Children May be Afraid of Masks. Here’s How to Help.

Published in the New York Times,  April 13, 2020Children May Be Afraid of Masks. Here’s How to Help.

By Perri Klass, M.D.

When you go out these days, if you must go out in this time of coronavirus, you see more and more masks — homemade fabric masks, surgical masks of all varieties, and the occasional high-tech mask that seems to have wandered out of a scuba sequence or a space movie.

But for some children, even the humblest of masks can be scary — scary in themselves, and scary as reminders of the threat of infection, and the generally frightening times through which we are living. There are children who find Halloween frightening, children who hate clowns, children who react badly to anyone without a standard human face. Roberto Olivardia, a lecturer in psychology at Harvard Medical School, said that as many as 1 percent of children may suffer from “maskaphobia,” a fear that persists for longer than six months, usually thought of in relation to costumes and superheroes.

But for many children, seeing their parents wearing masks as they come and go, or going outside, even with full social distancing, in a world where most people are wearing masks, can be disconcerting, frightening or just one more source of sadness.

One reason children may find masks disconcerting is that the ability to recognize — and read — faces is much weaker in young children than it will be by adolescence. A while ago, when I wrote about this ability, I spoke with Kang Lee, a professor of applied psychology and human development at the University of Toronto, who studies the development of facial recognition skills in children.

I reached out to him again to think about how the face masks we are now seeing everywhere might appear to preschoolers.

As adults, Dr. Lee said, we look at faces as a whole: “If you wear a mask, I can still recognize you, even though half of your face is covered, I can still recognize the structure of your face.”

Starting at around age 6, children begin to develop these skills, but, he said, it is not until they are about 14 that they reach adult skill levels in recognizing faces.

He explained that children younger than 6 tend to pay attention to individual features, rather than recognizing the person as a whole. “For example, they pay attention to the size of the nose, or the shape of the eye.” Studies in which children were asked to look at pictures in which faces were partially blocked off show that they may have trouble recognizing even familiar faces when some of those features were not fully visible. So friends and neighbors — seen from a distance — who are wearing masks may look more unfamiliar to children than they do to adults.

For example, in one study, children were given a set of pictures of their teacher, mixed up with pictures of another person, and asked to sort them out so that only pictures of the teacher were together. By the age of 6, they could do it, but 4- and 5-year-olds could not do it so reliably.

Catherine J. Mondloch, a professor of psychology and the director of the face perception lab at Brock University in Ontario, said, “If you think even about Halloween, one of the things we know about really young children, preschool age, is when the appearance of something changes, they think the thing itself has changed.”

For parents who are starting to wear masks, she said, “Put it on, put it off a few times, so the child sees it’s still daddy.”

We are accustomed to getting lots of different information from faces, Dr. Mondloch said, ranging from the age of the person to the emotion the person is feeling to the general question of recognition and identity — that is, whether we’ve met the person before. All of those perceptual skills improve across childhood, she said.

“Even if you show children pictures of pretty exaggerated expressions, young children will make more errors” in reading the emotional states, she said. “Children mix up emotions, look at a sad face and might say the person looks scared, or misperceive anger as disgust.”

And by putting on masks, she said, we’ve taken away some of that information — and made it especially difficult for children to read emotional signals, which is, again, unsettling and disconcerting. So if you are wearing a mask, make sure to explain yourself very clearly to your child, giving directions, telling the child if there’s a problem. Dr. Olivardia said that children with autism spectrum disorder, attention deficit hyperactivity disorder and social anxiety may be particularly vulnerable here.

Dr. Harold Koplewicz, the president of the Child Mind Institute, which has extensive coronavirus resources for parents, said, “I think it’s important to explain to kids that people are wearing masks as a way to help others — otherwise they assume it’s because they’re dangerous.” Children should think of this as an act of social responsibility, he said, and it might help to compare it to washing hands, as something you do to keep yourself safe, but also to help protect others.

“It is important to first validate that it can be uncomfortable when we don’t know what or who is behind a mask,” Dr. Olivardia said in an email. “You can have a child wear their own mask, even a scary one, and recognize that they can be perceived as scary despite being a nice person.”

For treating phobias, psychologists often rely on exposure therapy, and Dr. Christopher Willard, a psychologistin Cambridge, Mass., who is the author of “The Breathing Book,” suggested that parents try an informal version with masks. “Pick fun fabric, let kids design them for themselves and their parents, make it a craft activity and also a game,” he wrote in an email. “Practice taking them on and off and wearing them around the house for fun, but also taking it off, try to read each other’s facial expressions with just eyes while a mask is on,” he suggested. “These kinds of things normalize it a bit and make it less scary.”

Praise children for asking questions, Dr. Koplewicz said, and remind them that can always check back and ask additional questions. “This is a topic that’s going to come up again and again,” he said.

Dr. Willard suggested that it could help children to make a superhero connection, explaining that doctors and nurses are heroes protecting and helping other people, and masks are part of their uniforms. “We too can be superheroes and protect other people from germs by wearing these masks for a while,” he wrote.