Nationwide COVID-19 survey of Italian parents reveals useful information on attitudes to school attendance, medical support, vaccines and drug trials.

Children have tended to have milder symptoms during the COVID‐19 pandemic than adults, and multisystem inflammatory syndrome has been a rare complication. However, restrictions implemented to reduce transmission have directly affected children, as most countries closed schools during the first wave, despite a lack of strong evidence. Europe is now facing a rising of new cases, and this will be a challenge for health systems as temperatures drop and influenza and bronchiolitis rise. As schools started opening for the autumn term, a comprehensive approach that aims to reinforce preventive measures and educate patents will be very important if we are to manage this situation effectively.

This study aimed to assess Italian parents' views on how the COVID‐19 pandemic will affect key issues over the autumn and winter, including school attendance, vaccination and drug strategies and the use of telemedicine.

We carried out a cross‐sectional survey (Appendix S1). Briefly, parents with at least one school‐age child, including nursery school children under the age of one year, were recruited on Facebook groups for families and healthcare workers. They completed an anonymous Internet‐based SurveyMonkey questionnaire. The data collection took place from 10 July to 10 August and contained 31 questions in Italian and English that were pilot tested with a convenience sample of 20 parents working at the Fondazione Policlinico Universitario A. Gemelli in Rome, Italy.

All the variables have been summarised as frequencies and percentages. Ordered logistic regression models were created to understand the association between the parents' sociodemographic characteristics, attitudes and beliefs and their plans for their child's school attendance, COVID‐19 vaccine and paediatric drug trials and the use of telemedicine for consultations.

The survey was completed by 1812 families from all 20 Italian regions. The majority were native‐born Italians (97.1 of mothers and 97.4% of fathers) and 536 (29.6%) of the families had at least one healthcare worker.

Attitudes and beliefs about the first wave of the pandemic, and about children returning to school, vaccinations and a potential second wave, are summarised in Table S1 and Table S2, respectively. Key findings were that most families (97.3%) felt the COVID‐19 pandemic was a serious health problem, 70.9% felt that the preventive measures were necessary and 65.9% supported the Italian lockdown.

With regard to healthcare services during lockdown, 46.4% experienced at least some problems organising a medical examination. Many families (56.0%) did not receive pre‐consultation advice from their primary care paediatricians about conditions that required emergency department evaluations (56.0%) or what danger signs and symptoms they should look out for if their child had a fever (54.4%).

Although most families were worried about a possible second wave (92.2%), the majority supported schools re‐opening (74.2%). Fundamental changes that were supported included reduced numbers of students (70.1%), social distancing within classes (45.3%) and masks (27.2%). Most parents were willing to let their child have compulsory (98.1%) or recommended (91.1%) COVID‐19 vaccinations and flu (71.3%) vaccinations, but not to take part in a COVID‐19 vaccine (78.2%) or treatment trial (79.4%). The majority (80.0%) believed that they would encounter problems securing routine clinical appointments for their children during the second wave and (87.2%) would try telemedicine services.

Results from the ordered logistic regression models are shown in Table S3.

Most parents agreed on the Government's preventive measures, but wanted schools to be differently organised when they reopened. Importantly, the children of non‐healthcare workers were less likely to vaccinate their child against COVID‐19 if it was not compulsory and less likely to let their children take part in clinical trials for new COVID‐19 drugs. In addition, most parents did not receive any advice from primary care paediatricians on how to monitor a febrile child and the proper use of the emergency department. Most supported the use of telemedicine.

Our study had some limitations. The parents' age and family composition were not recorded and the voluntary nature of the study led to poor representativeness of the sample, but this was balanced by participation from all 20 Italian regions. To the best of our knowledge, this was the largest family survey to date to explore parents' perspectives about the COVID‐19 pandemic and the consequences for their children. A previous study from the United States mainly focused on what influenced sending children back to school, but not topics such as immunisation and telemedicine.

We hope that this survey will add valuable new knowledge to the ongoing debate about the effects that the COVID‐19 pandemic is having on children and families, particularly parental views.

CONFLICT OF INTEREST

Nothing to declare.

Table S1‐S3

Click here for additional data file.