by Thao Pham BS, COTA/L and Brittney Weinerth MS, OTR/L
Note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or occupational therapist.
Recently the Centers for Disease Control (CDC) issued guidance on measures that schools will need to take in order to reopen which included encouraging students to wear masks during times that they would be unable to social distance.
The CDC guidelines state that schools and families should:
"Teach and reinforce use of cloth face coverings. Face coverings may be challenging for students (especially younger students) to wear in all-day settings such as school. Face coverings should be worn by staff and students (particularly older students) as feasible, and are most essential in times when physical distancing is difficult. Individuals should be frequently reminded not to touch the face covering and to wash their hands frequently. Information should be provided to staff, students, and students’ families on proper use, removal, and washing of cloth face coverings."
Many parents expressed concern about the need for children to wear masks next school year and understandably were worried about their child's ability to tolerate wearing a mask. Wearing a face covering is difficult for most children, however children with sensory sensitivities will undoubtedly experience distress and difficulties complying with wearing a face covering. In this blog we are offering strategies to assist you in supporting your child to tolerate wearing a mask easier and have also included a free tool at the end of the post that can be used to incorporate the ideas presented in this blog.
Individuals with tactile sensory aversions can have a hard time tolerating wearing things (ie. sunglasses, hats, helmets, etc.) on their heads. The sense of touch is located throughout the body, in your largest organ, the skin. The sense of touch originates in the bottom layer of your skin called the dermis. The dermis is filled with nerve endings that give your brain important information about heat, cold, pain, and pressure or touch receptors. The face is an especially sensitive and delicate area because there are more touch receptors. It makes sense why wearing a facemask for long periods of time can be extremely difficult for many individuals. The lack of air, hot temperature, smells, the pinching of the straps, or texture of the mask can all play a role in making it hard for people with sensory difficulties to withstand. So what can you do?
Occupational therapists specialize in supporting children who experience life disruptions due to sensory processing difficulties. OT's are experienced in determining what underlies a child's difficulties as well as establishing a strong therapeutic relationship built on trust and understanding which often is what allows a child to engage in tasks that would normally be challenging for them. If your child currently has an occupational therapist, reach out to them to find out strategies that they feel would be best to support your child in their ability to tolerate a face cover. If not and you feel like your child struggles with sensory sensitivities in general, finding an OT who specializes in sensory processing is advised.
1. Approach From a Place of Understanding
What we are asking children to do - children with and without sensitivities - is hard. If your child senses that you know their struggle, can empathize with their struggle and that you support them regardless of if they can "succeed" with tolerating a mask will allow them to be in a better place to try hard things. Oftentimes children are unwilling to try hard things that they might not be successful at for fear of frustrating or disappointing others (or themselves).
Phrases to try might include: "I know wearing a mask feels uncomfortable for you. It sometimes feels that way for me too." "I'm here to help you with this."
2. Incorporate Your Child
Have your child be a part of the process. Children with Sensory Processing Disorder often need to be able to control or manage their environment in order to feel safe to try hard things. Work with your child to think about what kind of mask would be suitable for them. In particular, I recommend paying attention to their preferences, here are some different types of masks to consider:
In addition to having your child help you determine the type of mask you could have them help create a plan for increasing their tolerance such as when, where, how long. The method for incorporating a child will obviously differ based on their age but when a child feels like they have some control they will be more able to remain calm.
Phrases to try might include: "When do they think they will be most successful practicing the mask - morning, evening, when they're alone, etc.?" "Where would they like to practice?" "How long do they think they can tolerate it today?" "I really like my mask to be soft, which kind of mask do you think you would like [showing pictures]?"
3. Build Tolerance Slowly
Consistency, patience, and repetition are all important components when establishing any routine. Likewise, increasing tolerance to sensory aversions takes time. Explore what your child can currently tolerate. It may be holding the mask in their hand. Would they be willing to touch the mask to their cheek? Perhaps they don't even want to look at the mask. If that’s the case, you might start by having them sit at a table with the mask close by. Remember, you want to set them up for success so start wherever they're comfortable.
Using a timer can be a great way to help your child see improvements or work towards their goal. Set the timer for a small amount initially that you know they can be successful at – even if it’s for just 5 seconds. Then reward their success and slowly increase their time next time. When first introducing I find the most success when I stop at their first success rather than continuing to push them to their limits. It shows them that I respect how hard this is and help them trust me as we get further down the process when I do need to push them harder.
We strongly recommend short and targeted practice sessions. Let’s say 5-15 minutes depending on their tolerance. These sessions need to become part of their daily schedule, add it to their daily routine.
At first, it may help to hold these practice sessions at the same general time and location during the day. You know when your child is at their best. Perhaps right after lunch, dinner, or before bed. Try to be consistent. But also remember that the goal is to get them used to wearing it when going outside and any time it is needed. So once they are able to tolerate it without distress, start varying the time of the practice sessions throughout the day and where they practice (again encouraging them to come up with this plan rather than telling them what to do).
Phrases to try might include: "Great job! You tolerated wearing the mask for 3 minutes today which is 1 minute more than you did last time."
Other Ideas and Strategies: