The COVID-19 pandemic has been spreading around the world for more than half a year, posing a risk to both the physical and mental health of adults, but also children and young people, especially in countries with a large daily number of new cases. The perception of a pandemic is different among people, and while some consider it to be “ordinary flu”, others are overwhelmed by anxiety about their own health and fear of infection and the like. We know that children generally have a similar perception of important life events as people around them, especially parents, caregivers and other close family members or adolescents’ friends.
Don’t panic – children feel it
Research during the 2009 H1N1 (swine flu) pandemic showed that parental fear is a significant predictor of children’s fear of the virus, and also the transmission of information about the danger of the virus to parents is positively associated with children’s fear (Remmerswaal and Muris, 2011). It is important to be aware of just that during our own emotional reactions to a pandemic, namely if children see that adults are upset and they are very likely to become upset (Taylor, 2019, p. 104). We can act on this by communicating openly with them, maintaining our and their routines and schedules, fulfilling our usual obligations in a flexible way and not forgetting to set aside time for ourselves – remembering how parents put oxygen masks on airplanes first so they can then put to your children as well.
Protective face masks for children in the media
Protective face masks currently seem to be one of the leading strategies to combat the spread of COVID-19 infection. Nevertheless, information and news are spreading in the media and on social networks about the numerous consequences that face masks can have on children, such as hypercapnia (increased blood CO2 levels) or hypoxia (decreased blood O2 levels) (Villani et al., 2020). Unverified information from social networks, false news, and inaccurate sources can create suspicion and additional feelings of fear and anxiety about the health of their children in parents (Larson, 2020).
Tolerance to wearing face masks
Just like in adults, children’s tolerance to protective masks can be reduced due to a large number of psychophysiological factors such as feeling unable to breathe, heat, moisture accumulation, facial pressure, claustrophobia, anxiety, but also boredom or lack of motivation to wear a mask, discomfort, etc. (Arad et al., 1991; Mauritzson-Sandberg, 1991)
In situations where children are younger than the age at which it is recommended to wear a face mask, it is necessary to ensure that adults in the child’s vicinity involved in upbringing and education try to wear a face mask as much as possible, especially in situations where children have other chronic conditions such as asthma, bronchitis, etc.
During the recent H1N1 pandemic, the wearing of a face mask in children over a long period of time under various conditions (during school, activities, etc.) was studied, and the findings indicate that children are tolerant of wearing face masks for a period of time (Del Valle, Tellier, Settles and Tang, 2010). Studies of the psychological reactions of children to wearing a protective mass suggest that 50% of children aged 7 to 10 years wore a protective mask continuously for 6 hours (Mauritzson-Sandberg, 1991). In another study, 59% of primary school children tolerated wearing a protective mask throughout the day spent at school (except during lunch and outdoor breaks) for one week (Allison et al., 2010).
Face masks can be uncomfortable if they do not fit the child’s face or itch, but Villiani et al. (2020) emphasize that they have no negative effects on the health of healthy children over the age of three. In the coming period, it will certainly be necessary to further examine children’s attitudes and tolerance towards wearing face masks in order to develop strategies that will make it as easy as possible for them to wear them in the circumstances when it is mandatory.
Although there is a perception in the general population that children do not want to wear face masks over a long period of time, there are certain ways in which children can be encouraged or made easier to wear a face mask, through persuasion (a process of changing attitudes or behavior of a person without coercion through communication with others), education, continuous stimuli, and the process of habituation (habituation) (Child et al., 2001; Klug et al., 1997; Arad et al., 1991).
How can we communicate with the child about wearing a face mask :
– Teach you how to properly put on and take off the face mask in a safe environment.
– Ensure that the child has a protective mask when going to school (if it is mandatory there).
– Ask for feedback what it is like for a child to wear a mask and whether it stings somewhere or does not suit him.
– Check the child’s feelings, ie whether the child is confused, scared, and anxious or it is not entirely clear to him/her why he is wearing a protective mask.
– Explain that behind the protective mask other children and adults have different facial expressions and although we cannot see them we can always ask them how they feel.
– Praise the child for the effort and be sure to give him recognition even if wearing a protective mask is harder for him than for other children.
Reminder: How to make it as easy as possible for children to wear a face mask where they are prescribed:
– Provide a mask that fits the child’s face adequately.
– Explain that we wear a mask not only to protect ourselves, but also others.
– Emphasize that sometimes we are hot and sweaty under the mask as well as under the goods, but we do not take it off immediately, but to pass or take off the goods when we get home.
– Draw or stick a face mask on the cartoon characters your child loves.
– Allow the child to just choose a face mask with decorations of his choice.
– Be an example to your own child in the way you will wear the mask, but also in the consistency of wearing the mask in situations where they are necessary.
– Through play, bring the child closer to the positive aspects of wearing masks and allow him/her to ask questions about those aspects that are not clear to him/her.
– Encourage solidarity and flexibility in the child so that it does not stigmatize those children who do not wear or wear masks or visors.
– Normalize the wearing of masks by children by showing them photos of other children wearing protective masks.
– Direct the conversation with the children so that if they wear masks and follow other instructions that fewer people will get sick.
Be careful with protective masks for smaller children
Wearing a protective mask can still pose certain risks for younger children, so the Croatian Institute of Public Health (2020) in its recommendations on exemption from the obligation to wear a mask states that protective face mask should not be worn by children under 2 years, children with other chronic conditions or those children who offer resistance when wearing the mask or cannot refrain from touching the mask and face. Experts from the Ohio Children’s Hospital note that children under the age of 2 have less developed airways, which is why wearing a mask increases the risk of suffocation (Macklin, 2020). Adults from the child’s environment should also be aware of how children may have difficulty communicating when wearing a protective mask which may prevent them from alerting adults to aspects of wearing masks that bother them or create discomfort (Roberge, 2011). In any case, it is good to often check with children what it is like to wear a mask and what feelings they feel about wearing it. Also, if a child for some reason refuses to wear the mask continuously, adults from his environment should show flexibility and follow the instructions of the competent institutions (https://www.koronavirus.hr/sto-moram-znati/o-prevenciji/preporuke- for-use-of-face-masks-for-medical-and-protective-masks / 497).
By: Krešimir Prijatelj, M.Sc. psych.
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Villani, A., Bozzola, E., Staiano, A., Agostiniani, R., Del Vecchio, A., Zamperini, N., … i Corsello, G. (2020). Facial masks in children: the position statement of the Italian pediatric society. Italian Journal of Pediatrics, 46(1), 1-2.
Disclaimer: This is unofficial translation provided for information purposes. Zagreb Child and Youth Protection Center cannot be held legally responsible for any translation inaccuracy.