In this post Hope Metzler discusses masks for children including: six considerations for making and/or buying masks for children, information about when children should and should not wear masks, and an in depth look at the alternatives to masks for infants. This is part of a series of guest blog posts where we get a chance to hear voices and perspectives about making masks more accessible.

6 Considerations for Making or Buying Masks for Children

We all want the very best for our children, and that includes the masks that we make or buy during COVID-19.

Now that the initial rush to make simple, effective masks is over, makers are beginning to get very creative with their masks, often because our children are very vocal in their preferences for colors, action figures, favorite animals, popular characters, etc.  However, there are several considerations I encourage you to remember as you make or buy a mask for your child.

There is no one correct mask for every child. However, there are considerations that you should keep in mind:

1. Will Any Pattern Do?

The mask should be made from a pattern designed for children, so that there are not large gaps around the face.  Remember that time you put your child in an adult shirt and it was so cute?  The neckline dipped low, the armholes were huge and it hung down to their knees.  We want a mask that fits the child all around their face — nose to chin and from cheek to cheek.

2. Nose Wire or No Nose Wire?

This is an interesting debate.  Some schools that are preparing for reopening do not want the nose wire, which is understandable if the wire is removable or sharp. However, the nose wire is considered a critical piece of face masks:

• To hold the mask in place while talking
• To close the gaps around the nose
• To prevent the child’s eye glasses from fogging up from their moist breath

I am a fan of the flexible closures used on 12 ounce bags of coffee.  They are two wires wide and covered in a plastic coating, almost like a tiny railroad track. Many makers cut the closure in half for a child’s mask.  And when sewn into the mask or into a channel along the nose, they become part of the mask and not something the child can pull out to use as a sword for a mini-fencing match.

3. Ties or Ear Loops?

Most experts agree that young children should wear ear loops. Unlike ties which have a tendency to slip or come undone, the loops are placed behind the ears and do not move.  The concern with the ties relates to the same concern with anything tied around a child’s head.  Should the tie slip down while playing and become loose, the tie could get caught and become a strangulation hazard.  Children with glasses or hearing aides could use an extender behind the head.  Search for ear loop extenders for more examples.

 

4. Beads to Make Ties or Loops Adjustable?

The use of beads on masks for children fall under the same guidance as small parts in toys for young children.  They are choking hazards because children love to put things in their mouths.  Think of it this way, children that are too young for small parts in toys, are too young for beads on their mask.

 

5. Fabric?

It is recommended to have at least two layers of fabric. Ensure that the child can breathe comfortably for the length of time needed for your outing. The WHO recommends an inner layer of moisture absorbing fabric and an outer layer of water-resistant, nonwoven material, such as nonwoven polypropylene (NWPP) (see makermask.org/research for the science behind using NWPP). While adult masks often use more layers, young lungs may have a harder time breathing through thicker masks.

6. Can I Add Decorations?

The rule of thumb is to allow for breathing through the nose and mouth without restriction.  It is best to leave off applications, iron-on pictures, and any added decorations that block airflow in front of the nose and mouth.  Exceptions might be screen-printed fabrics, small details around the edges of the mask, or an application to the cheek.

Gluing on sequins, buttons and beads is not recommended for two reasons:

1. We do not want kids breathing in any toxic fumes from the glue.
2. Decorations could fall off and become choking hazards

Masks for Children: Additional Considerations

When Should Children Wear Masks?

Children should wear masks if they will be around other people, especially in cases where social distancing isn’t possible. As with adults, masks are not a substitution for social distancing or good hand hygiene. Be sure to check with appropriate local, regional, and national agencies about mask policies for children specific to your area:

• CDC Guidance – “Help Stop the Spread of COVID-19 in Children”

• WHO Guidance – “Coronavirus disease (COVID-19): Children and masks”

Cincinnati Children’s Hospital provides a video for kids (below) as well as additional tips to help kids wear face masks (click here):

Is it OK for children have play dates now? According to Juan Dumois, M.D., a pediatric infectious diseases physician at Johns Hopkins All Children’s Hospital:

The pandemic has not ended, so any activities that involve close contact with other persons outside your family entail a risk of getting infected. Although most children are not getting as sick as adults with COVID-19, they can bring it home to the adults in the household who may be more likely to be hospitalized for it. With that said, it is still a good idea to have children minimize contact with other kids and conduct social distancing outside the home. If they will be around any other people, they should wear a mask. This is even more important in situations where social distancing isn’t possible.

What About Children with Special Health Concerns?

Although fabric masks are generally considered appropriate for children, the Academy of Pediatrics provides this advice about children with special health concerns:

Children who are considered high risk or severely immunocompromised are encouraged to wear an N95 mask to best protect themselves. Families of children at higher risk are encouraged to use a standard surgical mask if they are sick to prevent the spread of illness to others.

When should masks be avoided?

In general, the Center of Disease Control (CDC) says that people that cannot safely remove masks unassisted should not wear masks, but provides only one specific recommendation concerning children and masks, that they shouldn’t be worn by children under the age of 2. However, the Academy of Pediatrics provides guidance on three additional situations when children, regardless of age, should not wear masks. Summarized below, these recommendations suggest that children should not wear face masks:

1. If they are under the age of 2 years, due to risk of suffocation
2. If the only face covering available is a possible choking or strangulation hazard
3. If the child has difficulty breathing with the face covering or is unconscious, incapacitated or otherwise unable to remove the cover without assistance.
4. If wearing the face covering causes the child an increased risk of getting exposed to the virus because they are touching their face more often.

5 Reasons Why Infants Should Not Wear Masks

Many mask makers have very good intentions with making masks for infants and toddlers, but there are very good reasons why we do not want to cover an infant’s airway (mouth and nose) with cloth from 700 Children’s – A Blog by Pediatric Experts:

1. Baby’s airways are smaller, so breathing through a mask is even harder on them.
2. Using a mask on an infant may increase the risk of suffocation. Masks are harder to breathe through. A snug fit will give them less access to air, and a loose fit will not provide much protection.
3. If the infant is having a hard time breathing, they are unable to take the mask off themselves and could suffocate.
4. Older infants or young toddlers are not likely to keep the mask on and will likely try to remove it, as well as touch their face more.
5. There are no N95 masks approved for young children.

7 Tips for Protecting Infants During COVID-19

Instead of using masks for infants, the American Academy of Pediatrics recommends placing infants in carriers, and then covering the carrier with a blanket:

If you must go outside or to a place where you are not able to practice social distancing with an infant, cover the car carrier with a blanket, which helps protect the baby but gives them the ability to breathe comfortably. Do not leave the blanket on the carrier in the car or at any time when the baby and carrier are not in direct view.

The Nationwide Children’s Hospital in Columbus, OH has more specific advice, suggesting 7 things you can do to help protect infants and children:

1. Limit exposure and avoid unnecessary public contact.
2. If going out is essential, cover the infant carrier (NOT THE INFANT) with a blanket, which helps protect the baby, but still gives them the ability to breathe comfortably. Do not leave the blanket on the carrier in the car or at any time when the baby and carrier are not in direct view.
3. Keep your hands clean. Frequent hand washing with soap and water for 20 seconds is optimal, but hand sanitizer, with at least 60% alcohol is the next best substitute.
4. Clean frequently-touched surfaces such as doorknobs, handles, light switches and electronics often.
5. Teach older children to avoid touching their faces.
6. If you cannot leave the young infant at home and you are pressed to go into the public, keep the outing short and always follow the 6 feet distancing rule.
7. Remember to always wash your hands (and any siblings’ hands) as soon as you return home.

Final Thoughts:

Making or buying a mask for a child can be fun!  There are so many exciting fabrics to choose from and most likely your child will want several choices.

Can they have a fun, crazy animal mask for play time?  Of course!

But when you are headed out the door to a place where social distancing will be difficult, then that is the time for the “outside” mask.

And leave our furry, novelty mask at home.

Finally, masks help the most when they are worn correctly. The video tutorial below provides a “how-to” guide to help kids learn when, and how, to wear masks.

Edit (2020 August 27): For more information about masks for children, check with local, regional, and national guidance. Links to guidance from the CDC and the WHO are provided for your convenience below:

• The Centers for Disease Control and Prevention (CDC) – “Tips to Protect Children During a COVID-19 Outbreak” (July 21, 2020)
• The World Health Organization (WHO) – “Q&A: Children and masks related to COVID-19” (August 21, 2020)

About the Author

Hope Metzler, M.Ed.

Hope graduated from the University of Maryland with a Masters in Special Education with a concentration in Early Childhood. She has been working with children for 30 years. As a military wife, she has moved around the world and has been a special needs consultant, training & curriculum specialist, special education teacher, and early interventionist. Her undergraduate work included deaf education and she is fluent in American Sign Language.