Mixed emotions including frustration, worry and anxiousness (to name a few) fill my being yet again on the eve of the day my kids return back to school. It is no longer a new experience for me or the many other parents who have experienced the same feelings over the last 22 months.

 The significant positivity rate in our community and the marked rapid increase in the pediatric cases and pediatric hospitalizations in the last week and a half (all while kids are out of school) is what causes some of my angst. Unfortunately, now it is not too uncommon to hear situations in which people “did all the right things” but COVID still veered its way in. So while I have been able to shield and protect my own children from being infected during the pandemic so far, I fear that the time will come when the inevitable will happen to my own. What’s different now?

 In the midst of all these emotions, I look for the silver lining in our current situation. My kids are NOW vaccinated! Although we are well aware that even fully vaccinated people are susceptible to infection they are less likely to develop severe disease and the need for hospitalization. So in the midst of the mixed emotions I have come to the point of realization and acceptance that this time around I will not likely be able to shield my own children from becoming infected with the current COVID omicron variant.

 The current significant community positivity rate makes exposure and subsequent infection while attending school more likely in the era of optional masking and confusion regarding isolation/quarantine recommendations. In the midst of an ongoing roller coaster of emotions, I will hold on to what I can control and continue to practice and encourage my own children to practice preventive precautions as best we can, including vaccination (done), hand washing and mask-wearing.

 I make the same recommendations to my own patients and their families including the following disease prevention strategies:

• Eat a balanced diet and exercise regularly
• Get plenty of sleep
• Drink plenty of water
• Do not send sick children to school (regardless of COVID exposures or not). Keeping sick children home is the best way to prevent spread in the school setting. 
• Get yourself/or your child tested if you/they develop any symptoms of COVID-19. Testing and identifying infections and subsequent proper isolation practices will prevent further spread.
• Get vaccinated if you haven't already and get a booster if you or your child are eligible (primary series approved for 5 years old and up, boosters approved from 16 and up and anticipating approval for 12-15 year olds soon).
• Practice good hand hygiene, wear a mask and avoid large crowds.

 Given the ongoing change and updates to guidance regarding isolation/quarantine guidelines for different populations of the community, we know that navigating these situations can become confusing and overwhelming. For questions regarding testing, length of quarantine or isolation, and the COVID-19 vaccine for your child, please ask your pediatrician for guidance.

 Wishing you a Happy and Healthy New Year!

Dr. Soria-Olmos

Get to know Bianka Soria-Olmos, D.O.

Dr. Soria-Olmos is a Cook Children's pediatrician in Haslet. She was born and raised in Fort Worth, Texas, so Cook Children's has always had a special place in her heart. She came to know Cook Children's when she was just a kid herself. She went to the medical center a number of times with her active younger brother, who needed care following several mishaps with broken bones. The visits inspired her to decide, "I want to be a Cook Children’s doctor one day."

In pursuit of her dream, Dr. Soria-Olmos attended Texas Christian University (TCU) for a degree in biology and to fulfill the pre-medical school requirements. After graduating from TCU, she chose to stay local and attended medical school at the University of North Texas Health Science Center/Texas College of Osteopathic Medicine in Fort Worth. She completed part of her pediatric clerkship at Cook Children's, learning about pediatric medicine by attending rounds with pediatric hospitalists. It was then she knew she wanted to be a pediatrician.

She began her career with Cook Children's in 2014 as a pediatric hospitalist caring for sick children admitted to the hospital. Today, she works at Cook Children's primary care office in Haslet. Her special interests include child safety, child development and asthma.

So says Suzanne Bonifert, MC, CCC-SLP, speech-language program manager at Cook Children’s Medical Center, who adds that masks aren’t ideal, but they’re “helpful and keep disease at bay” for children and those around them.

“And that’s a good thing,” she says.

Since the COVID-19 pandemic began, some parents have expressed concerns that their younger children’s speech and language development could be stunted by masks covering the lower portion of faces, an area that provides additional cues about what’s being said and what’s not being said when humans communicate with one another.

But in the past year and a half, Bonifert and her team haven’t seen any overall change in children’s speech and language skill development, she says, nor in their comprehension of what’s being communicated to them.

“Our kids are able to communicate with us and with each other with masks on. Children are so adaptable and so resilient,” she says. “We should look to them more often to see how they handle things so much better. Sometimes it’s us as adults who worry so much.”

Adults have lots of different ways to effectively communicate with kids and facilitate comprehension, Bonifert says. Children of all ages instinctively pick up non-verbal cues from the upper half of the face, she says, such as eyes, eyebrows and forehead, as well as other methods humans use to express themselves, including tone of voice, body positioning and gestures.

Scientific research backs what Bonifert has found to be true. For instance, a pre-pandemic study published in the scientific journal Cognition in November 2012 examined how humans (age 3 to adult) processed facial cues when covered with face masks or sunglasses. The study concluded that children ages 3 to 8 showed no difference in deciphering emotions when viewing faces covered by face masks. Researchers also found the children, even when they could see the entire face, tended to focus on the eyes of the person communicating, according to the study.

Based on her own anecdotal evidence, babies are perfect examples of how that works, Bonifert says, adding that an adult wearing a surgical mask can pick up a baby, smile, speak in an animated voice, and the baby “will literally light up in front of you.”

“Because they see it in my eyes,” she says. “And I know they’re able to see what I’m doing by looking at the top half of my face. They also hear the intonation of my voice. They’re not understanding specific words and sentences, but they’re hearing that excitement in my voice and seeing it on my face, even though I’m partially covered with a mask. I’ve done this over and over and over.”

But, in general, babies and young children mostly see and hear their families without masks at home, which helps with their early speech and language development. Increasing that face-to-face interaction time—minus the distraction of screens—would benefit them, as well, Bonifert says.

When out of the house and wearing a mask, adults should use the same techniques practiced in public speaking while communicating with children, she says. Her tips for adults include:

• Articulate clearly so your words can be understood.
• Project your voice and increase the volume in case your voice sounds muffled behind a mask.
• Use facial expressions.
• Smile bigger than usual—it will show through your eyes.
• Make eye contact.
• Make sure you have their attention before speaking.

The latter tip—gaining children’s attention—is a skill “we encourage, in general, when working with kids to facilitate communication,” Bonifert says.

“It’s a key point. Mask or no mask, that’s always important, but especially with a mask. We need to make sure we have their attention, their bodies are positioned toward us, and we have good eye contact with them,” she says. “We talk about getting face-to-face with children—that’s really important.”

The children also pick up on these techniques and use them to communicate, Bonifert says.

“In particular, with typically developing children, when they’re wearing masks, they start to learn these skills, too. They learn ‘I just have to speak a little bit louder sometimes’ or ‘I can’t be turned away like this when we’re in math class because my teacher’s probably not going to hear me,’” she says.

For parents of children with developmental delays or disorders who may already face speech and/or language challenges, Bonifert suggests using window face masks, which have see-through plastic over the mouth area. Window face masks may help, for example, when adults need children to see the way their lips and tongues move while forming words, she says. The masks can be purchased online.

Overall, it’s important for parents to remember babies and young children have continued to progress with communication and comprehension skills despite their encounters with a mask-wearing society during the pandemic. While wearing face masks isn’t ideal, Bonifert says, parents shouldn’t be overly concerned about any long-term speech or language effects.

“Again, it’s not like we have had an influx of tons and tons of children who are not developing typically,” Bonifert says. “It just shows the resilience of the human body and brain, and how neurologically children can adapt.”

The rising number of COVID-19 cases in North Texas is due to the delta variant, which is more contagious than other strains of COVID-19, and a significant number of unvaccinated people. With Texas doing away with virtual learning this school year and the COVID-19 vaccine not yet available for those under 12, many parents and children are understandably feeling anxious.

Amanda Jordan, Psy.D., a licensed psychologist at Cook Children’s Alliance, can relate. She has a child starting kindergarten in the fall and is experiencing similar feelings.

“I want parents to understand you can’t take care of others if you don’t take care of yourself first,” Dr. Jordan said. “You have to check in with yourself first to see how you’re feeling because you don’t want your children to pick up on your negative energy.”

As for parents, Dr. Jordan says it is important to engage with other parents, make sure to create and maintain their own schedule, talk with their partner/spouse and seek professional help when necessary.

Dr. Jordan says once parents have worked through their anxiety, it is good to start preparing children for their ‘new normal’ as early as possible. She says it’s important to pose open-ended questions such as, “I wonder what your first day will be like?” or “I wonder who your teacher will be this year?” These types of questions allow your child to open up about how they’re feeling and can lead to other questions or concerns they may have.

Dr. Jordan also stresses the importance of establishing a routine as school beings again because many children have been off of their schedule for more than a year. This routine includes bedtimes, meal times, changing eating habits, etc.

“There has been so much flexibility with virtual learning,” Dr. Jordan said. “Children have been going to bed and waking up later than normal, and could do their work at their own pace.”

She says starting a ‘school year’ routine before school officially starts can help ease some of the anxiety on the parents and children.

Another technique Dr. Jordan recommends to parents is called ‘Name it to tame it.’

“It is important to help children put a name on their feelings,” she said. “As parents, we want to fix things and say things like ‘don’t be scared’ or ‘you’re going to be fine,’ but you must validate their feelings.”

Dr. Jordan says to respond to children by validating their feelings and letting them know you understand how they feel and let them know they always have a safe space to express their feelings.

Along with the anxiety of returning to school, medical professionals at Cook Children’s are also getting questions about children wearing masks in the classrooms. Alice Phillips, M.D., a Cook Children’s pediatrician at Cook Children’s Cityview says she stands behind the recent recommendations from the American Association of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), that all children K-12 should wear masks in classrooms this school year.

“I believe children need to be in school for their social skills, mental health, and other key personal connections,” Dr. Phillips said. “I recognize it’s a hot topic, but for students to stay in school without shutdowns or quarantines, we must do it safely.”

Dr. Phillips says the new delta variant is spreading rapidly in our unvaccinated population. At Cook Children’s we have seen a rise in the number of children testing positive for COVID as well as an increase in the number of children being hospitalized. For this reason, she believes it is even more important to make sure all children have masks on in the classroom, no matter their vaccination status.

“Parents have to begin modeling mask-wearing behavior at home, and support their children if they feel pressured to do otherwise by their peers,” Dr. Phillips said.

To prepare children to wear masks in the classroom, she says it’s important to explain to children the reality of doing ‘hard things,’  for our friends and communities. Equally important is providing encouragement to children when they're doing the right thing.

“I understand that it’s hard to be brave sometimes,” Dr. Phillips said. “The best we can do is encourage, support, and validate children’s feelings and let them know the ‘why’ behind masking and the importance of keeping themselves and others safe.”

Dr. Phillips says her advice to all adults is to get vaccinated and be an example. She advises all adults to wear a mask when they are in the grocery store and other public settings as recommended by the current CDC guidelines, 

“If parents are vaccinated and their children are not, I still advise the entire family to mask up to support the child and protect them,” she said.

If you have any questions about preparing for your children to head back to the classroom or need guidance for masking, contact your child’s pediatrician.

Read more about preparing for the upcoming school year here:

Cook Children's 10-Point Guide for Safely Reopening Schools

Should My Child Wear a Mask to School this Fall? 

1. Make sure all children are up to date on the routine childhood vaccinations needed for school entry. Access to medical offices, fear of leaving home and of waiting room exposures, and closed schedules of weary medical providers taking long-awaited vacations could result in a drop in vaccination rates against measles, mumps, rubella, pertussis, and the bacteria causing meningitis. A slight drop in vaccine coverage for measles, pertussis, and mumps translates quickly to a loss of herd immunity and outbreaks of serious, vaccine-preventable illnesses.

2. Revisit the latest masking decisions in light of the recent surge in COVID-19 cases. The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) advocate for masking in schools, especially in areas with moderate to high transmission of COVID-19. Follow guidance from your local health department which will be in line with the current state of the pandemic and regional community health recommendations.  We have learned during the pandemic that most children, 2 years of age and older, can wear a mask.

3. Encourage COVID-19 vaccination of all eligible children and adults. COVID-19 efficiently spreads from adults and teenagers to younger children, not often the reverse. The key to keeping schools open during the COVID-19 pandemic is getting unimmunized parents and all eligible family members vaccinated.

4. Arrange for mobile COVID-19 vaccination units to be present during orientation and events such as 'meet–the-teacher' nights. Gains in U.S. vaccine acceptance are likely to come amidst the group of people who don’t have a solid reason to avoid vaccination. Surveys reveal that most of these people were hoping that the pandemic was wrapping up and that they would not have to take a risk by taking an “untested” vaccine. They are reasonable people who describe themselves as cautious, slow adopters of things that are new. Most are not necessarily opposed to vaccination philosophically. They were just hoping to wait out the pandemic while relying on social distancing, masking, and herd immunity to keep them from having to getting a vaccine. With the loosening of restrictions and the surge in cases due to the Delta variant, many are now ready to stop holding out.

5. Continue to utilize strategies promoting social distancing in the classroom (by using partitions, separating desks, and cohorting of student groups), during passing periods (by keeping them short to discourage standing around in small groups and conversing), and during meal times (by moving meals outside in the fresh air, limiting line length for meal service, and by observing social distancing).

6. Re-enforce good hand-hygiene practices and cleaning of shared workstation areas with demonstrations that highlight effective hand hygiene and disinfection techniques.

7. Quarantine unvaccinated children and school staff members exposed to COVID-19 per CDC guidance. Vaccinated exposed persons may still get sick with COVID-19 and could be contagious, though their risk of hospitalization and severe disease is extremely low. Quarantine exposed, vaccinated persons if they develop symptoms of COVID-19 until testing results are available.

8. Provide interactive and technologically sound, distance-learning alternatives for immunocompromised students who should not be in the classroom during the pandemic.

9. Encourage precautions for bus riders like masking and opening windows to promote adequate ventilation and reduce the transmission of COVID-19 while traveling to and from school.

10. Above all, send recurring reminders to parents not to send ill children to daycare and to school. Many parents are returning to the workplace for the first time in over a year. They may be experiencing pressures to be physically present, rather than staying home with an ill child. Memories are short when pressures are high. However, we are still in the midst of a global COVID-19 pandemic that has already claimed the lives of more than 600,000 people in the U.S.

The American Academy of Pediatrics is recommending that all children over age 2 wear masks in school this fall. The internet rejoiced, everyone agreed it was a great plan, scientists and politicians shook hands, and no one had anything to say about it.

Ha. Kidding. I promptly picked up some curly fries and wine when I heard about it and laid face-down on my office floor. Not the most sanitary place to do some deep breathing, but whatever.

I hate to joke about serious things like this, but if I don’t, I may cry. The idea of a uniform and agreed-upon plan for halting the spread of a disease that could prevent the deaths of many seems like a pipe dream at this point.

Let’s walk through this and see if I can help you with your decisions this fall.

What did the American Academy of Pediatrics recommend?

• “Everything possible must be done to keep school in-person.” This is because the rates of academic struggle, obesity, and mental health crisis all rose tremendously this past year. Kids need to be in school. We all agree on that.
• They recommend all eligible kids receive the COVID vaccine (12 and up currently)
• Universal masking for anyone in school over age 2 (all students and all staff)
• Flexibility in policy – COVID is an ever-changing scenario and if something isn’t working well, schools need to recognize it and change it
• Attendance of students should be closely watched, and mental health resources for both students and staff should be available
• There should be ongoing federal, state, and local funding to schools to help them with all this.

Why is the AAP recommending all kids wear masks this Fall?

• The AAP is asking all students to wear masks in order to not only protect those that cannot be vaccinated yet, but also the families of these children, and the community as a whole.
• The AAP advocates for children. ALL children. Not just your kid. The wealthy ones. The poor ones. The sick ones. The healthy ones. The physically and mentally challenged. The kid who is being raised by his elderly grandmother and doesn’t have the means or transportation to get that vaccine yet. The kid who doesn’t have enough food at home but gets 2 good meals at school. The child who doesn’t have access to the fancy laptop or functioning internet. The AAP gives us advice based on what will help our community better support and protect our kids.
• Guess what? Last year, we masked in schools. We washed hands more. We asked sick kids to stay home. And schools were then found to not contribute significantly to the spread of COVID-19. (Click here for more information)
• We also noticed a pleasant, NONEXISTENT flu and RSV season as an added side-bonus.
• What happened this summer? We took our masks off, had playdates, saw friends, had parties. And now have plunged into a winter-sized scourge of viral illness. My office has been booked days in advance. The hospital is full. In July. These school strategies work not only in regards to COVID, but all viral illness– both focused studies and my own practice numbers have proven this.

What is the “Delta variant”?

• The COVID virus is mutating (as we expected), and this is the newest and most common version of it in the U.S. right now
• It is crazy, freaking contagious. More so than the original bad boy.
• Verdict’s out on whether it makes you sicker. I suspect it will put a larger burden on hospitals just given the number of unvaccinated people who may be infected.
• Vaccines seem to be working well against it.
• A recent study from the United Kingdom showed that children and adults under 50 were 2.5 times more likely to become infected with Delta.

Why should my vaccinated kid wear a mask?

• Because keeping track of who is vaccinated and who isn’t is a huge burden on schools. And trust me, they have already suffered enough burden.
• Because many kids cannot have the vaccine yet, or haven’t had access to it.
• Because we don’t yet know how well the vaccines work against the new COVID variants and until we are more comfortable with seeing how effective it will be, this is the most low-risk and safe thing we can do.

Will masking harm my kid? Why are all these people saying these awful things about masks?

• Putting a piece of thin cloth on your child’s face does not harm your child.
• I have written one mask exemption this entire year. One. It was for a child with a very rare lung disease. The child’s lungs are anatomically and physiologically very different than a normal child’s and keeping oxygen levels up even without a mask was a struggle for this kiddo.
• The worst I’ve seen is a mild face rash here and there. Otherwise, don’t believe the hype. Masks are not causing TMJ problems, lost social development, increased CO2 levels, increased illness, etc etc. It’s a lot of weak arguments with no evidence and as a pediatrician who saw and examined thousands of children this past year: the kids are fine.

Does masking protect other people? Or me?

• Both.
• Even if your child is the only child wearing a mask in the class, it will protect him. (Click here for more information)
• This all works better if everyone masks.
• If an unmasked sneeze happens nearby, a mask prevents your child from inhaling AS MUCH virus into his airway – and there is brewing evidence that the MORE virus particles you inhale into your body, the more severe the subsequent illness may be.
• I also think it really keeps kids from touching their face, picking their nose, putting fingers in mouth, etc. Our absolute lack of flu and RSV last winter can attest to this.

What if only some kids are wearing masks? Will my kids get bullied?

• I don’t know. I doubt it. We did a whole year where everyone masked and school-aged and young kids were generally pretty cool and flexible about it. Most don’t seem to care either way. The bullies in this scenario often seem to be the adults.

When are the vaccines for the younger kids going to be ready?

• Pfizer’s clinical trial data for children age 5 to 11 is likely coming in September. If approved, shots for kids this age will be available within 1-2 weeks after that.
• Ages 2 to under 5 coming soon after that, in October.
• 6 months to 2 years soon after that.

What about my child under 2 who can’t wear a mask?

• It’s okay. Send them to daycare. Send them to mother’s day out. Do the swim lesson. Get the speech therapy. You need it to work, thrive, survive. COVID seems to be milder in young kids. And while I can never guarantee anything in life 100%, I think the benefits outweigh the risks for kids in this age group.

What if the daycare doesn’t require their staff to be masked? Vaccinated?

• I’m hopeful that daycare centers will strongly encourage their staffs to vaccinate and mask up, but I know that not all will. I think you should ask the questions and expect answers from childcare centers. You can certainly make that a part of your decision-making process when choosing where to place your child.

Do kids really get severely sick with COVID?

• COVID in children is mostly mild. No one debates that. But kids (especially the older kids) contribute to the spread in the community.
• Let’s not forget the times it’s not mild. I’ve seen kids with post-COVID chronic fatigue, long-term smell and taste change or loss, multisystem inflammatory problems, psychosis, and cardiac issues that have kept them out of sports for the year.
• We are still learning about the long-term consequences of COVID infection. There is thought that up to 30% of people who have had COVID will develop long-term medical problems.
• I talked to one of the Cook Children’s Pediatric ICU doctors the other day, Dr. Linda Thompson. I wanted her input about kids with more severe illness as she has seen much more of it than I. She said she’s seen more severe illness in older children compared to the younger ages. She also mentioned “please let everyone know I vaccinated my 14-year-old as soon as I could.”

What do you recommend, Dr. Diane? What will you be doing with your kids?

My kids (6 and 7 years old) will be going to school in-person this fall. They will be wearing masks regardless of what the other children are doing. They can take them off when outside. We will talk about it a lot before it happens, and expectations will be clear.

We will practice wearing them while we watch our screen time to get used to them again on our faces. We will pick the favorite fabrics. If our community numbers drop and my children are able to safely get vaccinated this winter, I can’t wait to tell them to take ‘em off.

But until enough of us get vaccinated, COVID is not going away. And it will likely surge again this winter.

As long as the numbers keep climbing in the community, we have to protect not only the kids, but all of us. Remember those hospital numbers in January? Remember the goal of not over-straining our medical resources? Remember Uncle Pete who had a heart attack and there wasn’t a single hospital bed available for him last winter?

I’ve said it before and I’ll say it again: we are building this boat as we float in it. We don’t know what the future holds for us and we are making the best decisions we can in a situation that no one has yet conquered. Having patience as we gather the data and learn from our successes and mistakes is the beautiful and necessary process of science.

You may be asking questions like:

“Does my child still need to wear a mask?”

“What does this mean for my child’s school?”

“Can we have a normal spring break?”

Mandate or no mandate, unfortunately COVID-19 is still spreading in our community. This means unvaccinated people, including children, are still at risk for developing the disease and severe symptoms.

According to Marc Mazade, M.D., medical director of Infection Prevention and Control at Cook Children's Medical Center, Tarrant County (and many other Texas counties) remain in a state of substantial transmission according to public health advisories. This means large-scale community transmission is still occurring, including within communal settings such as schools and workplaces.

At Cook Children’s, the number of COVID-19 patients has dropped dramatically since peaking in January. Our rate of patients testing positive within a seven day period is now below 4%. At the beginning of 2021, that rate was over 20%, meaning we are making progress. (See chart below.)

To continue this trend, Dr. Mazade says we must remain vigilant, especially in schools.

“Shortly after Memorial Day 2020, we released our ‘Recommendations for the Safe Reopening of Schools K-12 in Texas,’ which urged the wearing of masks in schools and elsewhere in the community,” said Dr. Mazade. “Our recommendations have not changed as they were developed with a scientific understanding of how infections spread and of basic human nature.”

Dr. Mazade urges everyone to revisit these recommendations and says they are as important today as ever.

“As most people are now aware, more highly transmissible and even some vaccine-resistant COVID-19 strains are gaining a foothold. Now is not the time to relax. Rather it is the time for even more vigilance,” said Dr. Mazade.

With spring break coming up (or even in full swing for some), it’s vital to remember the basics of COVID-19 prevention:

• Wear a mask around people outside of your household
• Stay six feet away from others
• Wash your hands diligently

“We all want to get back to normal, but this spring break is not the time to let your guard down,” said Dr. Mazade.

This message could seem confusing with changes like the Texas mask mandate expiring and a new direction from the Centers for Disease Control and Prevention (CDC) that says fully-vaccinated people can gather without masks. Despite these changes, parents need to stay the course until children are able to be vaccinated against COVID-19, which could happen later this year.

“We must trust the people who best understand what we are up against and how best to combat it and follow their lead,” he said. “When the CDC eradicated smallpox, it did so because it never stopped pressing, diligently researching disease clusters, vaccinating everyone wherever disease emerged, never abandoning the objective. We all would do well to remember that we live and interact closely with many beloved yet vulnerable teachers, students, and family members who benefit from our diligent adherence to public health guidance.”

The next time you visit one of our clinics or hospitals, you may notice a slight change to our mask policy. We still require all patients, accompanying family members, and staff to wear a mask when they enter any of our facilities. However, we now discourage anyone from wearing masks with valves.

Now why is that?

The reason why we wear masks is two-fold. It is to protect us, but also to protect those around us. The valves that are used in masks are one-way valves. These valves close when you inhale so air and other particles cannot get in. Therefore, you are protected when you breathe in. However, the valves open when you breathe out, which exposes those around you to completely unfiltered exhaled air. Though you may be protected by these masks, everyone around you is not. This is especially important if you are or could be sick. Anyone with COVID-19 could be contagious before they start developing symptoms. This is why it is important for all of us to help prevent the spread of infection by wearing masks that protect ourselves and those around us.

If anyone happens to come to any of our Cook Children’s locations wearing masks with valves, they will be provided a mask (without a valve) instead. 

Here are examples of acceptable masks (homemade masks, surgical/procedural masks (tie or ear loop) and dust masks), courtesy of the Mayo Clinic:

N95 masks are preferred for health care personnel during specific activities, but may be worn by patients or visitors if that is what they are wearing when they arrive on campus.

As far as unacceptable masks, the are the masks with vents that allow unfiltered exhaled air to escape. These are the masks that should not be worn at any Cook Children's site.

Please help us keep you and our patients safe. We are all in this together!

Beginning June 26, the wearing of masks in public is mandatory in Tarrant County. But for some, the idea of wearing face masks is the cause of much anxiety.

“Many people have complained that they are not able to breathe while wearing a mask,” said Karen Schultz, M.D., medical director of Pulmonology at Cook Children’s. “Some are even concerned that wearing a mask will cause oxygen levels to go down. Fortunately, this is not the case. The cloth masks worn in public as well as the surgical masks worn in the hospital allow airflow while breathing but they contain the mist that we all exhale.“

Dr. Schultz adds the masks allow for adequate entry of oxygen as well as removal of carbon dioxide. Medical staff have worn masks for prolonged periods of time long before the outbreak of the SARS-CoV2 virus without any difficulties.

“However, anxiety about wearing the mask can lead to feelings of difficulty breathing. The hyperventilation associated with anxiety can actually DECREASE carbon dioxide levels which can cause a feeling of dizziness but this is not related to any restriction to airflow by the mask.

If someone feels like they are having difficulty breathing with a mask, they should take slow deep breaths such as those taught in yoga.

 Masks are a courtesy to others. They protect those who may be more vulnerable to the disease, such as the elderly or those with chronic illnesses such as cystic fibrosis or diabetes. Masks should cover the mouth and nose to keep others safe.

 So why is wearing a face mask important?

• Face coverings help to prevent the spread of COVID-19 because our everyday actions, such as speaking, coughing and sneezing, can easily transmit it.
• Some people with COVID-19 may not have symptoms (asymptomatic) and can transmit the virus unknowingly. By wearing a mask, they can help prevent that.
• While social distancing is still crucial, there are times when 6-feet of space is not always possible. For instance, when you’re at a grocery store check-out register. The mask helps to provide another layer of protection.
• By covering part of your face, you’re less likely to touch your eyes, nose and mouth. Plus, the mask reminds yourself and others to maintain social distancing.
• Your face covering helps to protect the people around you ~ your friends, your neighbors, your co-workers ~ from getting sick. And when others wear masks, they are helping to protect YOU.

“I don’t think any of us enjoy wearing masks, but we need to wear them to help our community,” Dr. Schultz said. “Until we get a vaccine, wearing a mask is the best alternative to preventing COVID-19.”

Important Links:

• With COVID-19 Cases On The Rise, County Leaders and Physicians Urge Community To Wear Masks
• Why Wear A Mask? One Pediatrician's Perspective
• Tarrant County Public Health COVID-19 (Coronavirus) Site
• Johns Hopkins University & Medicine's Coronavirus Resource Center 
• Checkup Newsroom COVID-19 Information
• COVID-19 Resources & Education (cookchildrens.org)
• Medical Director of Infectious Diseases Urges Us All To Wear Our Masks
• 'Because We Are All Taking an Amazing Handwashing Journey Together, Aren't We?'
• Why It's Important To See Your Pediatrician During a Pandemic and What To Expect During Your Visit
• Cook Children’s Pediatricians Welcome Patients Back to Clinic Visits. The Plan to Keep You Safe.

• Face coverings help to prevent the spread of COVID-19 because our everyday actions, such as speaking, coughing and sneezing, can easily transmit it.

• Some people with COVID-19 may not have symptoms (asymptomatic) and can transmit the virus unknowingly. By wearing a mask, they can help prevent that.

• While social distancing is still crucial, there are times when 6-feet of space is not always possible. For instance, when you’re at a grocery store check-out register. The mask helps to provide another layer of protection.

• By covering part of your face, you’re less likely to touch your eyes, nose and mouth. Plus, the mask reminds yourself and others to maintain social distancing.

• Your face covering helps to protect the people around you ~ your friends, your neighbors, your co-workers ~ from getting sick. And when others wear masks, they are helping to protect YOU.

Historically recognized as Autism Awareness Month, April 2020, like everything else, has been overshadowed by COVID-19.

It’s important to recognize that children with autism are adapting to new daily routines just like the rest of us, but for some, new routines can be hard to establish.

For example, the Centers for Disease Control and Prevention have recently recommended the use of cloth face coverings in public settings, like grocery stores and pharmacies.

For kids who don’t like wearing shoes or other tight fitting clothing, parents may be wondering how in the world they can get them to wear a face mask?!

Research on applied behavior analysis points to two solutions to adapting to new routines: pairing and shaping.

Pairing is a method introducing unfamiliar objects, like a face mask, to children with autism. To appropriately pair the new item, we deliver it to the child along with positive reinforcers like tickles and hugs.

Prior to asking the child to wear the mask, we simply want them to become more familiar with it. We can do this by giving them a mask followed by praise or high fives. Don’t be afraid to be silly with it either! Try making goofy faces with your child and using the mask to play peek-a-boo. Once the child is comfortable in the presence of the mask, we use shaping to get them to wear it.

The goal of shaping is to reinforce each small step towards wearing the mask. With pairing, we simply want the child to enjoy holding the mask. Now we may provide the same rewards for (a) bringing the mask toward their face, (b) touching the mask to the face, (c) allowing us to pulling back the elastic, and (d) fitting the elastic over the head.

It sounds easy, but each step may require several trials, and it’s important not to move ahead too fast. As we continue to celebrate this year’s Autism Awareness Month, let’s remember that we’re not the only ones who are adjusting to a new way of life.