Tolerating Face Masks for Children with Autism

I recently received a question from a member in my online community, which is attached to my online course, about how to get a child to wear a mask. I know many of us have struggled with tolerating face masks, since we’re still in the middle of the COVID-19 pandemic. Even though the pandemic started in March of 2020, masks weren’t really considered needed or required until later in the spring and summer of 2020. And then all of a sudden in the United States places like schools, churches, airplanes, and hospitals all required anyone 2 and over to wear a face covering. There is no mask mandate for children under 2 as a mask is still considered a suffocation risk at that point.

I do know that parents can get medical exemptions about masks from their child’s physician in many cases, but that little slip of paper might not work in places like airplanes and I would not want to just risk showing up because it seems like airplanes are very strict. 

But I also know as a registered nurse and a behavior analyst that anything can be desensitized, including kids wearing masks. I have previously done video blogs and podcasts on desensitizing dental work, getting haircuts and more. In my new book, Turn Autism Around, chapter 13 is all about desensitization. I set up the steps for how to re-pair bath time which suddenly became aversive for a child. 

Tolerating Face Masks Using the Turn Autism Around Approach

So the first step of the four step Turn Autism Around approach is assessment. We have to look at, is this child able to wear a mask or a face covering at any point? Are they tolerating other things like wearing a hat or wearing headphones? Will they tolerate teeth brushing? And you might think, well, that doesn’t have anything to do with it. But actually it does because kids that can’t tolerate face masks or won’t wear headphones probably are sensitive to different foods, clothing, and textures. 

The second step is to make a plan. And this shouldn’t just be a plan like, hey, I’m going to force my kid to wear a mask on our way to daycare. That’s not a plan because if a child is pushing you away, is ripping off the mask, or is crying, that is not a good procedure to be using. We don’t want a child or any human to be upset at any point, let alone for minutes or hours of a day. It’s not helpful. And I know that we can scale it way back and teach a child how to wear a face covering if and when needed. 

Table Time for Autism Face Masks

A big part of the Turn Autism Around approach is to pair up a table and chairs. So if it’s a very little child, we want to pair up a small sized table and chairs. If it’s a larger child, a card table. And we want to make it comfortable for both the adult and the child. So if it is a very small table, you don’t have to sit in a child sized chair. You can carry it over to a sofa where the adult could sit on the sofa and the child could sit in a child sized chair.

So we want to pair up the table, not just for language and learning skills and imitation and matching, which provides a nice structure for those kinds of tasks, but also to teach and desensitize other things. So at a table I have worked on desensitization to haircuts or looking in the mouth or headphones.

Types of Masks

One thing to look at is there are different types of masks, obviously, and face shields. Now sometimes depending on your location in the world, maybe face shields aren’t acceptable. But in the United States where my son has gone, face shields have been an acceptable face covering for him.

I have found that face shields are better for longer duration tasks, like when he volunteers at the food bank, for instance.  Also the nice thing about face shields is that I can see his lips and if I’m wearing one, he can see mine.

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If he starts to get unhappy or slightly agitated, he will show it in his face. But if his face is covered up, we won’t be able to see it. So face shields, or even clear face masks, might be a really good thing for you to invest in. Maybe give one to the speech therapist and your child. Because a lot of our kids need to look at mouths in order to see what you’re saying. 

The other important thing we’re going to use when we systematically desensitize or pair masks is positive reinforcement. If we’re pushing too hard and getting crying or swiping or pushing you away then we’ve pushed too far. The demands are too high. Reinforcement is too low. We also want to use imitation, which is so powerful. Don’t just get one face mask, get a bunch so that the child can wear a face mask and you can wear a face mask while you’re practicing or out in the community.

I would get two masks of the same color. If your child is into characters or trains, you can also search on the internet and find some masks with those things on them. 

How to Get a Child to Wear a Mask

If I were sitting down at a table with a child who was not into masks at all, I would not just be going in and trying to attach the mask to their ears. They will probably start crying then. What I would do instead is I would have my mask and his mask. I would be at a table where he’s comfortable getting lots of reinforcement, maybe watching a favorite video on an iPad or a portable DVD player or a TV. And then I might say, okay, we’re going to practice wearing our masks.

And I might put the mask up to my face for a count of 10. Maybe he’ll follow. You can also use a mirror or video modeling. But at first hold the mask up for just a few seconds. 

Then I’m going to help him attach or I’m going to show him how to attach the mask. Again it’s going to be for seconds then for minutes – unless the child’s already tolerating a mask. We might have to set timers or give more reinforcement or try a face shield if that’s permitted where you’re going. 


In general, we just need to get into the idea that we can desensitize, we can pair or re-pair anything and we can help our kids be comfortable with all kinds of procedures or new demands that weren’t part of our lives just two years ago. 

So hopefully these couple techniques might help you move forward with helping your child or clients to wear masks or face shields. If you would like to learn more about how you can join our online course and community, you can attend a free online workshop at Hope to see you there!

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