Do masks impede children’s development?

By Perri Klass, M.D.

Nothing about masks and masking has come easily in the United States, it seems. There were mixed and confusing messages at the beginning of the pandemic; then political discussion that got in the way of sane public health decision-making; as well as disinformation, anger and shaming and finger-pointing by those who wanted masks and by those who didn’t.

But evidence keeps accumulating that masks help keep us all safer.

Now, with many families dealing with the specifics of children returning to at least some classroom instruction, pediatricians are getting questions about whether masks — on the children or on their caregivers — may interfere with development, including speech, language and social interactions.

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, pointed to three potential problems masks might pose for children in interacting with classmates or teachers. First, he said, kids under the age of 12 may have difficulty recognizing people, because they often focus on individual features.

Second, and perhaps more important, he said, “a lot of our emotional information, we display through movement of our facial musculature.” Because that musculature and therefore that information will be obscured by a mask, he said, children may have issues with “emotional recognition and social interaction.”

And finally, Lee said, children may have problems with speech recognition; even though we tend to think of speech communication as taking place through sound, he said, a great deal of information can be communicated visually.

David Lewkowicz, a senior scientist at the Haskins Laboratories and the Yale Child Study Center, has studied lip-reading in babies. Around the age of 6 months to 8 months, he said, as babies start to babble, they change the ways that they are looking at people who are speaking to them. Instead of concentrating on the eyes, he said, “they spend a lot of time looking at that person’s mouth, trying to master their own native speech, getting not only auditory cues but visual.”

In one type of experiment, people are asked to look at multiple faces on a screen, while listening to a voice talking — but the voice is synchronized with only one of the faces. Children as young as 3 already tend to show a preference for that synchronized face, and the preference gets markedly stronger as they grow.

Babies whose caretakers are masked will miss some of these visual cues, and it’s possible, Lewkowicz said, that young children may have some trouble sorting out who goes with which voice.

“Masks are not a great thing for communication in young kids,” Lewkowicz said.

On the other hand, he said, the time children spend at home with people who are not masked will give them a chance to practice picking up the visual cues. And there is opportunity to be creative and to help children take full advantage of the information that they do get. He suggested that parents and teachers could “encourage their kids to communicate more through gestures” and even make a game of helping children to find ways of communicating with their hands and bodies.

Eva Chen, a developmental psychologist who is an associate professor at the Hong Kong University of Science and Technology, focuses her research on children’s cognitive development with respect to social groups. “We should give more credit to our own children,” she said, “that being covered for a few hours every day isn’t going to make them less able to recognize social expressions.”

Voices, gestures and overall body language are all important for children, she said. While children typically pay attention to people’s mouths while they are talking, “it’s by far not the only cue children have to communicate and to learn,” she said, and referred to a 2012 study showing that children were able to read facial emotions just as well when a mask was added.

In fact, all of the scientists I talked to who have studied the complex ways that children process and use the information hidden by masks also believe that children will find ways to communicate and that parents and teachers can help them. Several of them also pointed out that children with neurodevelopmental issues such as autism will need special consideration — but also that some of the techniques that parents and teachers already use to help these children learn to interpret social cues may be helpful for everyone when masks are in use.

As far as emotional communication, Lee suggested that teachers emphasize their gestures and pay attention to their tones of voice. “Make your voice more expressive, your gesture more expressive, your eyes more expressive,” he said. And finally, he said, “I would slow down my speech as a teacher, particularly when interacting with younger ones, so kids can pick up more from the auditory channel.”

There is no evidence, Chen said, that children from cultures with much more extensive face covering are any worse at recognizing faces or emotions.

In Hong Kong and elsewhere in Asia, it’s standard to wear masks as protection against illness or air pollution. Because there are always a fair number of people wearing masks in public, “culturally, there is not the same level of anxiety — not the urgency to see whether wearing masks interferes with children’s development that we have heard from European colleagues and American colleagues,” Chen said. People understand, she said, that children will see the full faces of parents and siblings at home.

And given the adaptability of children’s brains, it seems reasonable to hope that one effect of spending time masked and around masked people may be that children actually improve their ability to read those other cues. Children may end up “more sensitive to tones, more sensitive to someone’s overall body language,” Chen said.

“Kids are very, very adaptive, more adaptive than we are — they learn very quickly,” Lee said. “I don’t think parents should be too worried.”

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