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A pediatrician explains why mask wearing is harder for some children than others

By Gina DiPietro
Novant Health

Explaining to children why they need to wear a mask can be a difficult task, but experts say parents and caregivers of special needs children face additional challenges. Kids with special needs, such as autism, can experience sensory issues that make it more difficult for them to tolerate a mask.

Dr. Angelica Robles, a developmental behavioral pediatrician at Novant Health, said kids whose speech or language is severely delayed may also face challenges, as well as preschool-aged youngsters. She answered questions for parents who may need a little extra help.

What questions are you getting from parents or caregivers of special needs children?

We’ve had a few questions from parents asking, “Can we get a letter of exemption in order to say that our child doesn’t have to wear a mask at school?” But we’re really trying not to write those letters. We want people to do their best to wear masks. For kids with severe autism or severe delays, we’re suggesting that parents work with the schools on this, as they know the needs of that child. Maybe they can arrange different accommodations to get through that challenge.

Other questions are, “How do we get our child to wear a mask?” So, with that one, I suggest they practice wearing a mask, even for a short period of time, to see if they can keep it on. You can increase the amount of time as you go. I tell parents to lead by example and wear a mask, as well.

What’s the best way to practice wearing a mask with your child?

Go outside in the backyard, just for a few minutes. It doesn’t have to be that long. Maybe then extending it out. If you go to the store, have them try it out for a short period of time. But don’t have them wear it for the first time when they go to school or some other prolonged activity. Work up to it.

What makes wearing a mask harder for some children than others?

Some children will experience sensory sensitivities. Certain fabrics may be uncomfortable, or they may not like the loops around their ears, because some children will sense or feel things a lot more than others. I think that’s where it may be important to have the child pick out their mask. They can touch it, make sure they like the texture and look at the colors. A lot of kids don’t like that restricted feeling, so it can be tricky. Have your child try them on and see which one they prefer.

In some cases, is it simply not realistic for kids with extra challenges to wear masks?

I do think sometimes it’s just not going to happen, especially for the nonverbal kids with autism and sensory issues, along with ADHD. I think that when kids are having all these different challenges at once, it’s going to be hard to ask them to do that. And again, it’s worth a try, but I do think there are some cases where it’s just not going to happen.

How can parents tell the difference between defiance and an inability to wear a mask?

Every parent knows their child best. They know what challenges they face. I don’t think kids are going to be defiant most of the time. That may be more typical of older kids, but I think children who have special needs, most of the time they are not being defiant. They may be feeling something they cannot express. They may not be able to tolerate it, because they feel things so much more than another typical child might.

It’s important to explain why they should wear the mask. Explain its purpose. If you’re doing something and it’s uncomfortable, that can be hard to cope with. So, think about what your child may already struggle with day-to-day to distinguish between what really bothers them and what they just may not want to do.

How can parents explain mask wearing to children with special needs? 

For kids who can understand more language, tell them a story. There are plenty of books about a child wearing a mask that explain why we wear it — to keep away germs and keep us healthy. I think books are a really great way of trying to introduce that. And lead by example. Do it as a family.

There are also things called social stories that are used for kids with autism, again, because it’s very visual. It talks about an individual story. You can even make up your own story about your child — say what it would look like going to school and what to expect. I think setting the expectation is helpful. So, describe it with pictures, visuals and stories, and talk to them about it on their own level.

Should parents provide an incentive?

You don’t have to give them a present for behavior that you expect them to follow. That said, I think anytime a child does something you’re proud of, you want to reinforce that behavior. I would say, “I’m so proud that you’re wearing your mask for this long. I know it’s uncomfortable.” Be specific about what you’re proud of. They usually enjoy that attention. You can also reinforce mask wearing by saying, “If you can wear your mask for this long, we can do something special together.”

Robles added that she understands it is a hard time in general but says to trust your gut and know your child. Try to create balance and an understanding around mask wearing. At the end of the day, Robles said parents can only try their best, love their child and give them the support they need.