It seems like each day brings more news of contagious COVID strains popping up around the globe. First the U.K. strain, now more in Brazil, South Africa and even Los Angeles, California. With rising cases and new strains, we’re getting lots of questions about protecting kids and questions about when, how and what kind of masks families should be wearing. Brave Care pediatrician Dr. Joanna Zamora did a Q&A on the new, more contagious variants and she’s back answering parents’ practical questions about masks. 

Will wearing masks help protect my family and community from these more contagious variants of COVID-19?

Yes, wearing masks outside of the home, in every environment including outdoors, will help protect everyone from the more contagious variants of COVID-19. The new COVID variants, combined with pandemic fatigue and vaccine misconceptions, make proper mask use more important than ever. 

The best protection is achieved when the mask chosen for yourself and family members has the following characteristics:

1. It's made from several layers, ideally 3, of tightly woven fabric in order to be an effective filter. 
2. The mask is comfortable enough to wear properly without adjusting it for the amount of time you need to keep it on. 
3. It stays in place while talking and moving, so it can be worn without slipping and so it does not require you to touch it frequently.  
4. The mask has a flexible nose bridge to conform to the face and prevent fogging of eyeglasses. 
5. The mask conforms to your face without gaps so that most of the air you breath in and out flows through the mask rather than around the masks through gaps at the sides, top and bottom.  
6. The mask should not have an exhalation valve, even if the exhalation valve has a carbon filter.  

How do I know if my mask’s fabric or material is protective enough? 

Both the cloth and disposable masks you choose should pass both the light test and the candle test. For the light test, when you hold the mask up to the sun or a bright lamp to see how much light passes through, the less light that comes through the better. For the candle test (which you may have seen when Bill Nye used the test on TikTok), if you aren’t able to blow out a candle while wearing the mask, it’s a good sign that your mask is protective. Just don't get too close!

I've heard that some countries in Europe are requiring that everyone wear medical-grade masks. What does it mean for a mask to be "medical-grade?"

N95 respirators (USA), KN95s (China), KF94s (South Korea), and FFP2 (European Union) are medical grade masks that are designed to form a tight seal between the air outside and the face. They filter at least 94-95% of airborne particles. They're designed to protect healthcare workers from droplets in the air and provide a high level of protection against COVID-19 when properly fit-tested. Medical-grade masks are not recommended for use by the general public in the United States at this time. 

Surgical masks, even though they are often worn by medical workers, are not considered to be medical-grade masks. Surgical masks are disposable covers that are worn by medical professionals as personal protective equipment (PPE) during surgeries or other procedures. Surgical masks are designed to protect against large respiratory droplets but don’t protect against smaller droplets. These masks are less protective than respirators in large part because they lack a seal around the face, allowing air and droplets to escape and enter freely in the gaps around the mask.    

Are there medical grade masks for kids in the United States? 

While there are a few brands of children’s masks that are advertised as KN95 masks, there are no certified brands of medical-grade masks available for children. 

Disposable masks available for children are best understood as being just that, a disposable alternative to a cloth mask. Any disposable mask you purchase for your child should be tested with both the light and candle tests to help determine if the mask is effective, and the mask should have the characteristics of an effective mask as described above. 

I’ve heard that European countries are making people wear surgical masks; should I do that too? 

It is true that in recent weeks several European countries have announced mandates for the general population to wear medical-grade masks in all public spaces. 

In the future, we hope to be able to recommend a certified high-quality medical-grade mask for you and your family to wear to keep yourselves and others safe from the more contagious variants of COVID-19. Unfortunately, the United States is swamped with fraudulent medical-grade masks, some of which are completely ineffective. Furthermore, there is an ongoing concern about a potential shortage of medical-grade masks for health care and frontline workers in the United States. Until the United States is able to ensure the manufacture and distribution of enough certified high-quality medical-grade masks to serve the entire population, medical-grade masks are not recommended for the general public. For these reasons, it remains the official recommendation in the United States to continue to wear a multi-layer, well-fitting cloth mask. 

With that said, health experts are starting to suggest that essential workers like teachers, grocery-store clerks, public transit workers, and other frontline workers, as well as high-risk individuals with underlying medical conditions who have to be out in public, can consider wearing NIOSH-certified N95 and KN95 masks. There are several of these on the market for adults, and you can always ask your medical provider for advice to help prevent the purchase of fraudulent masks. Just as with cloth masks, it is important for NIOSH-certified masks to fit your face properly. 

What about double-masking? Is double-masking more effective against the virus?

Double-masking may provide more protection than a single mask as long as the double-mask is comfortable and does not require frequent adjustments. If your fabric mask does not have 3 layers or if a second mask allows for a better fit, double masking is a reasonable option for trips to the grocery store or other closed spaces.  

When should I wear a mask?

Everyone 2 years of age and older should wear an adequate mask in all public settings and when they are around people who do not live in their household. This applies to outdoor spaces as well. Individuals who have already been vaccinated against COVID-19 should also continue to wear a mask. 

What about when I can easily socially distance? Like while I’m walking the dog or in an outdoor area? 

If you are walking the dog or in an outdoor area where you can see other people, even if they are not exactly within 6 feet of you, it is recommended to wear a mask due to the possibility that you will come into contact with someone. Furthermore, it is best to simply leave on your mask when you are outside and might possibly come in contact with others, to avoid repeatedly touching your mask and face to put on and take off your mask.  

What about for kids? Can they skip masks in outdoor areas like on the playground or on hikes? 

If there are other people at the playground, and if you see other people on a hike or are passing other hikers, it is best for everyone, including children, to wear a mask. Since masks worn outdoors are more likely to get damp from sweat or rain, bring replacement masks to change out when needed while enjoying the outdoors.  

What about masks for high-intensity activities?

Masks should be used in public settings, but if you are unable to wear a mask because of difficulty breathing during high-intensity activities, do that activity outside and where you can keep at least 6 feet (ideally 12 feet) from others during the activity. If you are able to wear a mask, remove your mask if it gets damp from sweat and replace it with a clean mask. Opt for an activity that does not require using mouth guards or helmets. Wearing a mask with these types of protective equipment is not safe if it makes it hard to breathe. Supervise children who are wearing a mask while playing sports.  

How can I make masks more comfortable for kids?

It takes some trial and error to determine which type of mask is most comfortable for your child. 

There are two main types of masks for children we recommend, Ear-Loop Style Masks and Tie-Behind Style Masks.  We find that children differ in terms of which type they prefer. 

PROS of Ear-Loop Style Mask: Easy elastic fit, no tying necessary, no interference with hair.

CONS of Ear-Loop Style Mask: tugging ears forward, may interfere with glasses, usually not adjustable.

PROS of Tie-Behind Style Mask: Easy elastic fit, no pulling on ears, less interference with glasses, adjustable tightness. 

CONS of Tie-Behind Style Mask: Tying or cinching is necessary, interferes with hair, harder for younger kids.  

The next variation to consider is the fit of the mask. Masks can have a fitted shape that clings to the nose and face, a pleated shape that fits almost any face or a predefined shape (sometimes called a Korean-fit) that stands out a bit from the nose and mouth. We find that many kids do well with the predefined style because it tends to sit farther away from the nose and mouth, providing a small air gap inside the mask, making it more comfortable. 

Children with glasses should have face masks with the following features:

• An adjustable metal nose bridge helps tremendously with glasses fogging. 
• If your child wears glasses, the tie-behind style face mask may be preferred to avoid interfering with glasses and causing discomfort. 

Here are a few other thoughts to consider if your child struggles with wearing a mask:

1. Some masks have a stronger odor than others, and they develop an odor when they are used. Always wash a mask before using it for the first time. Make sure your child brushes their teeth before wearing the mask. Consider changing your child’s mask half-way through the day so that your child’s mask always smells fresh. 
2. Some masks feel firm or hard against the face. Masks with a seam at the center of the nose area, or masks without a soft cotton inner lining, can be uncomfortable.  
3. Masks that require repeated and substantial manual adjustments are not comfortable. For example, masks that tie or cinch behind the head can be annoying because they need to be adjusted often and/or they can get tangled in hair. 
4. Some masks pull against the ears in a way that might be uncomfortable for your child. Masks without adjustable ear elastics can be uncomfortable throughout the school day.  
5. Masks that become wet for any reason need to be replaced with a dry mask, even if this means changing out the mask several times per day.

With children for whom these recommendations are not enough, or for whom these recommendations do not address the child’s specific needs and challenges, we recommend that you speak directly with your medical care provider for more specific advice. 

What about teens? How can I help my older kids with annoying masks? 

1. If your teen resists wearing a mask, find out where your teen is coming from. Your teen’s refusal to wear a mask might stem from a fear of “maskne!” which, if addressed and treated, can make wearing a mask a much less troubling situation for your teen. It is important to let teens know that their voice is being heard, especially since so many aspects of the pandemic are outside their control. It is also helpful to assess their perception of how others in their life, including friends, classmates, other family members, are dealing with the pandemic. This information will give you some insight into where your teen gets their information and what they value. Do this before addressing their behavior.  
2. Reference news stories in a matter-of-fact way. If you’re concerned about your teen’s lack of social distancing and/or mask wearing, a conversation about a current news story can prove a good jumping off point. While having the conversation, be matter of fact and honest without overdoing the fear or using the news story as a scare tactic.  
3. Encourage your teen to consider how their actions might impact others. Introduce the idea that wearing masks is important to protect other significant people in their lives, including their friends and their friends’ family members. 
4. Model the behavior you want to see. If parents are actively trying to wear masks and maintain social distancing, their children, including their teens, are likely to have similar practices. Adolescents need role models. Find a social media influencer that your teen admires that also promotes mask wearing, and point this out to your teen in a matter of fact way.  
5. Don’t give up: In conveying the importance of COVID safety to your teen or young adult, it’s important to stay the course - especially as schools begin to return to the classroom. Ultimately, some adolescents will refuse wearing masks as a form of defiance. Even so, continue to engage them and try to understand why they developed this opinion against masking. 

When will everyone be able to stop wearing masks?

The current estimate is that everyone will need to keep wearing a mask until 70-80% of the population is vaccinated against COVID-19, so at least until late 2021. While wearing masks is difficult, at Brave Care we have been impressed by how children of all ages have been able to rise to the challenge of mask-wearing with the proper guidance and encouragement from their caregivers. Fortunately, studies are starting to show that mask-wearing is not detrimental to children’s social and emotional development. Please let us know how Brave Care can help you and your family continue to get through this difficult time.