Are masks healthy for social development?
As a clinical psychologist and mother, I’m deeply concerned about masking children. Although I’m speaking from a psychology perspective rather than an infectious disease perspective, it may be a helpful backdrop to know that The New York Times reports that children have a greater risk from car rides than from covid. There are several domains where I’m concerned we’re inadvertently tampering with healthy development by masking children for multiple hours on a daily basis. Obviously, each person and situation are different. As we consider what’s best for our children, our communities, and ourselves, here is some information that might be helpful to put the social factors of masking children into perspective:
1. Mirror neurons: We all have “mirror neurons” in our brains. These fascinating neurons fire in response to a face, and their response is (you guessed it) to mirror whatever expression is displayed on the faces we observe. For example, if I were feeling very happy and suddenly noticed my office mate across the room wearing a facial expression of sadness, my mirror neurons would respond to mirror the sadness-- I wouldn’t begin to feel sad myself, but my brain would physically register the presence of my office mate’s sadness. As you can see, mirror neurons are part of the neurological underpinning of empathy. Facial expressions, of course, showcase the mouth and nose--- smiles, grimaces, pouts, even a slight wrinkling of the nose can communicate anything from happiness to sadness to disgust, or anywhere in between. Even more subtle facial gestures like the tensing of a jaw or the pursing of the lips can signal more that we consciously realize we’re observing-- but our mirror neurons are silently registering these signals and then quietly shaping our perceptions of, as well as our social responses to, the people around us. Yes, eyes communicate as well– but the visibility of the mouth has been demonstrated as a primary player for facial expressions and mirror neurons; as well as a visual aid for learning and understanding speech.
To disrupt the mirror neuron process in adults presents its own challenges to social connection, though at least adults have sophisticated social and verbal skills to “fill in the (giant) blank” that is created by literally masking the mouth and nose. I fear that masking children, whose social skills are less developed, could deprive them of an important and basic social connection device that Mother Nature so elegantly affords us: the face.
2. Social cognition and language: It’s no surprise that social development for children includes learning to read and send social signals; including reading facial expressions. We'll also include things like “reading lips” here as well, since reading lips helps young children tremendously to learn and understand language.
Social skills can be as basic as learning to recognize a smile as a friendly greeting and to offer one in return when you approach a group; or learning to not smile broadly when someone is wearing a sad expression telling a story about how their favorite toy got dumped in the garbage (it may be hard to believe for readers without experience with children, but the “toy in the garbage” story can actually sound quite funny to four-year-old ears).
Social cognition skill acquisition also includes things like learning the power of how cracking a slightly campy, sly, or nervous smile in a tense moment can help to introduce a touch of levity and decrease anxiety– for example, my five year old loves this type of humor in life's "uh oh" moments like when he suddenly can’t find his special show-and-tell item anywhere at the exact “showtime” moment in class; and his (totally unmasked because I live in Florida) class will often respond to his sheepish smile with giggles that put him and themselves at ease. The same is true for other “faux distress” responses like an exaggerated sense of surprise. For example:
His teacher may form her mouth into an “O” shape and perhaps even raise a hand to cover her mouth in silly, pretend shock to convey a light “no-no” if something slightly inappropriate happens such a child letting out a loud and deliberate belch during storytime (ah, preschoolers!). The examples above are basic, but social cognition skills can be nuanced as well:
For example, if a twelve-year-old child (let’s call her Morgan) see a small group of friends clustered together across the playground or classroom with relaxed facial expressions, perhaps with many of them simultaneously showing animated lips or laughing mouths, then Morgan can see that a lively conversation is likely unfolding. She might feel drawn to approach the group casually as she mentally prepares to join the fun. Conversely, if Morgan sees several friends clustered together with their mouths paused in somber expressions while one child is speaking with their lips moving only subtly, as if speaking quietly or slowly, then Morgan might approach more tentatively or perhaps even realize that this might not be the best time to approach the group at all. This type of social awareness not only requires real-time ability to see facial expressions in order to facilitate awareness in the first place, but it requires a history of past experiences viewing facial expressions to create the social cognition skills necessary to recognize, process, and respond to this situation in a socially appropriate manner.
Moreover, the scene above describes what Morgan might be able to see and infer from unmasked faces before she is even close enough to hear a word of what the children are actually saying– masks obviously muffle our voices and prevent us from seeing the words that lips are speaking. This means the masks could also impede Morgan’s ability to successfully gauge the conversation as she approaches and then decide whether to give them space or join the group, based on her ability to pick up the vocal tone and content of the chatter. For example, are the girls talking about a favorite teacher where Morgan can chime in easily; or discussing something sensitive about what happened to them earlier in the day when Morgan wasn’t around?
If Morgan approaches the group and as she draws closer she sees that it appears to be a “private conversation” where joining might seem intrusive, the experience can go so much better for her if she’s able to detect this sooner rather than later, without masks literally masking much of the information she needs to read a group dynamic– plus, an absence of masks will allow a friend in the cluster who happens to see Morgan cease her approach can still make brief eye contact and throw her a small smile, perhaps even mouthing the words “let’s talk later!” as Morgan reads the situation and notices her friend in the group.
These small, subtle moments of social interaction are pivotal in social cognition, as well as in the sense of well-being we get from the social support afforded from well-informed social interactions.
While mirror neurons help us to register certain parts of facial-emotional information, social cognition helps us understand how to navigate this awareness interpersonally. Certainly, there are other factors that could guide Morgan, such as general body language, if her classmates were masked– but as a parent and a psychologist, I can tell you that getting kids to really read and understand social scenes even with the bright beacon of facial-emotional information can be a challenge. Why make it even harder on them, unless absolutely necessary?
3. Self-esteem: When a young child engaged in group play suddenly feels left out, they may make an instantly recognizable pout as their lower lip sticks out into an upside-down U-shape. A parent or teacher from across the room sees this pout and is drawn over to ask the child what happened, thereby helping them to verbalize their experience– as well as potentially guide them to practice skills to remedy the situation (“Let’s tell Grayson it’s not nice to take toys away from people, but we’ll also let him know he can play with the toy in 5 minutes so the two of you can share.”). Similarly, when a young child is discovering something simple and wonderful such as the joy of building a tower 10 blocks tall, they may display a gleeful, infectious smile-- stimulating a parent or teacher to draw near, smile back, give their chubby cheeks a squeeze and say, “Yes, you’re building an amazing tower, aren’t you?!”. These experiences are subtly communicating to children that their experience matters to others. Even if we do read the situation despite the masks and make a face of sympathy as we walk over to help, the child cannot read (or even see!) the empathy on our face as we approach– nor can the child who has taken the toy to learn from our face that his behavior has triggered a very specific response in the adults around him– and thereby learn that his own behavior is perceived as hurtful to others. Yes, we can convey this with words– but children are often somewhat pre-verbal, and sometimes there’s truly nothing like a friendly face to say a thousand words in a single moment.
Of course, a child’s experience matters to us even if the child is masked-- but by masking the child, we’re losing one of the child’s key tools of communicating his experience to us– so we may inadvertently become less responsive. As adults, we understand that people don’t respond to our smiles or frowns when we’re masked because our facial expressions are largely invisible. This is more difficult for children to constantly bear in mind-- moreover, in the examples above, the child isn’t even necessarily consciously searching for an adult to respond-- the adult’s response is an unexpected enhancement to the child’s experience that simultaneously models social cognition while also communicating to the child that they matter.
I’m concerned that removing a key component of our ability to notice and respond to children’s facial displays of happiness or distress could inadvertently create an environment that doesn't respond to children’s basic facial expressions, thereby posing a threat to their self-esteem.
4. Emotional flattening-- I fear that if facial expressions repeatedly fail to yield normal supportive responses by adults or playmates for children (as explained in point 3 of this article), then facial expressions may become less rewarding to make-- and children may become less inclined to make them with the same frequency or intensity as before we began masking them for hours on end. In psychology, the facial feedback hypothesis states that while some facial expressions arise from emotions, emotions can also be informed by making facial expressions– sometimes your body “knows” how you feel first (this is why holding your face in a woeful expression may evoke sadness, and smiling more often may improve your mood). I’m concerned tampering with children’s ability to have rewarding socio-emotional experiences through normal facial expressions could lead to decreased facial expressions, and an emotional flattening where children are simply less emotionally (and socially) engaged with the world around and within them.
5. Anxiety and depression-- All of the factors above could create a sense of isolation and disconnection– which sets the stage for depression and anxiety (the Surgeon General’s recent report confirms a spike in these issues for children since the pandemic). If children don’t have the normal opportunities to learn how to navigate social situations, if adults don’t respond to their facial expressions (because the adults literally don’t/can’t notice them), and if children are deprived of normal “face to face” social interactions, then how could we be surprised they experience an increase in feelings of isolation and disconnection?
Conclusion
I’ve heard parents say they’ve been guided by “professionals” that it will be better for their children if they act like frequent masking is fine and normal; since kids take their cues from the adults they trust. In contrast, I’m actually concerned that signaling to our children that regular, ongoing masking of their nose and mouth is in any way healthy or normal is actually a form of gaslighting our children; and invalidating their natural awareness that covering their face as well as becoming effectively blind to the facial expressions of others is actually not “normal and healthy”, especially in an environment where children are not generally vulnerable to serious harm from covid and adults have their choice of vaccines and antiviral treatments. Some parents say their children "like" wearing masks-- however, some adolescents also like to shut themselves in their room all day while scarfing down candy bars, and parents don't accept this as normal or healthy. Part of the work of adolescence is overcoming awkwardness with yourself, and sometimes overcoming introversion (taken too far, introversion increases vulnerability to depression and anxiety). Simply shrugging our shoulders and saying, "Oh, the child says they like wearing a mask so I guess that means it's okay," doesn't reassure me as a psychologist.
I understand the pandemic hasn’t been easy for anyone, there are exceptions to every rule, and there is no panacea. Each person has to do what is right for their particular situation, and I’m all in favor of parents weighing their options before making whatever choice is best for their family. But as a clinical psychologist and mother, I felt the need to share these points of concern that have been on my heart as well as my mind– especially because it seems that speaking up for the side of concerns about masking children is somehow taboo in our current climate, I want parents to at least have the knowledge that other perspectives exist. I truly welcome ideas from all sides, and this article is in no way intended to be comprehensive. The point here is just to raise awareness about potential implications for masking children, especially for multiple hours daily on a frequent, ongoing basis.
For more information from an infectious disease perspective rather than a psychology perspective, see the toolkit at www.UrgencyofNormal.com.