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Masks Mask Communication – Communicating with Children in Health Care Settings

To the Editor: Communication, the process of exchanging information, plays an important role in social interactions and helps establish and maintain most relationships including patient-clinician relationships. Communication has two components: verbal (speech sounds) and non-verbal (gestures, body language and facial expression). In view of the COVID-19 pandemic, use of face masks is recommended [1, 2]. However, face masks hamper communication, both verbal (e.g., attenuates speech signals produced by the speaker thus degrading quality of speech) and non-verbal mode (e.g., eliminates large part of facial expressions). While some environments make for better communication even with the masks on, (e.g., when the content is known – communicating with a cashier in a grocery store), some can be harder (e.g., talking to a stranger, visiting a physician’s clinic). Using face masks and communicating with children can be challenging. For communication to be effective, it must take place in a manner appropriate to one’s age, understanding and communication abilities. As speech-language pathologists working with children with communication disorders, our transition to the new normal of communicating with face masks was quick and smooth. We present communication strategies (Fig. 1) we believe will be helpful for pediatric clinicians when wearing masks. While some of these strategies are similar to those, we have recommended for clinicians communicating with adults with neuro-psychiatric disorders [3], others are specifically useful when communicating with children (e.g., use of social stories). In addition to the more easily adaptable verbal strategies, we have provided non-verbal strategies that include communication using gestures, body language, pictures and written modes. We have also included tips for preparing a child for a clinic visit. Communication with children can be mediated through parents.

Fig. 1

Communication strategies for clinicians working with children when wearing masks

With the increase in active COVID-19 cases in the country, use of masks is expected to continue for the foreseeable future. Additionally, more families are bringing in children for clinical services, including non-emergency cases. Hence, equipping oneself with various communication strategies, being aware of the power of non-verbal communication, reminding oneself to be patient with children are crucial for patient care in these difficult times.


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We thank Nikita Dadlani, Prathiksha Vaidhyanathan and Dr. Prabha Chandra, Professor of Psychiatry, NIMHANS, for their valuable inputs in putting together communication strategies.

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Correspondence to Shoba S. Meera.

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Swaminathan, D., Meera, S.S. Masks Mask Communication – Communicating with Children in Health Care Settings. Indian J Pediatr 88, 283–284 (2021).

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