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Epidemiology for public health - ISS

Findings from the 2022 survey

Over 9 in 10 women reported not smoking during pregnancy, and over 8 in 10 reported not drinking alcohol. Despite that, the percentage of children living with at least one smoking parent and/or another smoker, and therefore potentially exposed to passive smoking, was still high (38%). Over 90% of all mothers were taking folic acid during pregnancy, but only one third of them (32.1%) started doing so one month before conception, as recommended. Over 50% of babies aged 11-15 months were already exposed to screens (TV, computers, tablets or mobile phones), and more than one third of mothers with children in that age group struggled to get them seated and properly strapped into a car seat. These are some of the findings from the 2022 survey of the Surveillance system for children aged 0-2 years, which were presented on 23 March 2023.


The objective of the surveillance is to collect information on specific health determinants in children from before conception to 2 years of age, so as to produce regional or local indicators (required by the World Health Organization and/or National and Regional Prevention Plans) which allow geographical and intertemporal comparisons.


Summary of the findings

All Regions took part in the second edition of the survey, except for Molise and the Autonomous Province of Bolzano, with Region Tuscany contributing the findings of its ongoing maternity care survey. Data were collected, between June and October 2022, from 35,550 mothers, and the response rates varied from 89.2% to 98.6% across the different regions.


Periconceptional intake of folic acid

A daily intake of 0.4 mg of folic acid (vitamin B9), from the moment a couple start planning a pregnancy until the end of the third month of gestation, is known to prevent severe birth defects. Over 90% of mothers were taking folic acid during pregnancy. However, the proportion of women who reported correct intake of folic acid, starting before pregnancy, was much lower (32.1%): it ranged from 21.4% to 42.5% across the regions, and tended to be higher in the north.


Smoking during pregnancy and breastfeeding

Smoking during pregnancy increases the risk of low birth weight, preterm birth, perinatal mortality, sudden infant death syndrome (SIDS) and bronchopulmonary diseases. Children exposed to passive smoking are at higher risk of lower respiratory disease and asthma attacks. The percentage of mothers who reported smoking during pregnancy was 6.4%, varying across the regions from 2.9% to 10.3%. The proportion of smokers among breastfeeding mothers was 8.7% (ranging from 4.9% to 13.9%). The percentage of children living with at least one smoking parent and/or another smoker, and therefore potentially exposed to passive smoking, varied from 27.4% to 46.6%, and tended to be higher in the south.


Alcohol consumption during pregnancy

Risks associated with alcohol consumption during pregnancy and breastfeeding include: foetal alcohol spectrum disorders (FASDs), miscarriage, preterm delivery, low birth weight, SIDS, birth defects, cognitive and social problems. The vast majority of mothers did not drink alcohol during pregnancy, but 18.6% reported drinking alcohol at least 1-2 times a month and 3.7% at least 3-4 times a month (range across regions: 1.7%-6.1%). Alcohol consumption, however, was found to be more widespread during breastfeeding than during pregnancy: between 3.4% and 12.9% of mothers with children aged 2-5 months had drunk at least 3-4 times in the month preceding the survey. Overall, alcohol consumption was more prevalent among mothers from the central and northern regions.



The benefits of breastfeeding for both mother and child are well documented. The WHO and UNICEF recommend that infants should be exclusively breastfed until 6 months of age and that breastfeeding should continue up to 2 years of age, if so desired by the mother and the child. The proportion of exclusively breastfed children aged 4-5 months was 30%, with marked regional variations (between 13.5% and 43.2%, and lower in the south). The percentage of children who had never been breastfed was 13%: it ranged from 7% to 17.2%, and tended to be higher in the southern regions.


Early reading at home

Regularly reading to children from the first months of life has a positive effect on their cognitive, emotional and social development. In the week preceding the survey, 58.3% of children aged 2-5 months and 32.6% of those aged 11-15 months had no books read to them: percentages ranged across the regions from 38.3% to 69.7% and from 16.4% to 48.5% respectively, and were generally higher in the south.


Exposure to screens

There is growing scientific evidence that excessive and/or improper use of audiovisual and digital technologies can have an impact on the physical and mental health of children, causing sleep, emotional and social disorders. It is recommended that these technologies be used in the presence of an adult and only by children who are at least 2 years of age. The survey showed that 22.1% of babies aged 2-5 months were spending some time in front of TVs, tablets, mobile phones or computer screens (range across regions: 13.6%-30.3%): the majority were spending less than one hour a day in front of a screen, but between 1.9% and 9.1% of them were doing so for at least 1-2 hours a day. Exposure grew with increasing age across all regions, and the proportion of children aged 11-15 months who were spending at least 1-2 hours a day in front of a screen varied from 6.5% to 39.3%. Overall, higher percentages of children exposed to screens were reported in the southern regions.


Position in the cot

Sudden infant death syndrome (SIDS) is one of the leading causes of post-neonatal death. Some simple and effective measures are recommended to reduce the risk of SIDS, including placing the child on their back to sleep. While two thirds of all mothers (66.7%) reported doing so (range across regions: 53.2%-79%), children were often laid to sleep in positions other than the recommended one, with 18.7% of women placing them on their side.


Safety at home

Children are at high risk of being involved in accidents at home, especially those aged up to 5 years. The percentage of mothers who reported a home accident involving their child (e.g. falls, injuries, burns, ingestion of harmful substances) to healthcare professionals was 12.4%, varying across the regions from 10.5% to 14.7%. Visits to paediatricians, rather than emergency departments, were more common in the central and southern regions, while no significant differences were observed in the north.


Car safety

The correct use of car safety equipment when travelling with a child can significantly reduce the risk of injuries and death resulting from road traffic accidents. Overall, 19.3% of the mothers with babies aged 2-5 months reported struggling to get them seated and strapped into a car seat (range across regions: 14.2%-29.7%). The proportion of mothers reporting difficulties using the car seat rose with the child’s increasing age across all regions and, among women with children aged 11-15 months, varied from 27% to 47%. 



Vaccinations protect children from infectious diseases that can cause dangerous complications. Of the surveyed mothers, 76.1% wanted their child to receive all mandatory and recommended vaccinations (range across regions: 68.6%-83.7%). The proportion of mothers who reported being undecided or in favour of only the mandatory vaccinations varied from 3.9% to 8.3% and from 10.2% to 23.8%, respectively.


Useful resources


Page created: 30 March 2023

Written by: Enrica Pizzi, Michele Antonio Salvatore, Laura Lauria, Serena Donati, National Centre for Disease Prevention and Health Promotion (CNAPPS), ISS