SINGAPORE - Wearing a mask daily has become routine during the Covid-19 outbreak, and it is a practice expected to continue under the "new normal".
But parents and experts have raised concerns over the long-term effects of mask wearing for children.
A 2016 study by Frontiers in Psychology - a peer-reviewed, open-access academic journal - showed that facial expressions and visual cues are of great importance in that they allow children to share and identify emotions during social interactions.
Ms Aarti Mundae, director of Incontact Counselling and Training, said that wearing a mask could lead to developmental delays in communication matters just as children are learning to express themselves.
Said Ms Mundae: "Communication is deeply influenced by visual cues. It is only 38 per cent affected by vocal cues and surprisingly, seven per cent by verbal. This makes the need to express and see facial cues significant."
Verbal cues refer to words while vocal cues encompass tone of voice, volume and pitch.
"It could also cause delays in their development of social and emotional intelligence as they are unable to pick up the finer nuances that are critical to their comprehension of feelings," she added.
But pre-schools are finding ways to work around this.
MapleBear's chief executive Patricia Koh said that speech development is particularly crucial for those aged two to three years old.
"Teachers will pay more attention to those who are more quiet and who may need more help. For the especially young ones, teachers will wear shields instead of masks, to speak clearly so the children can see their lips," she said, adding that this is a priority while also maintaining good hygiene habits to keep the children safe.
Mr Ng Yi Xian, executive director of EtonHouse International Education Group, also said that many emotional needs can go unnoticed when children have their masks on.
Hence, teachers at EtonHouse pay extra attention to the non-verbal cues children give, including body language and gestures to convey a message or express an emotion, Mr Ng said.
Masks can also make it harder to understand speech, especially in the case of similar-sounding words and sounds.
"Masks also block visual cues, including facial expressions and lip positions of the teachers that help children understand speech," he added.
Teachers now use face masks that have a transparent portion over their mouth area at times such as when they are reading a book.
At PAP Community Foundation (PCF) Sparkletots centres, teachers are trained to rely on auditory feedback - listening to the sounds made by the child - instead of visual observation of the child's mouth, when it comes to young children with unclear speech.
Parents of these children are also encouraged to provide speech samples recorded at home for further assessment, a process that is not impeded due to mask-wearing, said Dr Honey Ng, PCF Sparkletots' deputy director of the inclusive education team.
In September, the legal minimum age for children to wear masks in Singapore was increased to six years old and above, up from two years old and above before.
The change came after the World Health Organisation and United Nations International Children's Emergency Fund issued an advisory that children aged five and under should not be required to wear masks.
An international and multi-disciplinary expert group had reviewed evidence on Covid-19 transmission in children and the use of masks by children. They also considered the children's psycho-social needs and developmental milestones when making their recommendations.
Both organisations also recommended that age-appropriate communication to improve understanding of the purpose of mask wearing be provided by parents, teachers and educators through role-modelling.
PCF's Dr Ng said that PCF Sparkletots centres "strive to achieve desired behaviours through fun and creative ways". For example, some older children were appointed "Stay Safe Heroes" to help champion good practices in the classroom.
Teachers also make use of educational resources such as posters, stickers, storybooks, activity sheets and card games to help children understand the importance of keeping their masks on and following the safety measures in place.
Mrs Koh added that her staff at MapleBear have been finding creative ways to help children understand why they have to don masks. "We knew it was going to be difficult. We presented it as a game and said 'We are going on a mission to fight Virus C!'.
"As a teacher, in a learning environment, anything can be introduced to children as long as it's fun, meaningful and presented within context. We don't force them to do things because it becomes authoritarian and that's not the approach to early childhood education."