Population Care

When kids struggle with wearing masks, here’s how doctors can help

Marc Zarefsky , Contributing News Writer

Editor’s note: With the COVID-19 Delta variant surging across the country, the Centers for Disease Control and Prevention (CDC) released updated guidance on masks for children going back to school as well as for Americans. This includes those who are fully immunized with one of the three safe and effective COVID-19 vaccines available in this country—Moderna, Pfizer-BioNTech and Johnson & Johnson. The guidance urges everyone to wear masks in indoor public spaces if they live in areas with high or substantial rate of virus transmission.

Wearing a mask serves as another layer of protection against transmission of the SARS-CoV-2 Delta variant that now accounts for more than 80% of cases in the U.S. The CDC also is recommending that children, teachers and staffers in K–12 schools across the nation wear masks in the coming school year, regardless of COVID-19 vaccination status. This brings the agency’s recommendations in line with those of the American Academy of Pediatrics. Learn more about why the CDC is again turning to masks to help stop COVID-19.

This back-to-school season has been markedly different for children of all ages as the country continues to see a daily COVID-19 caseload in the tens of thousands, and there is one item on back-to-school lists that would have seemed bizarrely out of place just one year ago: masks.

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As schools begin to reopen, kids find themselves interacting more on playgrounds and physically distanced get togethers are becoming more common. That makes it critical for children older than 2 to wear a mask when they are around others outside the household. Data has shown that wearing a mask can save lives, and according to the Centers for Disease Control and Prevention, the number of COVID-19 cases could drastically be reduced if everyone wore a mask.

Children infected with SARS-CoV-2, the coronavirus that causes COVID-19, are often asymptomatic, said AMA member Tamaan Osbourne-Roberts, MD, a family physician in the Denver area and a member of the AMA Council on Science and Public Health. Children also are likelier to be together in small, enclosed spaces all at once. Preventing children from spreading the virus is a key component when it comes to limiting the spread of COVID-19.

Saying a child should wear a mask and actually having them wear one consistently and correctly, though, can be two very different things. There are lots of distractions in children’s lives, and it’s easy for them to overlook the need for—or the importance of—wearing a mask.

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“That’s the nature of being a young person,” said Dr. Osbourne-Roberts, team lead physician at Iora Health. “It can be difficult to always remember the best practices. Frankly, I think it’s hard for most adults, if any time I go to the grocery store is any indication. With adults having so much difficulty, clearly children are going to have issues.”



So, what can physicians say to parents about how to help children keep their masks on? Dr. Osbourne-Roberts offered three key pieces of advice.

Get a well-fitting, comfortable mask. Every child’s face is different, and because of that, there is no one right mask for all children. The important thing is that the mask is secure, meaning it hooks under the child’s chin and comes up to the mid-bridge of the nose. If a mask is sliding off the nose or constricting the face in any way, that is a no-go, Dr. Osbourne-Roberts said.

Let children get involved in picking their own mask. One way to help kids be more excited to wear a mask is to let them help pick out the mask’s design. Whether it be selecting the look from an online vendor or a neighbor making them with a sewing machine, when children are involved in the mask selection process, they become more invested and interested in wearing it, Dr. Osbourne-Roberts said.

“Having my children be able to pick their own masks has really been instrumental in keeping them excited about them and not getting upset about needing to wear them,” he said.

Listen to children. This can sometimes be the most challenging step. If a child is saying a mask is not comfortable, it’s important to listen and determine whether there is something about the mask that is indeed causing a problem. If there is, it’s up to parents to find a different option that works well.

“If a mask is truly uncomfortable for a child and they don’t like wearing it,” Dr. Osbourne-Roberts said, “then we’re not being as effective as we can be to ensure their safety—and everyone else’s—if we don’t listen to those concerns.”

Learn more about five keys to an effective exam-room talk with adult patients about masking up.

It’s important for parents and physicians to talk with children about mask wearing and its impact because it is a way to get children involved in their own health, said Dr. Osbourne-Roberts. This also is a way to get children talking about the pandemic and what they understand about it. These conversations not only showcase what kids are thinking or feeling, but they can also indicate additional worries, fears and anxieties they face.

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Dr. Osbourne-Roberts discovered this with his own children. With the spread of COVID-19, his 9-year-old daughter was concerned and had a number of questions, but she still wanted to get out in the world and live as much of a normal life as she could. His 11-year-old son, on the other hand, showed a higher level of worry and concern about catching the coronavirus than even Dr. Osbourne-Roberts had initially realized.

The reaction to the pandemic varies from child to child, he said.

“They’re people,” Dr. Osbourne-Roberts said. “They are smaller and with less experience, but they have their own thoughts, concerns and frustrations around this.”

Learn more about the AMA’s #MaskUp campaign to stop the spread of COVID-19 and track the pandemic with the AMA's COVID-19 resource center.