by Bob Doman
For many preschool children and children with special needs, particularly those on the autism spectrum, getting them to tolerate a mask can be a daunting task. For a child who doesn’t understand the need for a mask and who has some tactile defensiveness, getting them to wear a mask can be extremely difficult. Some of you might even think that it’s not just daunting, but impossible. But for some of your children, teaching them to tolerate a mask is vitally important. If your child needs to go to school, is exposed to teachers, aides, therapists, and other children, particularly children with lowered or weak immune systems, they need to be safe, as does the rest of your family.
There is neither a fast nor easy fix to this problem, but for most children we can work them through their issues. The main issue we need to address is the tactility problem. Most young children, and many with special needs, have an underdeveloped or hypersensitive fifth cranial nerve, the trigeminal nerve. This is the nerve that is responsible for processing facial sensation and is also involved with biting, chewing, and oral motor development and speech.
To help develop and/or desensitize the trigeminal nerve, we want to stimulate the nerve without being irritating. We develop neurological function by using the science of neuroplasticity, which means we need to be targeted with our input/stimulation and apply the specific input with high frequency, and avoid being aversive or irritating, with very short duration.
Specifically, we want to start when the child is distracted. They can be watching a video, playing, eating, or you can simply be talking to them. While distracted and without making an issue of it, gently start touching their face with your fingertips. Do this so gently and quickly so that they barely notice. For some children this can be as short as a second, but probably not more than a few seconds. Repeat this twenty or more times a day, always being mindful not to push the frequency (how often you are doing it) or duration (the length of time) to the point of being irritating. Very slowly over days increase the length of time you are providing the stimulation each session. Once your child is indicating that they are aware of what you are doing, speak to them in soft comforting words and tones—you are tying to make it a pleasant experience. As your child learns to accept your fingertips, you can add stimulation with a makeup brush and soft pieces of cloth, always remembering to progress slowly and only going longer as your child can accept it. If you push forward too fast and upset your child, you will probably need to stop completely for a couple of days and start over again.
As you slowly work to increase the seconds of time you are providing the stimulation and varying the textures, you can begin to decrease the number of times you do this per day. As you increase duration/length of time you can decrease frequency/times per day. You don’t want to be a pest. You do want to teach your child that this trigeminal stimulation is pleasant.
When you have built your child’s tolerance level to a point where you can provide the stimulation for a minute or more, it’s time to start conditioning your child to the texture of a mask. For most children, smooth textured masks are going to be tolerated better than those that are a bit fuzzy or ticklish. While providing your trigeminal stimulation, start spending more and more time touching and gently rubbing their face with the mask. Do not try to put it on yet, just work to get them comfortable with seeing the mask and feeling the mask. If you haven’t already, now would be a good time for you to start showing your child how you put on and wear a mask while teaching them to tolerate one. Show, don’t tell; and do it naturally, trying to make putting on a mask inconsequential.
Are you aware of any essential oils or extracts such as vanilla that your child likes? If so, start putting a little of the preferred essential oil or extract on the mask. If you know of an essential oil that your child likes and which also tends to calm them, then you have a winning combination.
At a point where your child can handle your touching their face with the mask, start putting the mask over their nose and mouth, without putting the strings over their ears, but for only a second at a time. You are going to need to start back at seconds again, working up to a couple of minutes, remembering to keep your child distracted and entertained. At this stage of the process, without making an issue of it, reward your child when you remove the mask. If they take the mask off, no reward; ignore it and move on. If possible try to anticipate when you child has had enough and remove the mask before they try to do it themselves. You should know what rewards works for your child, a tiny food treat, a hug, turning on their favorite video, etc., whatever works. Work back up to about two minutes. Maintain this for a couple of days.
It’s finally time to actually put the mask on, and again start with seconds and slowly build their tolerance. Build slowly, moving from seconds to minutes to even hours, keep your mask on, keep your child entertained, and reward them after you remove the mask.
How quickly you can move through this process is going to vary from child to child. If you have a child who is exposed to many people or who is physically compromised, then teaching them to tolerate a mask is really necessary. A bonus of taking your child through this process, even if you do not succeed in getting them to tolerate a mask, is development of their trigeminal nerve which will reap benefits for their eating, chewing, overall oral motor function, and tolerance for hats, glasses, headphones, and anything that may touch their face.
Good luck, go slowly, be patient. You may be saving a life.