Uso de máscaras faciais por crianças para prevenção de doenças transmissíveis: <i>scoping review</i>

Braga, Patrícia Pinto; Souza, Meriele Sabrina de; Oliveira, Patrícia Peres de; Romano, Márcia Christina Caetano; Rocha, Gustavo Machado; Gesteira, Elaine Cristina Rodrigues

doi:10.1590/1984-0462/2023/41/2021164

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Review Article • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2021164 linkcopiar

Uso de máscaras faciais por crianças para prevenção de doenças transmissíveis: scoping review

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo: Identificar e sintetizar evidências científicas sobre o uso de máscaras faciais de proteção por crianças, na comunidade e no domicílio, como forma de prevenção de doenças transmissíveis.

Fontes de dados: Revisão de escopo seguindo o método Joana Briggs Institute e o PRISMA-ScR. Realizou-se pesquisa em cinco bases de dados eletrônicas, na Biblioteca Cochrane e em sete sites de instituições governamentais e não governamentais. Os dados foram organizados em planilha e submetidos à análise narrativa.

Síntese dos dados: Inicialmente foram identificadas 658 produções, das quais 19 compuseram a amostra final. Estudos com melhores níveis de evidência são escassos. Os tipos de máscaras identificadas foram as profissionais (cirúrgicas e respiradores faciais com filtragem) e as não profissionais (caseiras). Os agentes transmissíveis estudados foram os vírus influenza e SARS-CoV-2, e os ambientes avaliados foram escolas, domicílios e espaços comunitários. Os principais desconfortos relatados foram calor, falta de ar, dor de cabeça e desajuste ao rosto. A indicação e a aceitabilidade mudam conforme faixa etária e condições clínicas. Não há consenso sobre a redução da transmissibilidade de infecções.

Conclusões: Crianças maiores de 5 anos podem se beneficiar com o uso correto de máscaras, desde que sejam supervisionadas e educadas para isso e que a máscara esteja bem ajustada ao rosto. Há melhores resultados quando seu uso está associado a outras medidas, como distanciamento físico, permanência em locais arejados e higiene frequente das mãos.

Palavras-chave:
Saúde da criança; Dispositivos de proteção respiratória; Transmissão de doença infecciosa

Database	Search strategy
PubMed/MEDLINE	Respiratory Tract Infections OR Communicable diseases OR Communicable diseases control OR Communicable diseases prevention OR Coronavirus Infections AND Masks AND child AND children NOT Health Personnel
LILACS	Doenças transmissíveis OR controle de doenças transmissíveis OR infecções por coronavirus OR doenças respiratórias AND máscaras OR equipamento de proteção individual OR dispositivos de proteção respiratória AND criança OR pré-escolar.
Scopus	Mask AND Children OR Child AND Communicable Diseases
Cochrane Central	Mask AND Children OR Child AND Communicable Diseases NOT Health Personnel
Web of Science	Mask AND Children AND Communicable Diseases NOT Health Personnel
CINAHL	Mask AND Children AND Communicable Diseases NOT Health Personnel
SBP; Anvisa; SPP	Máscaras
CDC	Facemasks; Cloth face coverings; child
EAP AAP	Mask; Facemasks
WHO	Use of masks for children

Study design	LE	Sample	Country	Type of mask	Communicable disease	Year
Randomized clinical essay¹⁵	1c	221 (<6 years) and 163 (7 to 11 years)	Thailand	Surgical	Influenza	2011
Observational¹⁶	4b	8,569 (6 to 13 years)	China	NI	COVID-19	2020
Observational¹⁷	4b	503 (preschoolers and schoolchildren)	United States	NI	Influenza	2010
Randomized clinical essay¹⁸	3c	39 (mean age of 7 to 9 years)	Germany	Surgical	Influenza	2011
Observational¹⁹	4b	494 students (6 to 12 years)	China	NI	Influenza	2008
Non-randomized clinical essay²⁰	2c	11 (5 to 11 years)	Netherlands	Surgical PFF2 Homemade	Influenza	2008
Observational²¹	4b	10,524 (7 to 12 years)	Japan	NI	Influenza	2017
Randomized clinical essay²²	2c	88 (<5 years) and 232 (6 to 15 years)	China	Surgical	Influenza	2009
Opinion article²³	5b	NA	China	Surgical PFF2 Homemade	COVID-19	2020
Opinion article²⁴	5b	NA	Italy	NI	COVID-19	2020
Opinion article²⁵	5b	NA	Canada	NI	Influenza	2010
Opinion article²⁶	5b	NA	Italy	Surgical PFF2	COVID-19	2020
Type of document		Institution	Country	Mask	Disease	Year
Recomendations⁸	5b	OMS	Switzerland	Homemade PFF2	COVID-19	2020
Recomendations²⁷	5b	AAP	United States	Homemade PFF2	COVID-19	2020
Recomendations²⁸	5b	AAP	United States	Homemade	COVID-19	2020
Recomendations²⁹	5b	AAP	United States	Homemade	COVID-19	2020
Recomendations²⁹	5b	AAP	United States	Homemade PFF2	COVID-19	2020
Guide³⁰	5b	CDC	United States	Homemade	COVID-19	2020
Note of alert⁴	5b	SBP	Brazil	Homemade PFF2	COVID-19	2020

Main results (scientific articles)	Context
Influenza transmission was not reduced by wearing a face mask and washing hands.¹⁵	Household
32.47% of children wore properly fitted masks, 42.42% had difficult access to children’s masks. The higher the mother’s education, the better the child’s behavior wearing them.¹⁶	Community environments
The regular use of the mask by children was 50%, it reduced over the days, caused distraction and physical discomfort, made communication between students and teachers difficult, and it was difficult to adjust to the face.¹⁷	School
There was no significant difference in adherence and in the use of masks by children and adults. Most did not report problems with use, but there were discomforts. Mask use was influenced more by intervention than by the participants’ perception of its importance.¹⁸	Household
The use of a mask was not enough to contain the potential for the spread of influenza. However, a reduction in the number of infections was identified when prevention measures (vaccination, use of mask, and well-ventilated environment) were associated.¹⁹	School
All types of masks provide protection by reducing particulate exposure during activities. Protection of children was lower than that of adults. PFF2 masks offered ten times greater protection than homemade masks and six times greater protection than surgical ones.²⁰	Community Environment
Mask use showed a significant protective association for influenza infection, varying between child age groups.²¹	Everyday
With handwashing and masking intervention, the risk of influenza virus infection was significantly higher for children aged 6 to 15 years and for household contacts with children who were the index case.²²	Household
Children over 2 years of age must wear a mask, adapted to the face, associated with other preventive measures. N95 masks should only be used by high-risk children. Parental guidance should be carried out.²³	Community environments
Children over 2 years of age must wear a mask fitted to the face. In preschoolers, mask use can only be achieved through thorough work by parents or guardians. N95 should only be used by high-risk children.²⁴	Community environments
The use of face masks can be an effective, practical intervention and a non-pharmacological strategy to reduce the spread of influenza.²⁵	School
Children over 2 years of age must wear a mask in crowded environments. Parents or guardians must educate children on correct handling. Do not use masks for the practice of physical activities. The first choice is the surgical mask; N95 only for high-risk children.²⁶	Community environments
Main results (documents)	Context
Children under 5 years of age should not wear a mask. Between 6 and 11 years, use under adult supervision and in association with frequent hand washing, physical distancing, and staying in well-ventilated places.⁸	Community environments
The use of a mask by children with special needs should be carried out in environments where distancing is not possible and under professional guidance.²⁷	Community environments
Children over 2 years of age can wear a mask. Children with special conditions should receive extra attention.²⁸	School
During the practice of physical activities, children should wear the mask when distancing is not possible. Do not use it during aquatic activities and when there is a risk of accident with the mask.²⁹	Physical activity
Children over 2 years of age must wear a mask adapted to the face. Parents or guardians must educate children about its use. The use of protectors as a substitute for masks is not recommended.⁵	School
Children over 2 years of age should wear the mask when it is not possible to keep the distance. Children at risk should use the N95 model and family members, the surgical one.³⁰	Community environments
Children over 2 years of age must wear a mask and parents or guardians must educate children about its correct handling. For children with special conditions, the need must be assessed.⁴	Community environments

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Sociedade de Pediatria de São Paulo R. Maria Figueiredo, 595 - 10o andar, 04002-003 São Paulo - SP - Brasil, Tel./Fax: (11 55) 3284-0308; 3289-9809; 3284-0051 - São Paulo - SP - Brazil
E-mail: rpp@spsp.org.br

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[T1FN1] Source: prepared by the authors.

LILACS: Latin American and Caribbean Health Sciences Literature; CINAHL: Cumulative Index to Nursing and Allied Health Literature; SBP: Brazilian Society of Pediatrics; Anvisa: National Agency for Sanitary Surveillance; SPP: Portuguese Society of Pediatrics; CDC: Centers for Disease Control and Prevention; EAP: European Academy of Pediatrics; AAP: American Academy of Pediatrics; WHO: World Health Organization.