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- Wearing masks: yes, even most kids can do it!
Wearing masks: yes, even most kids can do it!
As stay at home orders are lifted across the country, wearing masks will be one part of doing it safely. Many parents wonder: how can we get our kids to do this?
Why do I encourage masks?
Because they can help stop the spread of germs. I highly encourage everyone to read The Risks - Know Them - Avoid Them from Emily Bromage. The sections about how a virus is released into the environment and the role of asymptomatic people in the spread of COVID19 can help us all understand how the virus spreads and what we can do to protect ourselves, our family, and our community.
Another interesting read about how masks can be an effective way to stop the spread of infection is "The Real Reason to Wear a Mask: Much of the confusion around masks stems from the conflation of two very different uses."
But how?
Despite knowing this, many parents wonder how they'll get their kids to wear them.
I had strong willed kids who had sensory issues with certain clothing when they were young. I know what it's like.
But I also know when things were important, they learned to wear the uncomfortable sports gear or school uniform. They had to. There was no option. So they practiced and it got easier each time.

Who should NOT wear masks?
Most kids over 2 years of age can learn to safely wear a mask, but under 2 years of age should not wear one. Under that age the American Academy of Pediatrics does not recommend masks. It could be a choking or strangulation risk for them.
If a child is not able to leave the mask in place, it may be better to leave it off. Every time they touch the mask, they risk introducing germs onto the mask (contaminating themselves) and touching other surfaces to share all the germs the mask has collected (sharing with others).
For those who are too young or unable to wear a mask safely, it is best to try to keep them home or in outdoor areas without close contact with others.
If they must go to a public area, such as a doctor's office, use other safety precautions:
Clean their hands often with soap and water or hand sanitizer.
Try to get them to avoid touching their face and surfaces by giving them something to hold and occupy their hands or by telling them to keep their hands in their pockets. If they suck on a finger or thumb, offer something else for them to keep in their mouth when in public areas.
Gloves should not be used for germ control because they collect the same germs as hands and are less likely to be cleaned often.
When are masks NOT necessary?
In our own homes we do not need to wear masks unless there is risk of spread in the home, such as someone with an immune compromised condition or a known case of infection in the home.
Outdoors masks are not needed if people can maintain a 6 foot distance from others.
What if they're scared?
It's anticipated that kids will initially see masks as scary, but not all do. I've been quite pleasantly surprised in my clinic over the past few months how rarely kids are scared of my surgical mask.
Most are either indifferent or just curious. Some days I think I have fewer toddlers scream during exams than normal. It's odd, but I'll take it!
You won't know how your own kids will react until you try them out.
They'll be less likely to be scared if they see you put it on and take it off.
They can look in the mirror as you cover their nose and mouth with a scarf, bandanna or mask to get used to their own face being covered.
A note about anti-mask propaganda
If older kids have seen some of the anti-mask propaganda and are worried about their oxygen or CO2 levels, talk about how many people wear masks safely, such as surgeons and people with immunocompromised conditions.
Even surgeons with asthma can safely wear a mask through a long surgical procedure.
They do this all the time. If it really wasn't safe, they wouldn't be able to do it day after day.
Talk to your tween or teen about why some people feel threatened by wearing a mask. Personal liberties are important in the US, but so is keeping a community safe.
We do not allow people to drive drunk without consequence. This is for the greater good and helps to save lives, just like masks can help to save lives.
Masks are germ catchers
If kids understand why something is happening, they're more likely to accept it, so talk about germs with preschool and school aged children on a level they can understand.

Talking points:
Germs make us sick, but we don't always know when we catch them
Sometimes we know we're sick from germs and we should stay home.
There are times we have germs but don't know it yet. We can share our germs for a couple of days before we get sick, but we don't want to make other people sick so we can try to keep our germs to ourselves.
Masks: keep the inside in/outside out
Masks have two sides: the inside has our own germs, the outside has everyone else's germs.
We can keep our germs in our mask so we don't make people sick.
The mask also keeps other people's germs on the outside so we are less likely to get sick.
This is why we should try to only touch the elastic or ties of the mask, not the mask itself and why we should wash our hands before and after touching the mask.
The T Zone
Germs get into and out of our body through our eyes, nose or mouth - the T Zone.

Our hands can carry germs even if we can't see germs.
It's really important to not touch the T Zone without first washing our hands so we don't catch other people's germs. Then we wash our hands after touching our face so we don't give other people our germs.
Wear them correctly
Masks should cover the nose and chin. Too often people pull them down, but this increases the risk of mixing the inside and outside germs and contaminating your hands.
Take a look at these pictures from the NYTimes article "How NOT to Wear a Mask" that show common inappropriate ways to wear a mask.
Talk to your kids about the right ways to wear masks. Explain that some people don't always do this, just like some people don't wear helmets or sunscreen, but to be safe, you and your family will wear them properly.
The less we touch our mask, the better. Make it a game to see who can go longer without touching their mask. Since we all need to adjust it or remove it to eat or drink, they get a "free" touch if they properly clean hands before and after touching it and if they avoid touching the mask itself.
People who wear masks are helpers
Let kids know that when people wear masks they are being kind and considerate of others because they're keeping their germs to themselves when they are in public.
(They are also kind and considerate if they stay home when they know they're sick.)
Make masks familiar
Use old clothes
You can make masks from familiar clothing that they're outgrowing so it's familiar to them and inexpensive for you.
Get kids to help
Have your kids help make the mask for added buy into wearing it!
Some sites for instructions to make your own mask include the CDC and this blogger (I have no ties, but I liked that it has several options, including no sew and places to buy online for those who don't want to DIY.)
They can decorate their masks with fabric markers for added fun!
Everyone (over 2) gets a mask!
Much like seatbelts and helmets, kids do what they're shown, not what they're told. You should wear your mask properly to show them how it's done.
You can have your kids make small masks for stuffed animals and dolls. (I'd encourage them to keep them in the house and not to join the family on outings though... toys pick up germs that aren't needed!)
Practice at home
Wearing a mask can be difficult at first.
Start small - wear it for just a few minutes, then expand that time as it is tolerated.
Get the masks and start practicing now so kids will be pros if they have to wear them when they visit public areas this summer or to school in the fall.
Show them off
Call friends and family on a video chat (Facetime, Zoom, etc) to show off your new masks and to see how much they like to see your kids wearing masks.
Have kids draw self portraits and pictures of family members in their masks.
Role play
Have kids don their masks and play doctor or vet with family or stuffed animals and dolls.
This is a great way to get them to wear the mask for a longer period of time without focusing on the mask itself.
Keep em clean!
Before removing your mask, wash your hands with soap and water or sanitize them.
Do not touch the main part of your mask - it may have germs all over it. Remove the mask using the ear loops or ties.
When masks are removed, they should be placed in an area that won't contaminate other surfaces. Paper bags can be really helpful until they can be put in the laundry.
All homemade masks should be washed after every wearing or daily if they are kept in a paper bag when temporarily removed. Use a standard washing machine, hot water and laundry detergent.
Addendum:
Mask brackets
Mask brackets may help those who do not like the feel of fabric on their face or who do not like sucking the material in when they take a deep breath.
Face Shields
(Note: These are now shown NOT to be effective in preventing spread of COVID-19 unless worn with a mask. The shield serves to protect the wearer's eyes but does not stop exhaled particles from spreading to others.)
For those who don't know, shields are clear plastic sheets that can cover the face and may be protective against spreading COVID19.
They are cheap and can be easily cleaned, so can be reused indefinitely.
There are some that fit over ball caps or that attach to hats, so kids may find them familiar. If you look online, you can find DIY videos to make them from plastic folders or 2 Liter bottles.
Shields are still not recommended by the CDC for routine use, but as you know, recommendations are constantly changing!
For More
If you aren't sure how just talking can spread germs, this is an interesting video. It starts slow, but give it a chance!
Healthy Children (AAP site): Cloth Face Coverings for Children during COVID19
Best mask use:
How NOT to wear a mask (NYTimes)
For those who are hard of hearing, use a voice to text app, such as Google's Live Transcribe
The Ultimate Guide to Homemade Face Masks for Coronavirus: Ultimate facemask materials
Concerns About Masks?
For tips to help kids learn to wear masks:
We Wear Masks - a social story in video format from Mr. Mike
Mask Up! Talking to Young Children About Wearing Masks from Zero to Three
I Can Wear A Mask - a story for visual learners. There are many pictures to show why we wear masks to protect ourselves and others.
Wearing Masks from Cincinnati Children's to help kids with developmental disabilities learn to wear a mask
Autism Focused Intervention Resources and Modules (AFIRM) Toolkit
If you use a lanyard to avoid losing masks, choose one with a breakaway safety feature. One example is this one that also doubles as an ear saver, but there are many offering different features and you can make your own. (I have no relationship with this Etsy store seller but I like that it has those two features and you can customize it with your child's name, though the name piece might be uncomfortable for some. Dr.S)
Check out Mask Brackets - they help the mask stay off of your face, which some kids may think is more comfortable. Today Article on Mask Brackets
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