"The call of speech therapists against the return of the mask to primary school"

In this month of November 2021, we, speech therapists of the National Collective of Speech-Language Pathologists of France, are once again worried about the return of the wearing of masks among primary school children. Yet as Christèle Gras-Le Guen, Professor of Pediatrics at the University Hospital of Nantes and president of the French Pediatric Society proclaims: "

' [1].

We, language and communication therapists, believe that the benefit / risk balance is not in favor of wearing a mask, which is not trivial in children.

Indeed, it has a significant impact on language learning, reading, the construction of emotions, children's behavior but also sight or the development of oro-myo-facial functions.

The impact of the mask on the intelligibility of speech is not negligible, especially since the child does not always know the terms used since he is in the process of learning.

National Collective of Speech-Language Pathologists of France

The multisensory presentation of information allows better identification of what is said and better retention [2]. The fact of not seeing the shape of the mouth has the consequence of breaking the teacher / pupil self-corrective feedback and increasing the difficulties of setting up the rules of phoneme-grapheme correspondences, with an increased risk of confusion. sounds.

In CP / CE1, when starting to read, the teacher has no visual feedback on the mouth of the child who is reading syllables or little words and it will be difficult for him to remember. notice that he did say "ba" and not "da" for example and correct it. Grapho-phonemic memorization is done thanks to this learning which is at the same time visual (shape of the mouth / shape of the letter), auditory (noise of the letter) and kinesthetic (bodily felt during the pronunciation of the phoneme, bodily sensation truncated because of the mask covering the mouth).

Indeed, certain sounds are extremely close, they have only one point of articulation which separates them, for example the [b] and the [d] have the disadvantage of being close visually, it is the same inverted drawing and audibly, the [b] is done with the help of closed lips, the [d] with the teeth and lips slightly open. We therefore have an increased risk of delay for children with or without a specific learning disability. In 2021, a study showed that children with fragile phonological awareness were helped by lip reading. As lip reading disappears under the mask, the performance gap between the strong and the weak has increased [3].

Read also Covid-19: a teacher suspended for refusing to wear the mask, which she considers "incompatible with learning"

In addition, since the mask induces a loss of 5 to 10 db in the sound level of the voice [4], the impact of the mask on speech intelligibility [5] is not negligible, especially as the child does not always know the terms used since he is in the middle of learning.

He must therefore support a greater listening and attention effort.

Intelligibility is not the only parameter to take into account in understanding oral language, there is also the psychic state of the interlocutors. To learn, you have to have a brain "available for". We know that depression, for example, impacts several cognitive functions including attention, memory and executive functions (planning, mental flexibility) [6] [7].

While the school should be a safe place, the presence of the permanent mask is a reminder of the current anxiety-provoking situation of Covid which can contribute to: an increase in agitation; decreased motivation and concentration; increased sadness and anxiety, negatively correlated with learning; the increase in school dropouts going as far as school phobia; the increase in somato-psychic disorders: sleep disorders, eating disorders, transit disorders, bedwetting, headaches; and the increase in suicide attempts among children [8]. The confinement has widened educational inequalities across Europe. The mask at school therefore comes to rest on fragile ground and constantly reminds thechild the pandemic situation and underlying anxiety.

Wearing a mask can also impact the physical health and physiological development of children.

National Collective of Speech-Language Pathologists of France

In addition, at an age when cerebral plasticity is conducive to learning, wearing a mask while hiding part of the face prevents the child from developing links between facial expressions and emotions. This leads to a sudden decrease in the ability to recognize and classify the emotions of their peers, a decrease in the ability to decode non-verbal language (the message is less explicit); with additional difficulty for the teacher to perceive and interpret children's emotions and consequently to adjust his speech. Social skills are then reduced and interactions between children hampered, leading to more and more frequent problems of socio-emotional adjustments and an increased risk of developing behavioral disorders.

Wearing a mask can also impact the physical health and physiological development of children.

This is because it makes it difficult to wear glasses because of the fogging, which frequently leads to the wearing of glasses being abandoned, or even a deterioration of existing visual disturbances.

The mask also implies a reduction in the visual field, which is a real problem for children who constantly go back and forth between the horizontal plane where their notebook is located and the vertical plane of the painting.

Read alsoMasks for children: advantages and disadvantages

The somatic consequences of wearing a mask (skin irritation, oral thrush, respiratory discomfort, headaches [9], simple eye irritation which can go as far as inflammation / infection [10]) lead to greater distractibility and fatigability which decreases concentration.

Regarding physiological areas, a tendency to mouth breathing was also noticed when wearing the mask.

Oral breathing poses many problems [11]: abolition of the role of the nose in filtering viruses and bacteria, dry mouth, halitosis and caries, disharmony in the development of the jaw and the face.

The role of the nose is to retain thanks to its "hairs" a large part of the harmful particles contained in the air: dust, viruses, bacteria….

The fact that the mouth is open bypasses the preventive filtering role of the nose.

In this context where the child is little affected by Covid disease, it seems important to us to put the best interests of children back at the center of adults' concerns.

National Collective of Speech-Language Pathologists of France

Under the mask, the open mouth dries up, saliva plays its protective role less well, bacteria proliferate causing bad odors (halitosis) and cavities if oral hygiene is not optimal. Oral breathing has an impact on the growth of the facial sphere. When breathing is nasal (normal), the tongue models the upper arch taking up a large space. This is what allows harmonious growth of the face (wide palate, aligned teeth). When breathing is oral, the tongue is positioned on the floor of the mouth, it does not play its role of expanding the upper arch. The palate remains narrow, the teeth advance, the face grows in length, the bones and muscles of the face develop in a disharmonious manner [12].Dry mouth causes dehydration of the vocal cords causing hemmages (clearing of the throat) and tightening tensions of the muscles of the speech organs which, in the long term, can create nodules, even polyps and consequently dysphonia. The disorganization of the respiratory mechanism can lead to shortness of breath and vocal forcings [13], also leading to dysphonia.

All these inconveniences make learning at school difficult.

They cause cognitive, auditory, visual, vocal fatigue, etc.

;

inducing a drop in concentration, but also a drop in oral participation and social interactions, because the latter become more costly in terms of effort.

In this context where the child is little affected by the Covid disease, it seems important to us to put the best interests of the children back at the center of the concerns of adults and to let them evolve in an environment without masks in order to allow them to grow up in a context that respects their needs.

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Signatories:

Sophie ADLER, Speech therapist, 74520 VALLEIRY

Marielle AVRILLON, Speech therapist, 34500 BEZIERS

Virginie BAQUERRE, Speech therapist, 91410 DOURDAN

Sophie BEZERT, Speech therapist, 84200 CARPENTRAS

Nathalie BOYAVAL, Speech therapist, 31600 SEYSSES

Brigitte CANAAN, Speech therapist, 04700 LA BRILLANNE

Sylvia-Anna CAZABAT, Speech therapist, 31300 TOULOUSE

Véronique CHAVIN, Speech therapist, 71330 LE PLANOIS

Anne-Claire DANEN, Speech therapist, 37100 TOURS

Delphine DELACOUR, Speech therapist, 84210 PERNES-LES-FONTAINES

Céline DEPINOIS, Certified speech therapist, 85200 FONTENAY-LE-COMTE

Violaine DUMOULIN, Speech therapist, 71850 CHARNAY-LES-MACON

Laurence DUTEY-HARISPE, Speech therapist, 37300 JOUE LES TOURS

Céline DURY, Speech therapist, 14100 LISIEUX

Noémie FLOTTES, Speech therapist, 37100 TOURS

Anne GAUQUELIN, Speech therapist, 97351 MATOURY

Aline GELMAN, Speech therapist, 83840 TRIGANCE

Brigitte GEVAUDAN, Speech therapist, 94800 VILLEJUIF

Nathalie GUAL HANCALI, Speech therapist, 32120 MAUVEZIN

Pascale GUILBERT, Speech therapist, 14430 DOZULE

Marie-Clotilde HEMERY-LEGRAIN, Speech therapist, 02000 CHAMBRY

Karine HOURCADE, Speech therapist, 84660 MAUBEC

Marina JAMIN, Speech therapist, 38450 VIF

Benjamin LEROY, Speech therapist, 57730 FOLSCHVILLER

Arzhelenn LIGAON, Speech therapist, 72000 LE MANS

Anne MOURIES, Speech therapist, 84360 LAURIS

Armelle NOËL, Speech therapist, 21000 DIJON

Maryline PLANCHER, Speech therapist, 17450 SAINT-LAURENT-DE-LA-PREE

Marie-Laure PORTELLO, Speech therapist, 64270 LAHONTAN

Laurence PRUNEL, Speech therapist, 64990 MOUGUERRE

Pascale RENAUD, Speech therapist, 50170 PONTORSON

Claire SAINT-LOUBERT, Speech therapist 72340 LA CHARTRE SUR LE LOIR

Hélène SUAUD, Speech therapist, 72000 LE MANS

Clémentine TEZZON, Speech therapist, 77000 MELUN

Catherine TRANNOY, Speech therapist, 84120 LA BASTIDONNE

Marie-Clotilde VUATRIN, Speech therapist, 78530 BUC

[1] https://www.ouest-france.fr/sante/virus/coronavirus/retour-du-masque-al-ecole-ca-na-pas-de-sens-juge-la-societe-francaise-de -pediatrie-80aaf1c6-3cb0-11ec-b2dd-875829662230

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967384/

[3] https://www.cairn.info/revue-l-annee-psychologique-2021-2-page-3.htm

[4] https://www.mgen.fr/fileadmin/user_upload/Livret_Voix_Masque.pdf

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7945988/

[6] https://www.edimark.fr/Front/frontpost/getfiles/15125.pdf

[7] https://jamanetwork.com/journals/jamapsychiatry/article-abstract/492795

[8] https://www.mediscoop.net/neurologie/index.php?pageID=b645dfcec10643b62270147dd0aad9e1&id_newsletter=15651&liste=0&site_origin=revue_mediscoop&nuid=77ec95e6162a5281d06f2bace=newsletter&id_newsletter=15651&liste=0&site_origine=revue_mediscoop&nuid=77ec95e6162a5281d06f2bace=newsletter=newsletter=15651

[9] https://link.springer.com/article/10.1007/s00112-021-01133-9

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362770/

[11] https://www.allodocteurs.fr/maladies-orl-bouche-ou-nez-quelle-est-la-meilleure-facon-de-respirer-19633.html

[12] https://pubmed.ncbi.nlm.nih.gov/20129889/

[13] http://chinois.discipline.ac-lille.fr/quoi-de-neuf/revue-de-presse/2020-11-mgen_livret_voixmasque_novembre2020-1