What Italian Pediatricians Can Tell Us

“Our main task at the moment is supporting families,” wrote Dr. Zanetto. “Every day more and more parents are infected or have relatives infected.” The pediatricians reinforce the importance of the government recommendation about staying home, and direct parents toward correct and authoritative information about the epidemic, and away from what she called “fake and disturbing news crowding social media.”

My friend and colleague Dr. Stefania Manetti practices in Southern Italy as a family pediatrician, in a town not far from Naples, in a region of the country which has so far been relatively spared. The children she takes care of have been locked in at home for three weeks, with drones and the military deployed to make sure there are no gatherings.

People can go out for health care, but that is meant to be a last resort; like many pediatricians in the United States now, Dr. Manetti is mostly attending to her patients by telephone and video conference; for vaccines, she can refer them to the public health office where vaccines are given — though some parents are afraid to take their children out.

Many parents are calling her, she said, because their children are having trouble sleeping — in fact, she switched from telephone visits to video conferencing because she wanted to be able to look people in the face while discussing the anxieties that are turning into sleep disturbances, loss of appetite, stomach aches and other physical symptoms.

“We have a lot of somatization,” she said, using a term that usually means the emergence — or expression — of anxiety or depression as a physical symptom. “They keep going to the bathroom, they have abdominal pain, all these things.”

The bedtime advice in Italy — as here — is to minimize the child’s exposure to news, to do quiet and pleasant activities for an hour or two before bedtime, reading books, listening to music, playing quiet games. “It must be a moment where the child has to be calm before going to sleep, a moment when he switches off,” Dr. Manetti said. “The children are afraid of switching off, they don’t know what will happen when they switch off.”

There are families, she said, who have found some positive aspects to being home together, but that’s much harder when parents are anxious about their jobs and their economic prospects. “If there’s a stressor in the family, it’s extremely difficult” to follow the advice about engaging children, distracting children, caring for children. “These families have to be economically sustained somehow.” These are also questions that American pediatricians are realizing we must address.

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