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During this time of uncertainty and unpredictability, there has been a clear and consistent message from the medical and scientific communities: The best way to prevent the spread of COVID-19 includes social distancing, wearing a mask when in public and washing our hands. While the message for prevention is consistent as a parent it may seem daunting to implement. In my own practice I have heard families frequently express concern for how to successfully introduce these prevention strategies to children, specifically teaching a child to successfully wear a face mask so they may return to school. At Texas Children’s Hospital, we understand that introducing something new can be challenging and want to best support our families with strategies to be successful.
My own role at Texas Children’s involves helping children of varying ages and ability levels get used to medical procedures and treatments within our sleep center, including tolerating their Continuous Positive Airway Pressure (CPAP) devices and masks. By using behavioral strategies and giving parents the right tools, families are able to be very successful with these medical devices. Given that the timeline for COVID-19 is unknown at this time and requirements have changed based on the data obtained, helping your child be prepared with wearing a mask successfully will help with the management of stress and anxiety associated with the uncertainty. Please consult with your child’s medical team if you have concerns regarding a preexisting condition.
Part of the challenge we are facing is the unpredictable nature of our current environment. Typically, we all thrive on knowing what to expect. Children rely on us to be structured, predictable and consistent. Because practices are continually changing, it’s important to know the expectations of businesses, agencies, or other places ahead of time because you and your child will be more successful if you have had a chance to prepare. For example, at Texas Children’s, children who are two years and older should be wearing masks when they visit our campus. Having that information in advance is helpful to prepare for the visit, but can cause considerable stress for both parent and child if you are surprised with that information at check-in. This could result in your child being unable to successfully complete their visit due to being unprepared to wear a mask.
So, let’s be honest about something for a minute. Wearing a mask is not always very comfortable and that is because it is new. Most of us are not used to it. This is going to sound like a silly example, but it’s like if you were wearing a new pair of shoes. They might be pretty uncomfortable at first, but you eventually get used to them after you’ve worn them for a bit. Luckily, I have some tips for you on how to increase your child’s comfort and cooperation with mask wearing.
In general, we need to first have appropriate expectations when children are learning a new skill. It isn’t fair to our children, their teachers, their medical teams and to you, their parents, to expect them to successfully wear a mask if they’ve never worn one before. Without preparation, you will likely see an increase in oppositional and anxious behaviors, which will result in stress responses from adults, typically seen as over responding to the child that often escalates the situation. The first time your child wears a mask shouldn’t be the day they have to wear it for a long period of time, during an exciting activity or a stressful event. Try this example on for size: Imagine you’re learning to play basketball. Would you take your first free throw ever during overtime in a championship game? No way! You would have been practicing afterschool with your friends in a less stressful situation to build your skills before performing in a game and then gradually work your way up to a high-pressure situation like a championship game. Now imagine that you are an 8-year-old in Texas lining up for recess where you are excited to see your friends and it is hot because it’s September! Probably not the best time to introduce a mask for the first time. Most of us would need to practice that. Really! It’s hot here!
To successfully introduce mask practicing, it’s important to remember that not everyone is going to have the exact same plan or starting place. Remember to think of learning this new skill as a marathon and not a sprint, so you’ll be more successful if you train for this. Help your child to do small brief practice sessions frequently. These sessions can be done daily or even multiple times per day if you are able to. Introduce the mask during a preferred activity, such as coloring or screen time, where your child (and you) are more likely to be calm and comfortable. Give lots (and I mean LOTS) of praise for behavior such as nice hands, being calm and taking slow breaths. Think about it. If your child has nice hands, they aren’t taking their mask off, right? The starting place may be different for each child. It’s important to know where they can start and work from there. You want to start with the amount of time your child is able to tolerate the mask BEFORE they get upset so you have an opportunity to praise them for being calm and end the practice. If you have to start with 15 seconds that is OK! If you have to start with the mask sitting next to your child that is OK! You will be able to gradually build up the amount of time or move the mask closer as they get more comfortable. The most important thing is that they start at a level where they are successful and that they keep practicing!
I have included a behavior chart that I made for learning how to wear a mask with the desired behaviors I mentioned. Some children really benefit from a visual and it also helps us adults to remember the positive behaviors we are looking for as well! On the chart are the steps I would recommend following related to setting up your practice sessions. For each practice session, set a goal with your child prior to beginning and review the expectations. I would also keep the time goal just for the parents but teach your child to focus on the desired behaviors. That will be more meaningful. Have your child help pick out rewards to start to increase their motivation to participate, as well as those preferred activities I mentioned that they want to do while they are practicing. After your child has successfully built up a tolerance to wearing a mask then increase difficulty of your sessions by having them practicing during schoolwork, chores or other activities that might be a little more challenging. As you think about making things more challenging start with brief easy tasks to build success. Parents should still, of course, provide lots of praise!
Even after all this practicing does this mean that your child will be able to independently wear a mask with no reminders or support? Or that they don’t need feedback on those appropriate behaviors I mentioned long-term? Absolutely not. They are still kids and are going to need your help. Just like they need your help for all of the other wonderful things that you teach them.