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Telemedicine has entered the daily lives of doctors, although the digital skills of healthcare professionals still remain a goal to be achieved. For the purpose of a large-scale development of telemedicine, it is necessary to create trust in the services it can offer and to favor their acceptance by healthcare professionals and patients. In this context, information for the patient regarding the use of telemedicine, the benefits that can be derived from it, and the training of healthcare professionals and patients for the use of new technologies are fundamental aspects. This consensus document is a commentary that has the aim of defining the information on and training aspects of telemedicine for pediatric patients and their caregivers, as well as pediatricians and other health professionals who deal with minors. For the present and the future of digital healthcare, there is a need for a growth in the skills of professionals and a lifelong learning approach throughout the professional life. Therefore, information and training actions are important to guarantee the necessary professionalism and knowledge of the tools, as well as a good understanding of the interactive context in which they are used. Furthermore, medical skills can also be integrated with the skills of various professionals (engineers, physicists, statisticians, and mathematicians) to birth a new category of health professionals responsible for building new semiotics, identifying criteria for predictive models to be integrated into clinical practice, standardizing clinical and research databases, and defining the boundaries of social networks and new communication technologies within health services.

Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.

Technological innovation can contribute to a reorganization of healthcare, particularly by supporting the shift in the focus of care from the hospital to the territory, through innovative citizen-centered models, and facilitating access to services in the territory. Health and social care delivery modalities, enabled by telemedicine, are crucial in this regard. The objective of this Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, is to define a standard for its use at the territorial level in various declinations in the pediatric field; this paper also identifies priority areas for its application and the types of services that most require intervention and investment. The changes that are underway in digital transformation in all sectors are unstoppable, and for the digital transformation to take place in a productive sense, the contribution of not only all health professionals, but also of patients, is necessary. From this perspective, authors from different backgrounds were involved in the drafting of this Consensus and, in the future, other figures, primarily patients, are expected to be involved. In fact, this belongs to the vision of connected care, in which the citizen/patient actively participates in the treatment path so that they are assisted in a personalized, predictive and preventive way. The future scenario must be able to provide for the involvement of patients from the initial stages of planning any treatment path, even in the pediatric age, and increasing, where possible, the proximity of the health service to the families.

Background In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research.

Recurrent respiratory infections (RRIs) are a common clinical condition in children, in fact about 25% of children under 1 year and 6% of children during the first 6 years of life have RRIs. In most cases, infections occur with mild clinical manifestations and the frequency of episodes tends to decrease over time with a complete resolution by 12 years of age. However, RRIs significantly reduce child and family quality of life and lead to significant medical and social costs. Despite the importance of this condition, there is currently no agreed definition of the term RRIs in the literature, especially concerning the frequency and type of infectious episodes to be considered. The aim of this consensus document is to propose an updated definition and provide recommendations with the intent of guiding the physician in the complex process of diagnosis, management and prevention of RRIs. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-01150-0.

Background A national consensus document on inhaled corticosteroids (ICS) use in childhood, produced by the main Italian pediatric scientific societies, has been recently released. The aim of this study was to gather information on the current pediatricians’ ICS prescription habits in Italy for the management of the most common pediatric respiratory diseases, namely allergic rhinitis (AR), asthma, preschool wheezing and laryngitis. Methods From the 1st October 2018 to the 31st January 2019 a link to an online questionnaire was sent monthly through a newsletter to the members of the Italian Society of Pediatrics. The questionnaire included 18 items on ICS use in the most common pediatric respiratory diseases. Data collection and reporting was based on STROBE Statement Checklist for cross-sectional studies. Results One thousand-two questionnaires were returned from primary care pediatricians (39.1%), hospital pediatricians (38.7%), private practicers (16.4%), university pediatricians (3.1%) and Pediatrics residents (2.7%). We found a good adherence to the international guidelines on AR, with prevalent use of oral antihistamine (60.6%) in the secretive phenotype and nasal ICS in the obstructive phenotype (64.8%). In asthma exacerbations ICS are not used in 53.4% of cases, but they are used at high dose in 27.9% and at low dose in 18.7% of cases. In intermittent asthma, ICS are not chosen as a daily controller therapy in 54.1% of cases, while they are chosen as a low dose daily therapy in 44.5% of cases (high dose in 1.4%). In children with persistent asthma, ICS are chosen as a daily low dose therapy in 67.4% of cases and as a daily high dose therapy in 31%. In the management of preschool wheezing, when a long-term treatment is needed, ICS are chosen both alone and in association with antileukotrienes in 71.4% of cases. Children affected by recurrent asthma exacerbations and wheezing are closely followed up, in particular by their primary care pediatricians. The preference for certain molecules in the treatment of different respiratory diseases also emerged. Conclusions Pediatricians’ ICS prescription habits in Italy should be improved, especially in the management of asthma. Future surveys on a more numerous sample will be useful to analyze differences in prescription habits on the basis of pediatricians’ work settings and geographical distribution.

Background Fever phobia is still a major issue in paediatrics. We report knowledge of a sample of Italian paediatricians performed six years after the release of the Italian guidelines for the management of fever in children (IFG). Methods A questionnaire, developed following the IFG recommendations and previously administered to 300 paediatricians in 2012, was proposed to all the paediatricians attending the 2015 National Congress of Practice Paediatrics, held in Florence, Italy. Changes in answers over time were analyzed. Results 70.2% (562/800) paediatricians returned the questionnaire. The recommended site and device for body temperature measurement in children > 1 year was correctly chosen by 89.3% of participants (vs. 80.7% of 2012 participants; P

Complementary feeding practices are debated among pediatricians, primarily regarding whether nutritional needs or developmental readiness should be prioritized in recommendations for starting complementary feeding. The aim of the present study was to analyze the timing of the start of complementary feeding and the related motivations with an 8-item online survey administered to active members of the Italian Society of Primary Care Pediatricians. The participation rate was 43.3% (350 of 808), and 213 (60.9%) and 137 (39.1%) of the participants chose items related to developmental readiness and nutritional needs, respectively, as the criteria for starting complementary feeding. Approximately 74% of the participants reported that they recommended starting complementary feeding between 5 and 6 months of age, 17% recommended starting before 5 months, and 8% recommended starting after 6 months. Predefined schemes were proposed by 38% of the participants, and a responsive feeding modality was proposed by 13%, while the majority (49%) recommended both modalities depending on family characteristics. Regarding recommendations based on nutritional needs, 89% of pediatricians reported providing indications concerning the quantity of meat consumed during the first year of life, and 91% reported recommending introducing added salt only after 12 months of age. Compared with pediatricians who emphasized developmental readiness, those who prioritized nutritional needs suggested earlier complementary feeding start and a higher use of predefined schemes and were more likely to make recommendations regarding meat quantity and added salt (p 0.0001).Conclusions: Pediatricians who used a developmental readiness criterion for starting complementary feeding may less frequently provide nutritional advice to parents, even if a trend to harmonize the different positions regarding complementary feeding start time is emerging.What is Known:• Pediatricians make suggestions for introducing complementary feeding based on scientific evidence, local traditions, and personal beliefs.• Either infants' nutritional needs or their developmental readiness currently is used as determinant for the timing of complementary feeding.What is New:• More than 60% of Italian pediatricians consider developmental readiness a priority for introducing complementary feeding.• Pediatricians following the criterion of developmental readiness may less frequently give detailed nutritional advice.

Introduction and aim An early education to avoid an excessive protein and salt consumption is now considered crucial for obesity and hypertension prevention. Complementary feeding (CF) practices are debated among Pediatricians, first of all about which criterion should be considered between nutritional needs (NN) or developmental readiness (DR) for CF start. The aim of the present study was to analyze if timing of CF, modalities, and nutritional advices during the first year of life were related with the criterion considered for CF start among Pediatricians. Methods An online Survey was conducted in march 2018 among Family Pediatricians in Italy investigating the criterion chosen for CF start, timing, method of feeding and specific dietary practices. A Good Nutritional Practice (GNP) was acknowledged to those Pediatricians who declared to give advices for meat quantity and salt consumption during the first year of life respect to those who declared to demand any decision to parents. Results Participation rate was 43.3% (350 of 808) among active members of the Italian Society of Primary Care Pediatricians (SICuPP), 213 of them (60.9%) choose DR and 137 (39.1%) NN as CF starting criterion. About 75% declared to counsel CF start between 5 and 6 months of age, 17% before 5 months and 8% after 6 months. Concerning CF modalities, 38% suggested Traditional pureed foods spoon feeding following written recommendations (T), 13% suggested a sort of Baby-led weaning (B) while the majority (49%) declared to use both according with family characteristics. Concerning specific advices, 89% declared to suggest meat quantity during the first year of life and 91% suggest to introduce added salt only after 12 months of age. A GPN was followed by 85% of them. NN Pediatricians had a significantly earlier CF starting, an higher use of T modality, meat quantity and added salt advices, and followed more frequently a GNP respect to DR Pediatricians (all p Conclusions Our data suggest that the criterion most considered for CF start might be associated with timing, modality and nutritional advices during the first year of life. Pediatricians following the developmental readiness position for CF start could less frequently give to parents adequate nutritional advices for hypertension and obesity prevention. An effort aimed to integrate new CF practices with adequate nutritional recommendations should be strongly encouraged.

Introduction The Italian Guideline for the management of acute otitis media (AOM) in children has been recently updated. We conducted a cross-sectional survey to investigate the adherence of Italian primary care paediatricians to the guideline recommendations. Methods A questionnaire including 13 closed-ended questions was administered to the paediatricians participating in the 24th National Congress of Practical Pediatrics, held in Florence in November 2019. The answers were collected and analyzed. Results Eight hundred fifty-four out of 1000 questionnaires were collected (85.4%). Most of the participants declared that they did not remove the cerumen (63.9%). Pneumatic otoscope and tympanometry were routinely used by a minority of paediatricians (9.6% and 3.9%, respectively); all the participants declared to routinely prescribe oral analgesic drugs and 97.6% of them considered amoxicillin or amoxicillin/clavulanic acid as the first-choice antibiotic. In an uncomplicated unilateral AOM case, the preferred strategy was immediate antibiotic therapy in children under two years of age (83.1%) and watchful waiting in those >2 years (77.3%). Oral amoxicillin was most commonly prescribed at the 80–100 mg/kg/day (56.6%), in 3 daily doses (87.7%), while amoxicillin/clavulanic acid was equally prescribed at 80–100 or 50 mg/kg/day (47.1%–48.5%), mainly in 2 doses (58.6%). However, both drugs are recommended at a dosage of 80–90 mg/kg/day (calculated on amoxicillin), in 3 daily doses. Although the Guideline recommends ten days of therapy, both drugs were most commonly prescribed for 7–8 days (55.5%–57.7%). Pneumococcal and flu vaccines were recommended only by 41.6% and 31.6% of participants, respectively. Conclusions Our data suggest adequate adherence of the guideline recommendations considering the preferred antibiotic drug, pain management and the choice between immediate antibiotic therapy and watchful waiting. Conversely, targeted training programs are needed to improve adherence to recommendations on cerumen removal, use of pneumatic otoscopy, correct use of antibiotics in terms of optimal dosage, duration and number of daily administrations, and to implement proper AOM prevention strategies.

Background In recent years, new information has been acquired regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society, therefore, decided to issue an update to the Italian Pediatric Society guidelines published in 2010. Methods The search was conducted on Pubmed, and only those studies regarding the pediatric age alone, in English or Italian, published between January 1, 2010 and December 31, 2018, were included. Each study included in the review was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The quality of the systematic reviews was evaluated using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts. Results The importance of eliminating risk factors (passive smoking, environmental pollution, use of pacifier, obesity, limitation of day-care center attendance) and the promotion of breastfeeding and hygiene practices (nasal lavages) was confirmed. The importance of pneumococcal vaccination in the prevention of AOM was reiterated with regard to the prevention of both the first episode of AOM and recurrences. Grommets can be inserted in selected cases of recurrent AOM that did not respond to all other prevention strategies. Antibiotic prophylaxis is not recommended for the prevention of recurrent AOM, except in certain carefully selected cases. The use of complementary therapies, probiotics, xylitol and vitamin D is not recommended. Conclusions The prevention of episodes of AOM requires the elimination of risk factors and pneumococcal and influenza vaccination. The use of other products such as probiotics and vitamin D is not supported by adequate evidence.

Objective To review new scientific evidence to update the Italian guidelines for managing fever in children as drafted by the panel of the Italian Pediatric Society. Study design Relevant publications in English and Italian were identified through search of MEDLINE and the Cochrane Database of Systematic Reviews from May 2012 to November 2015. Results Previous recommendations are substantially reaffirmed. Antipyretics should be administered with the purpose to control the child's discomfort. Antipyretics should be administered orally; rectal administration is discouraged except in the setting of vomiting. Combined use of paracetamol and ibuprofen is discouraged, considering risk and benefit. Antipyretics are not recommended preemptively to reduce the incidence of fever and local reactions in children undergoing vaccination, or in attempt to prevent febrile convulsions in children. Ibuprofen and paracetamol are not contraindicated in children who are febrile with asthma, with the exception of known cases of paracetamol- or nonsteroidal anti-inflammatory drug-induced asthma. Conclusions Recent medical literature leads to reaffirmation of previous recommendations for use of antipyretics in children who are febrile.

BackgroundPediculosis capitis is a worldwide health problem. One of the most important factor in effective head lice eradication is to ensure that infestation is adequately recognized and treated. Our survey investigated the knowledge and practice among primary care Italian pediatricians regarding to the prevention and treatment of head lice.MethodsThe questionnaire was distributed to all the pediatricians registered at the Annual Congress of Practice in Pediatrics held in Florence, Italy, November 11–12, 2011. It includes 10 questions in a multiple choice format, and one answer for each question was provided. The questionnaire was conceived by pediatricians at the Infectious Disease Unit of the Department of Science for the Health of Woman and Child, University of Florence. Questions were designed according to the guidelines by the Italian Pediatric Society (SIP), and international guidelines, such as the Centers for Disease Control and Prevention (CDC), and the American Academy of Pediatrics (AAP).ResultsOverall, 364/600 pediatricians (60.7% of physicians registered to the Congress) returned the questionnaire. The majority of them (232/364; 63,7%) believe that parents consult their primary care pediatrician only after the failure of other “remedies”. Mostly, they prescribe Malathion (116/364, 31,8%) as first line treatment. Two-hundred-fourty-three (66.7%) of participants consider creams, foams and gels the most effective formulations. Two-hundred-sixty-two of pediatricians interviewed (72.0%) suggest to repeat the treatment after one week, 37/364 (10.2%) after two weeks. The majority of the pediatricians interviewed reported that recurrences occur in less than 30% of cases (279/364; 76,6%). In their own opinion, most of recurrences are the consequence of a reinfestation in the community (259/264; 77%). Three-hundred-thirty-four (91.7%) of them have never prescribed oral therapy for the treatment of head lice. Finally, 289/364 (79.4%) pediatricians believe that no product is effective for prevention.ConclusionsThis is the first study that investigates the clinical practice of family pediatricians about the management and treatment of head lice globally, the Italian pediatricians surveyed proved to be quite informed on the head lice management. However, even in a country where pediatric assistance is free for everybody, a considerable proportion of parents do not seek advice to their own family pediatrician. Therefore, educations of parents, other than continuous updating of pediatricians, may contribute to a better management of head lice in the community.

Background Guidelines for the management of fever in children have been recently published, however “fever phobia” is still spreading. To provide information which may sustain educational interventions tailored to our population we investigated the parental and medical knowledge and management of fever in preschool children. Methods A questionnaire was administered to a convenient sample of Italian parents and paediatricians. The questionnaire elicited information about definition and cause of fever, concerns about fever, method of temperature measurement, and treatment modalities. Results Overall, 388 parents and 480 paediatricians were interviewed. All the parents believed that fever could cause at least one harmful effect and 89.9% (n = 349) believed that, if left untreated, it can cause brain damage or seizures. Parents used multiple resources to obtain information about fever but 67.8% (n = 264) considered paediatricians as their primary resource. Several wrong behaviours were found in the same proportions among parents and paediatricians: 78.5% of paediatricians (n = 377) and 77.8% of parents (n = 302) used physical method to reduce fever (P = 0.867); 27.0% of paediatricians (n = 103) and 21.4% (n = 83) of parents declared to alternate ibuprofen and acetaminophen (P = 0.953). Differently, 73.1% (n = 351) of paediatricians preferred oral to rectal administration of antipyretics compared to 48.7% (n = 190) of parents (P Conclusions Paediatricians’ attitudes greatly influence the parental behaviours and beliefs. Implementation of educational programs regarding the management of the febrile child are needed in our setting.

Toddler's diarrhea may be an allergic disease and its recurrences can be avoided with education to "internal spontaneity" in feeding, i.e., by education to a limited and reproducible decrease in eating incentives at the onset of meals. Serum IgE was thus investigated in 16 experimental children in a random comparison with 16 controls, all aged 1 to 4 years, before and after seven months' dietary treatment. Compliance was measured with a seven-day written diary, while serum IgE was measured by PRIST, before and after dietary treatment. A 21% decrease in energy intake (p less than 0.05) and about five times increase in fruit and nonstarchy vegetable intake amount was seen in treated children. A decrease in serum IgE level of 13.9 +/- 43.5 U/ml was found in the "internal spontaneity" group, as opposed to an increase of 33.2 +/- 50.5 U/ml in the control one (p less than 0.01). The differences between examinations were significantly correlated to the increase in NSV acceptance in all children plotted together (r = .51, p less than 0.005). The overall NSV effect on the changes of the 2 muscle areas, 2 symptoms, and 2 percent growth, 15 nutritional, 5 immune and 3 hepatic indices was significant with MANOVA (p less than 0.01). The education to "internal spontaneity" may be a useful tool for prevention of overeating, diarrhea recurrences and IgE increase in the second/third year of life.

Territorial primary pediatric care is provided by Family Pediatricians. According to the ACN, Family Pediatricians (PdF) may work individually, in a association or in a group (sharing the same site of the office). The new structure, in accordance with the "Balduzzi Law", instead will include two forms: The Functional Territorial Association (AFT), in which the PdF operate in their studies but are connected functionally, and the UCCP, which instead, should provide services by pediatricians, nurses and other specialists in one office. In a study conducted in Tuscany in 2010, Pediatricians resulted as being equally divided into three organizational modes. The presence of nursing personnel in the offices was almost exclusively limited to working groups. Conversely, office assistants (AdS) were present in all three categories. When the two figures worked together in the same office, the work was divided; sometimes, when there was only one type present, there was a tendency to assign one’s own work to the other person. It is therefore evident that in the prospective of radical change in regional pediatric care, the job description of the territorial pediatric nurse, what she should do in that particular job context, must be defined. Competences and a job description are the prerequisites to set a proper training process for this figure. A preventative approach to care represents one of the most important tasks of the family pediatrician. The implementation of routine health checkups (a series of regular assessments to obtain comprehensive health measures for each child) provided by the Childhood-Health project is the means for achieving this goal. The Nursing staff represents a valuable resource to assist family pediatricians in all of their activities. Nurses may do triage for accessing the study, run the self-help diagnostics (some quick tests in the office), offer vaccination counseling and perform vaccines, give advice on childcare, handle some pseudo-pathological situations and ease maternal anxiety. A document representing clear job guidelines, agreed upon by both doctors and nurses is necessary, also for legal purposes. In a time of reduced resources, there needs to be a certain degree of flexibility in the tasks assigned: obviously, for example, making appointments is a task that a nurse can do very well, but it is certainly not an "added value" for the structure in respect to the job of secretary.

Background Italian guidelines for the management of fever in children (IFG) have been published in 2009 and thereafter disseminated in all country. A survey was conducted before their publication and three years later to investigate their impact on knowledge and behaviors of paediatricians. Methods A questionnaire was administered to convenient samples of paediatricians in 2009 and in 2012, eliciting information about fever definition, methods of temperature measurement, and antipyretic use. Differences in responses between 2009 and 2012 and between paediatricians who were or were not aware of the IFG were evaluated. Results The responses rates were 74% (480/648) in 2009 and 69% (300/434) in 2012. In 2012 168/300 (56%) of participants were aware of the IFG. The proportion of paediatricians who correctly would never suggest the use of physical methods increased from 18.7% to 36.4% (P