This year, so much of our emotional energy has centered around keeping each other safe. Wearing masks in public and with those outside our household is an essential defense right now, and saves lives. But masks can also contribute to feelings of distance, and even emotional disconnection—and repairing the connection when we get home is essential for the health of both parents and babies.

We are born seeking emotional connection. We get that connection through the nurturing behaviors of our mother or other foundational relationship. Nurturing interaction makes us feel safe, seen, heard, fed, and held, and sets the stage for developmental changes in the first year of life: babies’ brains double in size, their gut linings grow and develop essential functions, and they explore the world through their five senses, developing social reflexes that lay the groundwork for future healthy relationships.

Emotional connection wires babies and parents for health and resilience. But when there’s emotional disconnect that goes unrepaired, it disrupts these essential processes.

When Babies Can’t See Faces, It Hurts Their Development in Two Key Ways:

At the Nurture Science Program, we’re partnering with Columbia University’s COMBO (Covid-19 Mother Baby Outcomes) Initiative, which has been studying the effects of the pandemic on mothers and babies since March of 2020. While the data are still preliminary, compared to pre-pandemic numbers, we’re seeing a decline of about 50% in emotional connection scores, even months after birth. This is a true crisis.

Why is this happening?

Babies can’t see much, but they can see faces. In fact, the distance a newborn can see is the distance to their parent’s face when they’re being nursed or held at breast level. Babies also can’t focus their attention on much in the beginning, but they have a special attention span for faces. From birth, they are capable of orienting to their mother’s voice and face, mirroring and mimicking her facial expressions, and matching her feeling state. This is how they build their emotional intelligence and their emotional connection.

It may be that masks fundamentally disrupt this process of face-to-face learning and growth. If your baby can’t see your changing facial expressions or your reactions to theirs, you can’t give each other those sensory-emotional inputs.

The second risk to babies routinely seeing masked faces is that it can trigger their stress response, which pumps the brakes on all that amazing development happening in their brain and body. “You’re just bathing that brain in stress hormones, like cortisol, which literally block the expansion of neurons,” says Dr. Dani Dumitriu, Director of Translational Research at the Nurture Science Program, and Chair of the COMBO Initiative

A well-studied phenomenon (the still-face paradigm, where parents maintain a blank, neutral expression), demonstrates that babies have extremely negative reactions to their parents not responding to them. “We’ve been doing [further] studies involving the still-face paradigm,” says NSP’s Director, Martha G. Welch MD, “where the mother and baby play for two minutes, then there are two minutes when the mother drops out of the interaction completely, and then two minutes of reunion. When the mother drops out, it’s extremely distressing to the baby. In the COMBO study, we’re doing this with mom adding a mask to her face instead of dropping out.”

“We’re seeing the exact same reaction when mom just adds a mask to her face, even though in this case, mom is still interacting with her baby!” says Dr. Dumitriu. “She’s still cooing and talking, her eyes are still visible, yet these babies get really distressed. We’re talking about all of these babies now seeing masks for the whole first year of their lives. From a public health perspective, this is of huge relevance because it doesn’t only involve children who are infected, or children born to mothers infected during pregnancy, but all children born and developing during this pandemic.”

Babies and parents need to be able to communicate on a two-way street. When babies try to interact with their parents and they get no response, they (correctly) interpret this as a threat. Their heart rate increases and their little body floods with big stress hormones. Without emotional reconnection, this stress state disrupts their physical development and their emotional connection—with their parents and with the rest of the world.

But curiously, we’ve actually seen a few instances of babies not reacting to their moms wearing a mask, and becoming agitated when moms take their masks off. These are extremely unusual reactions for a baby. What we’ve realized is that some moms are wearing masks all the time, even when it’s safe to take them off (such as at home, with no visitors).

These moms are afraid of putting their babies at risk, and that protective instinct is understandable. But what this translates to is babies thinking their mom’s face is the mask—no features, no expressions. From the baby’s perspective, when Mom takes her mask off, suddenly she’s not Mom. That is terrifying for the baby, and we don’t yet know what effects it will have on their long term physical, neurological, emotional, or behavioral development. It’s heartbreaking to see these mothers and babies so far removed from connection, and we worry about both of them.

While the desire to protect our babies is fundamental and essential, it’s important to know that evidence gathered over the past year is clear: the risk of passing COVID-19 from mother to baby is extremely low. Dr. Welch says, “Since the risk of passing COVID from mother to baby is so low, and the risks from emotional disruption due to masked contact are so high, it’s urgent that mothers spend as much unmasked face-to-face time with their babies as possible (in low-risk spaces).”

While this year has brought additional stressors into our relationships, disruptions have always been a part of life. During a time of long-standing disruptions, connection is even more important. As long as we know how to recover, we can support each other’s health and resilience. For a baby in this sensitive stage of exponential development, protecting and repairing deep connections can shape their future in a really impactful way.

So How Can We Help Babies Connect During the COVID Crisis?

While masks remain essential for saving lives right now, it’s so important to find safe opportunities to interact with your baby, face to (unmasked) face. There’s plenty we can do to counteract the limitations of mask-wearing and to support the beautiful babies coming into this new world:

  1. Wear your baby
    • When you leave the house with your baby, or are indoors with people outside of your pod, wear your baby in a wrap, sling, or carrier, with the baby facing toward you.
    • This positioning is good for your babies’ anatomy and lets them see your face when you’re able to safely take your mask off.
    • For both younger and older babies, connecting through as many senses as possible helps buffer the stress of seeing the mask instead of your face. Wearing your baby can involve:
      • sight (mutual gaze is associated with calming)
      • smell (which is closely tied to memory and emotion)
      • touch (which is warm, reassuring, and familiar)
      • hearing (the sound of your voice can calm them)
      • and taste (baby can taste your skin or even breastfeed while in the carrier)
    • Wearing your baby helps prevent a stress response in both of your bodies. Your baby can snuggle into your body, and you can regulate each other through continuous sensory and emotional contact.
  2. Keep breastfeeding
    • Breastfeeding or bottle-feeding are perfect times to have these face-to-face interactions. The baby’s at the right distance from your face to see you, and all 5 senses are engaged.
    • Breastfeeding releases oxytocin in both mom and baby, and babies get a delivery of oxytocin from breast milk as well. (Oxytocin is a hormone with many important functions, like quelling inflammation and building a strong mother-baby emotional connection.)
    • According to emerging research, breast milk also contains COVID-19 antibodies if mom has had the virus or the vaccine. Antibodies in breast milk are passed to babies, so breastfeeding may help keep baby safe from COVID (and other illnesses).
  3. Take your mask off around your baby as often as you safely can
    • Give your baby as much access to your face as possible, while still being safe. Spend time gazing into each other’s eyes.
    • If you’re outside and far away from other people, take your mask off.
    • As soon as you get home, take your mask off and spend lots of face-to-face time together. Even though your baby may not be talking yet, they are communicating, and you can have full emotional conversations with your facial expressions.
  4. When you get home, spend time doing skin-to-skin holding

It can be hard not to bring a sense of danger home with you when you’ve been in a risky environment. But we have to make sure we’re not adding risks to our home environment, and emotional disconnect is a real risk to our health. We have to remember what healthy interactions look like (and used to look like, before the pandemic), and then we have to find opportunities to do them together.

Between our ongoing studies of the virus and the increasing availability of vaccines, so much is changing right now. But it looks as though masks are going to stick around for quite a while.

In an ideal world, we would at least have access to effective clear masks. Then we’d be able to stay safe while still seeing and interacting with each other’s full range of facial expressions. Unfortunately, today’s clear masks fog up quickly and make it hard to breathe or be heard. Dr. Dumitriu remembers, “At the beginning of the pandemic, I tried to work with the engineering department at Columbia to see if there were any options out there. And it turned out that it was just a really difficult unsolved engineering problem.”

So while we wait for that technology to be developed and improved, it’s important to continue wearing the masks available to us. And then, to repair the disruptions caused by them when it’s safe to interact face-to-face without a barrier. 

This pandemic has baked separation into our daily lives. We aren’t looking at each other’s vibrant, expressive faces. We’re leaving our babies at home, when we may otherwise have taken them to the grocery store or the pharmacy. But repair is always possible after separation. Now and always, it’s our job and our joy to connect with the littlest members of our families.