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Face masks’ lasting impact on children: a Hong Kong mother and son reveal his struggles, and experts

Updated: Apr 18, 2023

  • Face-mask wearing during the pandemic affected young children in various ways, from stunting speech to emotional development, according to a psychologist

  • A mother and son reveal the effects Covid measures had on him, and experts explain the age groups hardest hit and how to help kids adjust to post-pandemic life


Many Hong Kong children, and their teachers, still wear face masks. Young children’s speech development and social skills have suffered from remote lessons and teachers wearing masks and, now they are back in classrooms, some struggle to cope. An NGO is helping. Photo: JUST FEEL

Marco was an energetic and sociable three-year-old just starting kindergarten when the Covid-19 pandemic hit in 2020. He stayed at home with his one-year-old sister and mother, who had switched to working from home.


“In the beginning, I was happy staying at home. Then I felt sad because I couldn’t go outside, I couldn’t go to the park. And I was bored. I felt powerless. And I got scared when we went outside. I didn’t want people to look at me,” says Marco, who is now six.

One year into the pandemic, Marco’s mother, Chloe, noticed that her son’s Chinese language development was poor and took him to see a speech therapist. Three years on and he is still seeing the therapist. (To protect their privacy, Chloe chose not to provide their surname.)


“If the therapist wasn’t wearing a mask, he would have progressed much faster,” Chloe says.


That’s right – the therapist wore a mask through the pandemic and even now, after the mask mandate has ended, she continues to wear one, ostensibly to protect her students.

“When they developed the transparent face masks, she wore one, but it fogged up and Marco felt scared when he saw her mouth and asked her to change to the standard mask,” Chloe says.


The effects are just now surfacing. The teachers don’t sound the same through masks. And it has affected [children’s] ability to read non-verbal cues.
Dr Melissa Giglio, clinical psychologist

Marco’s schooling switched to online during the pandemic. In the first year, the teacher did little more than take the attendance of 24 students in the 20-minute daily session.


By the second year, Chloe says the teacher was a little better trained in online teaching and there were two 20-minute classes with a 15-minute break between.


“The students had to show their homework on Zoom to the teacher. I don’t think there was much learning at all, and the teaching responsibility sat on the parents. It was a huge pressure,” she says.


The lack of a social life made him scared. I tried to not go out at the peak time because he would scream.
Parent Chloe on taking son Marco out during the pandemic

“The worst part was they had to stay at home every day. They never went to the park,” Chloe adds.


Marco became anxious about going outside.


He wasn’t fearful of the virus. He was worried about meeting other people. Chloe checked to make sure there was no one in the lift lobby before they ventured out.


“The kids saw only me every day, and the lack of a social life made him scared. I tried to not go out at the peak time because he would scream. He didn’t know how to express the feeling that he was scared,” she says.


When Marco returned to in-person school, his teacher wore a face mask and used a microphone so that students could hear her.


“My classmates shouted because they were wearing a face mask. I didn’t like it when it was so noisy and everyone was shouting,” Marco says.


A teacher and student use a microphone. When Marco returned to the classroom, his teacher wore a face mask and used a microphone so that students could hear. Photo: JUST FEEL

We are only now seeing the impact on children of Hong Kong’s long mask mandate.


Dr Melissa Giglio, a clinical psychologist and director of the child development team at Central Health Medical Practice in Hong Kong, says that almost three years of continuous face covering has affected multiple areas of children’s development.


These include speech, attention and motor skills, and social and emotional development. She also says vision issues have arisen because children have spent so much time looking at screens.


“The effects are just now surfacing. There are speech issues in terms of articulation and how to read and understand phonics. The teachers don’t sound the same through masks. And it has affected their ability to read non-verbal cues,” Giglio says.


She adds that the way forward is not to focus exclusively on academics to meet the demands of the curriculum, but to consider the whole child.


It is important to prioritise play, movement and exercise because if a child doesn’t develop core muscle strength, they won’t be able to sit and focus at a desk. And if they don’t learn to handle their emotions, there will be issues further down the line.


“Without social development, you may have a child who is very good academically, but they don’t develop a peer group who they can rely on.


“Peers are important for development during adolescence; without peers who they relate to and can go to, it can leave them lonely and depressed,” she says.


If the kid is silent all the time and wearing a mask and not able to connect with others, they may be experiencing depression.
Raymond Yang, of emotional education NGO JUST FEEL

Among the hardest hit were very young children – those who are now four to seven years old. They missed out on nursery school, playground time and play dates – all situations where social and emotional development and fine motor skills develop naturally.


Giglio says middle school students – 11- to 14-year-olds – are also suffering.


“They missed a lot of older primary school, where they would have developed executive functioning and social relationships, and are now in early secondary school and struggling because they don’t have those skills,” she says.


Executive function skills underlie the ability to plan and meet goals, have self-control, follow directions and stay focused despite distractions, among other things.


Marco took some time to adjust to in-person school. The first challenge was learning the names of his 23 classmates and then the novelty of eating lunch at school, which he found scary at first.


“When they said we can take off our mask, I felt a bit terrified. But now I am happy. Nineteen [students] are not wearing a mask and four of them are still wearing a mask,” Marco says.


Raymond Yang, co-founder and executive director of Just Feel, a Hong Kong NGO that is bringing emotional education back into classrooms, says while many children are happy to be mask-free, some still wear them.


Raymond Yang, co-founder and executive director of JUST FEEL, a Hong Kong NGO whose mission is to introduce emotional education into classrooms. Photo: JUST FEEL

“The masks give students a sense of security. When we are not ready to show ourselves, the mask can be a barrier,” Yang says.


He advises teachers and parents to let students decide for themselves when they are ready to take off their mask. To force a child to remove it is to ignore their feelings.


“Whether or not the kid is wearing a mask is a hint for us to know if anything is going wrong. If the kid is silent all the time and wearing a mask and not able to connect with others, they may be experiencing depression,” he says.


JUST FEEL’s Compassionate School Programme uses social emotional learning and compassionate communication to create holistic connections between students, parents and teachers.


One of the NGO’s programmes is the “Feelings Thermometer”. At the start of the school day, teachers invite students to indicate how they are feeling on the thermometer, which then leads to discussion.


“Some kids may say they are stressed wearing a mask so they take it off and others may say that taking off the masks makes them stressed.


“The key is that the teacher has a conversation starter and can better understand what is going on in the kids’ heart, instead of going straight into checking homework or administrative tasks,” Yang says.


As part of JUST FEEL’s Compassionate School Programme, students are invited to indicate how they are feeling using a “Feelings Thermometer”, which then leads to discussion. Photo: JUST FEEL

After several years of mask wearing, he sees children struggling to understand each other’s facial expressions, which is key for relationship building, and hopes the thermometer will encourage kids to openly express their feelings.


“Some schools use the thermometer in staff meetings so teachers can better connect with each other at the start of the meeting,” he says.


Chloe uses the thermometer with her two children at home and encourages a daily discussion about their feelings. The check-ins have brought them closer and are an opportunity to navigate the often-tricky post-pandemic world for kids.


“At primary school the boys might get a bit naughty and Marco doesn’t know how to respond when someone is not good to him, so he runs away. Luckily, he will tell me, and I create a social story for him to let him know how to respond in that situation,” Chloe says.


Giglio says at her practice she is seeing a lot of children who are struggling with discomfort in social situations and who find it difficult to share their ideas.


She also notes an increase in perfectionism, with cautious children being concerned about being wrong. She encourages parents to support their children to give things a go, and accept they often won’t get things right the first time.


“Help them grow in their bravery, push them to know they can do it. All challenges are learning opportunities. Even if you don’t get it right, that’s when you learn the most and that’s where resilience and the growth mindset comes in,” Giglio says.

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