Kids, masks and anxiety — a back-to-school guide for Ontario parents

The idling school bus fumes are turning your stomach into an even thicker knot of nerves. Your clammy palm tightly grips the hand of a loved one, as if trying to hold onto the last days of summer.

But you aren't a child. You are a parent in Ontario whose mind is racing, thinking about all the unknowables as you prepare to send your kids back to school this September.

Shraddha Pai, a computational scientist and research fellow at the University of Toronto's Donnelly Centre, is one such parent who says she's feeling very nervous" about sending her 11-year-old daughter and eight-year-old son.

Though masks have proven to slow the spread of COVID-19 in a hospital setting - and just this past week the American Academy of Pediatrics released new guidelines stating that children as young as two can safely wear them - kids returning to schoolyards across the province from kindergarten through Grade 3 won't be required to wear them.

The lack of mask mandate makes us very nervous," said Pai, referring to Ontario's back-to-school plan, and there's no question" in her mind that she will be masking her eight-year-old.

For parents who are opting for in-person teaching, or feel their hand is being forced, there are still a lot of questions about how to prepare their children. Fortunately, Morgan Livingstone, a child life specialist at Sunnybrook Hospital, and Dr. Jacqueline Wong, a pediatric infectious disease specialist at McMaster Children's Hospital, have some answers - from how to ease mask anxiety to what alternatives are safe and available.

What's the best way to make your child comfortable with wearing a mask?

Mnemonic devices are the key here, and the one to engrave in your mind is the four P's: play, practice, preparation and patience.

The patience comes last, because you're going to need a lot of it," Livingstone says in a phone interview.

When it comes to practice, both experts underscore that you don't simply want to have your child wear a mask inside and consider that a job well done.

You should be putting masks on their toys, on the family dog, and offering play opportunities that help to normalize this new task," Livingstone explains.

It's also important to understand how long you can hold your child's attention without creating a negative association with the mask, she adds.

You know, start with five minutes, then extend by one minute each day. Or, if you need to start smaller, that's fine too. Reasonable and measurable goals are a great way for kids to see progress if this is a particularly difficult thing for them."

Seeing parents, older siblings and other relatives in masks will also help normalize the behaviour.

Wong adds that it's important to recognize and address kids' frustration: If they're worried they won't look cool, if they're uncomfortable, make sure (you) acknowledge these feelings and look for solutions together."

On the flip side, she says, it's equally important to offer positive reinforcement when you see or hear from someone, such as a teacher, that your child has made progress.

That will help your child work through whatever negative feelings they are having."

What if your child messes up?

It's inevitable: kids are going to lose their masks. Instead of getting mad, Livingstone says, we should prepare for these bumps in the road. Packing an extra mask is the first line of defence.

When they do mess up, use it as a teachable moment," she says. You can even encourage games where they need to correct you."

Wong suggests designating one pocket of the child's backpack for a backup mask in a ziploc bag.

For younger kids, if opening a sealed bag is tricky, Livingstone recommends a breakaway lanyard - the kind that doesn't pose a strangulation risk: They're a great way to encourage your kid to have their mask on their body at all times."

How can anxious parents talk to kids about masks without scaring them?

It's important for parents to express their feelings in a way that encourages children to do the same.

So (parents) can say: I'm very hopeful that when you practise this, you'll be more comfortable and confident to wear your mask in the classroom," Livingstone says.

Too much talk, however, can lead to anxiety. So instead of dwelling on the things you can't control, such as what other students are doing, she says parents should focus on what they can control.

Pai, for instance, found a way to incorporate daily COVID-19 updates into family time: We watch the evening news as a family every night, and we sort of ask and encourage the kids to ask questions."

Family activities, such as sewing masks for others in the community, can also emphasize the importance of wearing them.

Kids will still worry, but Livingstone and Wong say that's OK.

A lot of the time, worry helps us actually to do things better and more effectively," Livingstone says. When we worry about COVID-19, it actually might help us to want to wear that mask a bit longer."

Encouraging children to talk about their concerns is a healthy norm that we should be embracing, she adds. Having a worry cup or a worry monster in the house - that you can feed your worries to" - can help.

Is there different advice for kids with developmental challenges?

Finding the right mask might take a bit more time and patience for kids with sensory sensitivities, but Wong says a comfortable fit is the key: The kids are less likely to fidget."

Livingstone suggests starting with a simple I'm touching your face and you're touching my face game," tracing with a finger from the nose, around the mouth and to the chin. This way, she says, they can see that it's not threatening and it won't hurt them."

You can build from there to having the child touch masks with different textures until you settle on one.

It's important to keep it fun and focus on exposing them to different sensory experiences, slowly and in a cumulative way."

What about really young kids?

Vernon Kee, who has a four-year-old entering kindergarten this fall in Toronto, finds that when his daughter is struggling to learn something new, it helps to create games with goals.

You can give an award for going a certain time without fidgeting, or play a game where they are superheroes and if they touch their mask they lose their superpowers."

In a now-viral tweet, the young girl learned to put her mask on in less than a minute. There are still hiccups but, as Livingstone advises, they use them as teachable moments.

Habits are hard to break," he says in an email interview. She has also learned to call us out if we touch our mask, so it can be a game we all play."

Social stories that your child creates can also enforce routines. Livingstone suggests a storybook that sets out exactly how your child's morning will look: I wake up, I get dressed and wash my hands and put my mask on as I leave the house."

If your child is getting used to a disposable mask, Livingstone recommends what some of her young cancer patients do: use markers to create fun designs.

Super red kissy faces. Funny moustaches. Toothless smiles. Anything you want ...we can make it fun through play."

While wearing the mask is non-negotiable, Wong says allowing them the opportunity to choose the pattern, the colour, designs ... makes it more fun and gives them some power in this decision making."

Does a reward system make sense?

It works for Kee, whose daughter must wear her mask to get screen time. But Livingstone cautions some kids will feel punished if they don't get the reward, and you might have to keep upping the ante.

One option, she says, is a reward for the whole family, such as a movie night. For younger children, a chart to collect stickers for mask wearing or hand washing is another possibility.

Are there mask alternatives?

After 20 years of medical practice, Livingstone says it's quite normal for families to seek options to cloth or disposable masks.

There are several: elastic around the head instead of behind the ears; versions that can settle on the back of the neck; ones that can attach to a headband.

If none of those work, Wong also mentions face shields and gaiters, which fit around the neck and can be pulled up over the face.

How can I control the risk in the school environment?

Masks are not the be all end all, Wong cautions. They're part of a bundle of precautions.

Washing your hands, practising physical distancing and covering our face when we can are all important," she says. Prolonged exposure in enclosed spaces, that increases risk. But doorways, hallways, bathrooms are all lower risk because they're transient."

Parents can't control every situation and that's OK," says Wong. There are going to be unknowns, because these are unprecedented times."

Correction - Aug. 16, 2020: This story has been edited to correct a quote by Dr. Jacqueline Wong.

Johanna Chisholm is a Star digital producer based in Toronto. Reach her via email: jchisholm@thestar.ca