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Purpose We conducted a review and meta-analysis to establish the international pooled prevalence of psychotropic drugs in children and adolescents, and comment on recent trends. Methods Medline, Embase, and PsycINFO were searched for studies with annual prevalence estimates of attention deficit hyperactivity disorder (ADHD) medications, antidepressants, antipsychotics, sedative/hypnotics and anxiolytics in outpatient children and adolescents. Data were extracted regarding the representativeness, sampling frame, and the quality of reporting. Results A total of 59 studies reporting prevalence data for 23 countries were collected. Most studies were conducted in Europe (42) and were at high or moderate risk of bias (35). The global random-effect pooled prevalence was 15.3‰ (95% confidence interval [CI], 7.6–25.7‰) for ADHD medications, 6.4‰ (95%CI 4.3–8.7) for antidepressants, and 5.5‰ (95%CI 3.6–7.8) for antipsychotics. Heterogeneity was extremely high ( I 2  > 99%). Large increases were found in the prevalence of ADHD medications in most countries, particularly up until 2010. The antidepressants’ trend was U-shaped in most countries with the lowest prevalence in 2007–2009 and rise more recently. Large to weak increases in the prevalence of antipsychotics were seen until 2011, and contrasting data were found more recently. Data on anxiolytics and sedative/hypnotics were limited. Conclusions The study provides global estimates of paediatric psychotropic drug prevalence and its trends. Systematic monitoring is lacking in most countries, and very heterogeneous reporting is common across studies.

Background School closure created difficulties for parents, who were asked to care for their children and help them with schooling, while working at home. We aimed to explore the experiences in organising school for children at home and its implications on children’s psychological well-being and educational progress during the quarantine for the COVID-19 pandemic. Methods A nationwide online survey of mothers of primary and middle school students was conducted during the COVID-19 pandemic. Demographic data and information on distance learning organisation and children’s attitudes and behavioural changes were collected. Results 2149 mothers completed the survey, with a final sample of 1601 subjects. Large differences between primary and middle school emerged: lessons were less organised and routines were more instable for the youngest, who could not pay attention for more than 20 min (28.3%) and needed breaks every 10 min (21.6%), with lower quality of learning (40.6%), increased restlessness (69.1%), and aggressiveness (33.3%). A large use of screens was reported, with an abuse in screen time in 2%. Two thirds of mothers did not approve of distance learning (72.2%) because of their role in replacing teachers (77.8%), the effort required (66%), and the great commitment required (78.3%). Conclusions Distance learning increased educational deprivation and social inequalities, especially for the youngest children, who lost almost one year of school. The situation was even worse for children with disabilities, who were neglected by the institutions. This period should be considered as an opportunity to correct the weaknesses of our school system.

Background Quarantine as a preventive action to reduce people’s exposure to a contagious disease has substantial psychological impact. We aimed to collect information on psychologically distressing experiences of Italians living in quarantine during the COVID-19 pandemic. Methods From 6 to 20 April 2020 participants filled out an online questionnaire. Demographic and physical symptoms data from the prior 14 days of quarantine were collected. Psychological impact of quarantine was assessed by the COVID-19 Peritraumatic Distress Index (CPDI). Results In all, 20,158 participants completed the online survey. Of these, 11,910 (59.1%) were from Lombardy, the region with 37.7% of positive cases identified during the survey period. 30.1% of responders were male. About half (55.9%) of responders were 18–50 years old, 54.3% had a tertiary level of education, 69.5% were workers, 84.1% were living in houses with ≥3 rooms, and 13.7% were living alone. 9.7% had had contact with COVID-19 positive people. Of all responders, 9978 (48.6%) reported a psychological impact, 8897 (43.4%) of whom reported mild or moderate and 1081 (5.2%) severe psychological impact. The multivariate analysis, after adjustments, showed that an increasing CPDI score was associated with gender (female), first-second educational level, being unemployed, living in a ≤2 room house, having had new health problems during the previous 14 days, and not having been out of the house in the previous week. Concerning the type of psychological distress, 2003 responders (9.9%) reported moderate to severe depressive symptoms, 1131 (5.5%) moderate to severe anxiety symptoms, and 802 (3.9%) moderate to severe physical symptoms. A positive correlation was found between responder rate (per 10.000 residents) and positive COVID-19 cases (per 10.000 residents) by region (r s  = + 0.83, p =  < 0.0001), and between responder rate and region latitude (r s = + 0.91, p = < 0.0001), with a greater response rate in the north. Considering Lombardy Region responders, a negative correlation between CPDI score and distance from place of residence to the red zone (Nembro-Alzano) was found. Higher prevalence of psychological distress was found up to 25 km away from the red zone and, in particular, severe distress up to 15 km. Conclusions Policy makers and mental health professionals should be aware of quarantine’s adverse mental health consequences. Factors influencing the success of quarantine and infection control practices for both disease containment and community recovery should be identified and additional support to vulnerable persons at increased risk of adverse psychological and social consequences of quarantine should be guaranteed.

To estimate the prevalence of overweight at 36 months of age and that of persistent overweight in an Italian birth cohort and to identify factors related to an increased likelihood of having overweight. The Italian NASCITA birth cohort was analysed. Children were classified in the underweight, normal or overweight range at 12, 24 and 36 months of age according to the World Health Organization percentiles, and the prevalence of overweight (≥ 85th centile) was estimated. Persistent overweight was defined as having overweight in all three assessments. To test the association between the chance of having overweight, and parental and child characteristics, healthy newborns with appropriate for gestational age birth weight were selected, and univariate and multivariate analyses were performed. The prevalence of overweight was 22.7% at 12 months of age and 21.2% at 36 months (chi square-for-trend = 1.5 and p = 0.21). In all, 8.8% of the children had persistent overweight. Overweight at 12 months (RR: 3.28 and 95% CI: 2.69-4.00) and a big appetite (RR: 2.00 and 95% CI: 1.59-2.52) were the main factors associated with greater likelihood of overweight at 36 months, while excessive appetite and frequency of interaction with electronic devices were the main determinants of persistent overweight. The body mass index status at 12 months greatly influenced that at 36 months. The increased risk of persistent overweight in children interacting with electronic devices suggests that extreme caution in allowing preschool children to use smartphone or tablets should be adopted. Furthermore, nutritional education of the entire family is essential to appropriately guide children's appetite.

Background For Attention Deficit/Hyperactivity Disorder (ADHD) youth transitioning from child to adult services, protocols that guide the transition process are essential. While some guidelines are available, they do not always consider the effective workload and scarce resources. In Italy, very few guidelines are currently available, and they do not adhere to common standards, possibly leading to non-uniform use. Methods The present study analyzes 6 protocols collected from the 21 Italian services for ADHD patients that took part in the TransiDEA (Transitioning in Diabetes, Epilepsy, and ADHD patients) Project. The protocols’ content is described, and a comparison with the National Institute for Clinical Health and Excellence (NICE) guidelines is carried out to determine whether the eight NICE fundamental dimensions were present. Results In line with the NICE guidelines, the dimensions addresses in the 6 analyzed documents are: early transition planning (although with variability in age criteria) (6/6), individualized planning (5/6), and the evaluation of transfer needs (5/6). All protocols also foresee joint meetings between child and adult services. The need to include the families is considered by 4 out of 6 protocols, while monitoring (2/6), and training programs (1/6) are less encompassed. In general, a highly heterogeneous picture emerges in terms of quality and quantity of regulations provided. Conclusions While some solid points and core elements are in common with international guidelines, the content’s variability highlights the need to standardize practices. Finally, future protocols should adhere more to the patients’ needs and the resources available to clinicians.

Background The early identification of infants with a risk for neurodevelopmental disorders in the first few years of life is essential for better developmental outcomes. Screenings should be carried out by combining the family pediatricians’ and parents’ perspectives, the two fundamental sources of information on children’s health. The present study has three aims: (a) to test the feasibility of parent-report instruments to detect warning signs in their children’s development; (b) to ascertain whether there is an agreement between the family pediatricians’ (FP) clinical judgments of warning signs and the parental perceptions; (c) to determine whether there is a link between parents’ distress and child development. Methods Within the NASCITA birth cohort, in addition to the family pediatrician’s clinical evaluation with routine tools, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) was completed by parents to assess the child’s language, social skills, behavior, and sensory areas. Parents were also asked to complete the Parenting Stress Index, Short Form (PSI-SF) to verify the magnitude of stress in the parent-child system. Univariate and multivariate analyses were performed to evaluate the association between child and parental characteristics and the presence of warning signs. Results The follow-up assessment was completed for 435 infants: 69 (15.8%) presented warning signs: 43 in the pediatrician’s assessment and 36 in the M-CHAT-R (10 in both). A total of 16 children (14 with warning signs) received a diagnosis after a specialist evaluation. Being male (OR 2.46, 95%CI: 1.23–4.91) and having sleep disorders (OR 2.43, 95% CI 1.17–5.04) was associated with a greater likelihood of warning signs in the multivariate analysis, while reading aloud was a protective factor (not exposed versus exposed (OR = 3.14; 95% CI 1.60–6.17). For 73 children (18.4%), at least one parent tested positive for PSI-SF. An increased prevalence of parental distress was observed in children with warning signs (OR 2.36, 95% CI 1.27–4.37). Conclusions Integrating physician and parental perspectives during well-child visits and in clinical practice appears feasible and can improve the identification of children at risk of developmental disorders.

The use of medications during pregnancy is a common event worldwide. Monitoring medicine prescriptions in clinical practice is a necessary step in assessing the impact of therapeutic choices in pregnant women as well as the adherence to clinical guidelines. The aim of this study was to provide prevalence data on medication use before, during and after pregnancy in the Italian population. A retrospective prevalence study using administrative healthcare databases was conducted. A cohort of 449,012 pregnant women (15-49 years) residing in eight Italian regions (59% of national population), who delivered in 2016-2018, were enrolled. The prevalence of medication use was estimated as the proportion (%) of pregnant women with any prescription. About 73.1% of enrolled women received at least one drug prescription during pregnancy, 57.1% in pre-pregnancy and 59.3% in postpartum period. The prevalence of drug prescriptions increased with maternal age, especially during the 1st trimester of pregnancy. The most prescribed medicine was folic acid (34.6%), followed by progesterone (19%), both concentrated in 1st trimester of pregnancy (29.2% and 14.8%, respectively). Eight of the top 30 most prescribed medications were antibiotics, whose prevalence was higher during 2nd trimester of pregnancy in women ≥ 40 years (21.6%). An increase in prescriptions of anti-hypertensives, antidiabetics, thyroid hormone and heparin preparations was observed during pregnancy; on the contrary, a decrease was found for chronic therapies, such as anti-epileptics or lipid-modifying agents. This study represents the largest and most representative population-based study illustrating the medication prescription patterns before, during and after pregnancy in Italy. The observed prescriptive trends were comparable to those reported in other European countries. Given the limited information on medication use in Italian pregnant women, the performed analyses provide an updated overview of drug prescribing in this population, which can help to identify critical aspects in clinical practice and to improve the medical care of pregnant and childbearing women in Italy.

Background The aim of this study is to compare the 2021–2022 bronchiolitis season to the four previous years (2017–2018, 2018–2019, 2019–2020, 2020–2021) to see if there was an anticipation of the peak, an overall increase of cases, and an increased need of intensive care. Methods A retrospective single-centre study in the San Gerardo Hospital Fondazione MBBM, Monza, Italy was performed. Emergency Departments (ED) visits of patients aged < 18 years and ≤ 12 months were analyzed: the incidence of bronchiolitis on total assessments, the urgency level at triage and the hospitalization rate were compared. Data of children admitted to the Pediatric Department due to bronchiolitis were analyzed in terms of need of intensive care, respiratory support (type and duration), length of hospital stay, main etiological agent, patient characteristics. Results During 2020–2021 (first pandemic period) an important reduction in the ED attendance for bronchiolitis was observed, while in 2021–2022 there was an increase in incidence of bronchiolitis (13% of visits in infants < 1 year) and in the rate of urgent accesses (p = 0.0002), but hospitalization rates did not differ compared to previous years. Furthermore, an anticipated peak in November 2021 was observed. In the 2021–2022 cohort of admitted children to the Pediatric Department, a statistically significative increased need of intensive care unit was detected (Odds Ratio 3.1, 95% CI 1.4–6.8 after adjustment for severity and clinical characteristics). Instead, respiratory support (type and duration) and length of hospital stay did not differ. RSV was the main etiological agent and RSV-bronchiolitis determined a more severe infection (type and duration of breathing support, intensive care need and length of hospital stay). Conclusions During Sars-CoV-2 lockdowns (2020–2021), there was a dramatic decrease of bronchiolitis and others respiratory infections. In the following season, 2021–2022, an overall increase of cases with an anticipated peak was observed and data analysis confirmed that patients in 2021–2022 required more intensive care than children in the four previous seasons.

BackgroundPrevious research has assessed the impact of the COVID-19 pandemic on adolescent mental health (MH). How the pandemic changed healthcare resource utilisation for MH conditions was investigated less, however, in particular in Italy.MethodsData concerning outpatient visits in child and adolescent mental health services (CAMHSs), access to emergency departments (EDs), hospital admissions and drug prescriptions collected in administrative databases of the Lombardy Region, Italy, concerning adolescents 12–17 years old and occurring in the 2016–2021 period were analysed.Annual and monthly prevalence of healthcare (CAHMS/ED visits/hospital admissions) use for MH conditions and of psychotropic drug prescriptions were estimated. A negative binomial regression model was used to model the pre-pandemic monthly number of prevalent cases by gender. The total number of pandemic (1 March 2020 to 31 December 2021) cases predicted from the model was compared with the number of observed cases.ResultsThe overall annual rate of healthcare service utilisation slightly increased in the 2016–2019 period (from 63.8‰ to 67.8‰), decreased in 2020 (57.1‰) and returned to values similar to 2016 (64.9‰) the following year. A 2% relative increase was observed in girls, and a 10% decrease in boys, when comparing the prevalence in 2021 with that in 2019. Differences between genders were particularly evident for ED attendance, with an observed/predicted cases ratio in 2021 of 0.81 (95% CI 0.79 to 0.83) in boys, and 1.18 (95% CI 1.16 to 1.20) in girls, and for psychotropic drug prescriptions (0.83 (95% CI 0.82 to 0.84) and 1.24 (95% CI 1.23 to 1.25), respectively).ConclusionsThe current study confirms that the use of health services for MH conditions during the COVID-19 pandemic increased among adolescent girls but decreased among boys, and that gender differences emerged in the MH impact of the pandemic.

Background Young children’s healthy development depends on nurturing care, which ensures health, nutrition, responsive caregiving, safety and security, and early learning. Infancy and childhood are characterized by rapid growth and development, and these two factors contribute largely to determining health status and well-being across the lifespan. Identification of modifiable risk factors and prognostic factors during the critical periods of life will contribute to the development of effective prevention and intervention strategies. The NASCITA ( NAscere e creSCere in ITAlia ) study was created to evaluate physical, cognitive, and psychological development, health status and health resource utilization during the first six years of life in a cohort of newborns, and to evaluate potential associated factors. Methods NASCITA is an ongoing, dynamic, prospective, population-based birth cohort study of an expected number of more than 5000 newborns who will be recruited in 22 national geographic clusters starting in 2019. It was designed to follow children from birth to school entry age for a wide range of determinants, disorders, and diseases. Recruitment of the newborns (and their parents) will take place during the first routine well-child visit, which takes place at the office of the pediatrician assigned to them by the local health unit of residence, and which is scheduled for all newborns born in Italy within the first 45 days of their life. Data will be web-based and collected by the family pediatricians during each of the 7 standard well-child visits scheduled for all children during their first 6 years of life. Information on every contact with the enrolled children in addition to these prescheduled visits will be also recorded. Discussion The NASCITA cohort study provides a framework in which children are followed from birth to six-years of age. NASCITA will broaden our understanding of the contribution of early-life factors to infant and child health and development. NASCITA provides opportunities to initiate new studies, also experimental ones, in parts of the cohort, and will contribute relevant information on determinants and health outcomes to policy and decision makers. Cohort details can be found on https://coortenascita.marionegri.it . Trial registration Clinicaltrials.gov : NCT03894566 . Ethics committee approval : 6 February 2019, Verbale N 59.