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

Authors’ contributionsStudy design: Braga PP, Oliveira PP, Romano MCC. Data collection: Braga PP, Oliveira PP, Romano MCC, Souza MS. Data analysis: Braga PP, Oliveira PP, Romano MCC, Souza MS, Gesteira ECR. Manuscript writing: Braga PP, Oliveira PP, Romano MCC, Souza MS, Gesteira ECR. Manuscript revision: Braga PP, Oliveira PP, Romano MCC, Souza MS, Gesteira ECR, Rocha GM. Study supervision: Braga PP, Oliveira PP, Romano MCC.

Declaration The database that originated the article is available with the corresponding author.

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 essay¹⁵15. Simmerman JM, Suntarattiwong P, Levy J, Jarman RG, Kaewchana S, Gibbons RV, et al. Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza Other Respir Viruses. 2011;5:256-67. https://doi.org/10.1111/j.1750-2659.2011.00205.x https://doi.org/10.1111/j.1750-2659.2011...	1c	221 (<6 years) and 163 (7 to 11 years)	Thailand	Surgical	Influenza	2011
Observational¹⁶16. Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand hygiene, mask-wearing behaviors and its associated factors during the COVID-19 Epidemic: a cross-sectional study among primary school students in Wuhan, China. Int J Environ Res Public Health. 2020;17:2893. https://doi.org/10.3390/ijerph17082893 https://doi.org/10.3390/ijerph17082893...	4b	8,569 (6 to 13 years)	China	NI	COVID-19	2020
Observational¹⁷17. Allison MA, Guest-Warnick G, Nelson D, Pavia AT, Srivastava R, Gesteland PH, et al. Feasibility of elementary school children’s use of hand gel and facemasks during influenza season. Influenza Other Respir Viruses. 2010;4:223-9. https://doi.org/10.1111/j.1750-2659.2010.00142.x https://doi.org/10.1111/j.1750-2659.2010...	4b	503 (preschoolers and schoolchildren)	United States	NI	Influenza	2010
Randomized clinical essay¹⁸18. Suess T, Remschmidt C, Schink S, Luchtenberg M, Haas W, Krause G, et al. Facemasks and intensified hand hygiene in a German household trial during the 2009/2010 influenza A(H1N1) pandemic: adherence and tolerability in children and adults. Epidemiol Infect. 2011;139:1895-901. https://doi.org/10.1017/S0950268810003006 https://doi.org/10.1017/S095026881000300...	3c	39 (mean age of 7 to 9 years)	Germany	Surgical	Influenza	2011
Observational¹⁹19. Chen SC, Liao CM. Modelling control measures to reduce the impact of pandemic influenza among schoolchildren. Epidemiol Infect. 2008;136:1035-45. https://doi.org/10.1017/S0950268807009284 https://doi.org/10.1017/S095026880700928...	4b	494 students (6 to 12 years)	China	NI	Influenza	2008
Non-randomized clinical essay²⁰20. van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One. 2008;3:e2618. https://doi.org/10.1371/journal.pone.0002618 https://doi.org/10.1371/journal.pone.000...	2c	11 (5 to 11 years)	Netherlands	Surgical PFF2 Homemade	Influenza	2008
Observational²¹21. Uchida M, Kaneko M, Hidaka Y, Yamamoto H, Honda T, Takeuchi S, et al. Effectiveness of vaccination and wearing masks on seasonal influenza in Matsumoto City, Japan, in the 2014/2015 season: an observational study among all elementary schoolchildren. Prev Med Rep. 2016;5:86-91. https://doi.org/10.1016/j.pmedr.2016.12.002 https://doi.org/10.1016/j.pmedr.2016.12....	4b	10,524 (7 to 12 years)	Japan	NI	Influenza	2017
Randomized clinical essay²²22. Cowling BJ, Chan KH, Fang VJ, Cheng CK, Fung RO, Wai W, et al. Facemasks and hand hygiene to prevent influenza transmission in households: a randomized trial. Ann Intern Med. 2009;151:437-46. https://doi.org/10.7326/0003-4819-151-7-200910060-00142 https://doi.org/10.7326/0003-4819-151-7-...	2c	88 (<5 years) and 232 (6 to 15 years)	China	Surgical	Influenza	2009
Opinion article²³23. Esposito S, Principi N. To mask or no to mask children to overcome COVID-19. Eur J Pediatr. 2020;179:1267-70. https://doi.org/10.1007/s00431-020-03674-9 https://doi.org/10.1007/s00431-020-03674...	5b	NA	China	Surgical PFF2 Homemade	COVID-19	2020
Opinion article²⁴24. Esposito S, Principi N. Mask-wearing in pediatric age. Eur J Pediatr. 2020;179:1341-2. https://doi.org/10.1007/s00431-020-03725-1 https://doi.org/10.1007/s00431-020-03725...	5b	NA	Italy	NI	COVID-19	2020
Opinion article²⁵25. Del Valle SY, Tellier R, Settles GS, Tang JW. Can we reduce the spread of influenza in schools with face masks? Am J Infect Control. 2010;38:676-7. https://doi.org/10.1016/j.ajic.2010.03.012 https://doi.org/10.1016/j.ajic.2010.03.0...	5b	NA	Canada	NI	Influenza	2010
Opinion article²⁶26. Jin K, Min J, Jin X. Re: Esposito et al.: To mask or not to mask children to overcome COVID-19. Eur J Pediatr. 2020;179:1339-40. https://doi.org/10.1007/s00431-020-03720-6 https://doi.org/10.1007/s00431-020-03720...	5b	NA	Italy	Surgical PFF2	COVID-19	2020
Type of document		Institution	Country	Mask	Disease	Year
Recomendations⁸8. World Health Organization [homepage on the internet]. Advice on the use of masks for children in the community in the context of COVID-19. Annex to the Advice on the use of masks in the context of COVID-19. 21 August 2020. Geneva: WHO; 2020 [cited 2020 Nov 10]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC_Masks-Children-2020.1. https://www.who.int/publications/i/item/...	5b	OMS	Switzerland	Homemade PFF2	COVID-19	2020
Recomendations²⁷27. American Academy of Pediatrics [homepage on the internet]. COVID-19: caring for children and youth with special health care needs. Rochester, NY: AAP; 2020 [cited 2020 Sep 20]. Available from: https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/COVID-19-Youth-with-Special-Health-Care-Needs.aspx. https://www.healthychildren.org/English/...	5b	AAP	United States	Homemade PFF2	COVID-19	2020
Recomendations²⁸28. American Academy of Pediatrics [homepage on the internet]. Return to school during COVID-19. Rochester, NY: AAP; 2020.	5b	AAP	United States	Homemade	COVID-19	2020
Recomendations²⁹29. American Academy of Pediatrics [homepage on the internet]. Kids and masks: why cloth face coverings are needed in youth sports during COVID-19. Rochester, NY: AAP; 2020.	5b	AAP	United States	Homemade	COVID-19	2020
Recomendations²⁹29. American Academy of Pediatrics [homepage on the internet]. Kids and masks: why cloth face coverings are needed in youth sports during COVID-19. Rochester, NY: AAP; 2020.	5b	AAP	United States	Homemade PFF2	COVID-19	2020
Guide³⁰30. Centers for Disease Control and Prevention [homepage on the internet]. Operating schools during COVID-19: CDC’s considerations. Atlanta, GA: CDC; 2020 [cited 2020 Sep 20]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html https://www.cdc.gov/coronavirus/2019-nco...	5b	CDC	United States	Homemade	COVID-19	2020
Note of alert⁴4. Sociedade Brasileira de Pediatria [homepage on the internet]. Uso de máscaras faciais em tempo de COVID-19 por crianças e adolescentes: uma proposta inicial. Rio de Janeiro (RJ): SBP; 2020 [cited 2020 Jun 4]. Available from: https://www.sbp.com.br/imprensa/detalhe/nid/o-uso-de-mascaras-faciais-em-tempo-de-covid-19-por-criancas-e-adolescentes-uma-proposta-inicial/ https://www.sbp.com.br/imprensa/detalhe/...	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.¹⁵15. Simmerman JM, Suntarattiwong P, Levy J, Jarman RG, Kaewchana S, Gibbons RV, et al. Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza Other Respir Viruses. 2011;5:256-67. https://doi.org/10.1111/j.1750-2659.2011.00205.x https://doi.org/10.1111/j.1750-2659.2011...	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.¹⁶16. Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand hygiene, mask-wearing behaviors and its associated factors during the COVID-19 Epidemic: a cross-sectional study among primary school students in Wuhan, China. Int J Environ Res Public Health. 2020;17:2893. https://doi.org/10.3390/ijerph17082893 https://doi.org/10.3390/ijerph17082893...	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.¹⁷17. Allison MA, Guest-Warnick G, Nelson D, Pavia AT, Srivastava R, Gesteland PH, et al. Feasibility of elementary school children’s use of hand gel and facemasks during influenza season. Influenza Other Respir Viruses. 2010;4:223-9. https://doi.org/10.1111/j.1750-2659.2010.00142.x https://doi.org/10.1111/j.1750-2659.2010...	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.¹⁸18. Suess T, Remschmidt C, Schink S, Luchtenberg M, Haas W, Krause G, et al. Facemasks and intensified hand hygiene in a German household trial during the 2009/2010 influenza A(H1N1) pandemic: adherence and tolerability in children and adults. Epidemiol Infect. 2011;139:1895-901. https://doi.org/10.1017/S0950268810003006 https://doi.org/10.1017/S095026881000300...	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.¹⁹19. Chen SC, Liao CM. Modelling control measures to reduce the impact of pandemic influenza among schoolchildren. Epidemiol Infect. 2008;136:1035-45. https://doi.org/10.1017/S0950268807009284 https://doi.org/10.1017/S095026880700928...	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.²⁰20. van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One. 2008;3:e2618. https://doi.org/10.1371/journal.pone.0002618 https://doi.org/10.1371/journal.pone.000...	Community Environment
Mask use showed a significant protective association for influenza infection, varying between child age groups.²¹21. Uchida M, Kaneko M, Hidaka Y, Yamamoto H, Honda T, Takeuchi S, et al. Effectiveness of vaccination and wearing masks on seasonal influenza in Matsumoto City, Japan, in the 2014/2015 season: an observational study among all elementary schoolchildren. Prev Med Rep. 2016;5:86-91. https://doi.org/10.1016/j.pmedr.2016.12.002 https://doi.org/10.1016/j.pmedr.2016.12....	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.²²22. Cowling BJ, Chan KH, Fang VJ, Cheng CK, Fung RO, Wai W, et al. Facemasks and hand hygiene to prevent influenza transmission in households: a randomized trial. Ann Intern Med. 2009;151:437-46. https://doi.org/10.7326/0003-4819-151-7-200910060-00142 https://doi.org/10.7326/0003-4819-151-7-...	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.²³23. Esposito S, Principi N. To mask or no to mask children to overcome COVID-19. Eur J Pediatr. 2020;179:1267-70. https://doi.org/10.1007/s00431-020-03674-9 https://doi.org/10.1007/s00431-020-03674...	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.²⁴24. Esposito S, Principi N. Mask-wearing in pediatric age. Eur J Pediatr. 2020;179:1341-2. https://doi.org/10.1007/s00431-020-03725-1 https://doi.org/10.1007/s00431-020-03725...	Community environments
The use of face masks can be an effective, practical intervention and a non-pharmacological strategy to reduce the spread of influenza.²⁵25. Del Valle SY, Tellier R, Settles GS, Tang JW. Can we reduce the spread of influenza in schools with face masks? Am J Infect Control. 2010;38:676-7. https://doi.org/10.1016/j.ajic.2010.03.012 https://doi.org/10.1016/j.ajic.2010.03.0...	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.²⁶26. Jin K, Min J, Jin X. Re: Esposito et al.: To mask or not to mask children to overcome COVID-19. Eur J Pediatr. 2020;179:1339-40. https://doi.org/10.1007/s00431-020-03720-6 https://doi.org/10.1007/s00431-020-03720...	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.⁸8. World Health Organization [homepage on the internet]. Advice on the use of masks for children in the community in the context of COVID-19. Annex to the Advice on the use of masks in the context of COVID-19. 21 August 2020. Geneva: WHO; 2020 [cited 2020 Nov 10]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC_Masks-Children-2020.1. https://www.who.int/publications/i/item/...	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.²⁷27. American Academy of Pediatrics [homepage on the internet]. COVID-19: caring for children and youth with special health care needs. Rochester, NY: AAP; 2020 [cited 2020 Sep 20]. Available from: https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/COVID-19-Youth-with-Special-Health-Care-Needs.aspx. https://www.healthychildren.org/English/...	Community environments
Children over 2 years of age can wear a mask. Children with special conditions should receive extra attention.²⁸28. American Academy of Pediatrics [homepage on the internet]. Return to school during COVID-19. Rochester, NY: AAP; 2020.	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.²⁹29. American Academy of Pediatrics [homepage on the internet]. Kids and masks: why cloth face coverings are needed in youth sports during COVID-19. Rochester, NY: AAP; 2020.	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.⁵5. American Academy of Pediatrics. Cloth face coverings for children during COVID-19 [homepage on the internet]. Rochester, NY: AAP; 2020 [cited 2020 Jun 8]. Available from: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Cloth-Face-Coverings-for-Children-During-COVID-19.aspx. https://www.healthychildren.org/English/...	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.³⁰30. Centers for Disease Control and Prevention [homepage on the internet]. Operating schools during COVID-19: CDC’s considerations. Atlanta, GA: CDC; 2020 [cited 2020 Sep 20]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html https://www.cdc.gov/coronavirus/2019-nco...	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.⁴4. Sociedade Brasileira de Pediatria [homepage on the internet]. Uso de máscaras faciais em tempo de COVID-19 por crianças e adolescentes: uma proposta inicial. Rio de Janeiro (RJ): SBP; 2020 [cited 2020 Jun 4]. Available from: https://www.sbp.com.br/imprensa/detalhe/nid/o-uso-de-mascaras-faciais-em-tempo-de-covid-19-por-criancas-e-adolescentes-uma-proposta-inicial/ https://www.sbp.com.br/imprensa/detalhe/...	Community environments

[1] *Corresponding author. E-mail: patricia_braga@ufsj.edu.br (P. P. Braga).

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

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