching your face are always useful and important, too.
Sammons says that as kids get older, you can talk to them in more detail about the rationale behind wearing a mask. Teach them about altruism and the importance of being a good member of the community.
And even for younger children, you can still help explain. The American Academy of Pediatrics recommends telling little ones that “sometimes people wear masks when they are sick, and when they are all better, they stop wearing the mask.”
Ok, you’ve tried all of the above, and yet, your kid’s still tugging on their mask at every blink of an eye. Now what?
In short, keep your kid at home.
“If they’re touching it a lot, it could present more challenges than it’s worth, and lead to self contamination,” says Sammons.
Double check the fit to see if there’s an issue with comfort. Masks should fully cover the mouth and nose, fitting close to the skin, but not too tight that it prevents breathing.
“Don’t take them if they don’t need to be out, but if you don’t have an option, it is important to try and keep that mask on their face as much as possible,” says Shapiro.
The CDC advises against masks for children under two, anyone who has trouble breathing, and those who are unconscious or otherwise unable to take one off.
Why is two the age cut off? “From a developmental point of view, kids under two are going to be pulling it down under their mouth, which defeats the purpose, and it could be a choking or suffocation hazard,” says Feldstein.
If you’re craving fresh air or have to go to a place where you can’t easily stay six feet away from other people, Summons suggests those with infants use a stroller, and tent a blanket on top to create a physical barrier. Note: don’t leave the blanket on the carrier in the car or when the carrier is not in direct view.
The answer is a quick no. It’s critical that mask-wearing doesn’t replace other measures to prevent spreading the virus, experts warn.
“Good hand hygiene and physical distancing are probably even more important than wearing the mask, and none of these interventions should be done in isolation,” says Sammons.