Digital Health in Early Childhood: A Cross-Sectional Study of Pediatricians' Knowledge, Practices, and Training Needs in Northern Italy

Abstract

Background: Digital devices (DDs) are increasingly present in early childhood, with screen exposure beginning as early as infancy. Despite international and national guidelines discouraging digital media use before age two, many children are exposed to screens far earlier, often mediated by parents and caregivers. Excessive or unregulated screen use has been linked to adverse neurodevelopmental, emotional, and physical outcomes. Objective: This study aims to assess the knowledge, attitudes, and educational needs of primary care pediatricians (PCPs) regarding digital education (DE) and DD use in preschool-aged children (0-6 years) in two provinces of Northern Italy. Methods: A cross-sectional survey was distributed to all 165 PCPs in the Modena and Reggio Emilia provinces between December 2024 and January 2025. The 17-item questionnaire explored PCPs' knowledge of guidelines, awareness of DD-related risks, current counseling practices, and training needs. Results: Of the 165 contacted PCPs, 93 (56%) completed the survey. While 77% were aware of Italian Pediatric Society recommendations, only 56% correctly identified age two as the threshold for total screen avoidance. 87% of PCPs recognized the risks of excessive DD use, particularly its cognitive, behavioral, and physical consequences. Nearly all participants (95%) reported discussing DE during clinical visits, and 96% expressed a desire for further training. Conclusions: PCPs show strong engagement in promoting healthy digital habits but lack specific knowledge of current recommendations. Structured tools such as digital health check-ups and targeted training programs are needed to strengthen pediatricians' roles in digital health education and support parental guidance.

Keywords: digital devices; digital education; early childhood; health promotion; pediatricians.

Figure 1

Percentage distribution of PCPs’ responses to the question: “According to your knowledge, up to what age should the use of digital devices be completely avoided?” (question no. 7).

Figure 2

Channels through which PCPs reported obtaining information on SIP recommendations (n = 72). Multiple answers were allowed (question no. 6).

Figure 3

Wordcloud illustrating the range and frequency of long-term consequences associated with excessive digital device use in preschool children, as reported by primary care providers (PCPs). The size of each word reflects the relative frequency with which each consequence was mentioned, highlighting the most commonly recognized effects. Detailed data underlying the word cloud are provided in the Supplementary Table S1.

Figure 4

Channels through which PCPs would like to obtain more information on digital education (n = 89). Multiple answers were allowed (question no. 16).