In December 2019, the outbreak of a new strain of coronavirus disease occurred in Wuhan, (China) and spread across the world within a short time; the WHO declared the coronavirus disease 2019 (COVID-19) outbreak, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), to be a pandemic on March 12, 2020.
This pandemic has resulted in governments implementing disease containment measures such as school closures, social distancing, and home quarantine.
In Lombardy, the most affected Italian region, the first school closure began the 21st of February 2020, and, on 5 March 2020, all schools in Italy were closed and students isolated at home for the rest of the academic year, with schooling shifted to home based distance-learning models. In Italy there is usually a Summer school break: children are on holiday from the beginning of June to the middle of September.
Evidence is emerging that children may be significantly less likely to become infected than adults, and do not appear to be super spreaders. Governments worldwide should allow all children back to school regardless of comorbidities. The media highlight of a possible, rare, new Kawasaki- like vasculitis that may or may not be due to SARS- CoV2 does not change the fact that severe COVID-19 is as rare as many other serious infection syndromes in children that do not cause schools to be closed .
The COVID-19 quarantine has affected more than 860 million children and adolescents worldwide. Moreover, the lockdown and school closure may have negative consequences on children, affecting their social life, their education, and their mental health. Although the current school closures differ from summer holidays in that learning is expected to continue digitally, the closures are likely to widen the learning gap between children from lower-income and higher-income families .
The COVID-19 pandemic may worsen existing mental health problems and lead to more cases among children and adolescents because of the unique combination of uncertainty, anxiety, fear of becoming ill or seeing a loved one become ill, loss of our normal routines, difficulties in maintaining social connection, and economic recession .
After the H1N1 and SARS epidemics, post-traumatic stress is estimated to be four times higher in children who have been in quarantine compared to those who have not, and their likelihood of presenting acute stress disorder, adjustment disorder, and grief is also higher .
A recent review highlighted that children and adolescents are probably more likely to experience high rates of depression and anxiety during and after enforced isolation ends . The authors found a clear association between loneliness and mental health problems, mostly depression, in children and adolescents. Loneliness was associated with future mental health problems up to 9 years later.
These results are consistent with data emerging from China during the COVID-19 pandemic, where children aged 6 to 18 years were more likely to show inattention and persistent inquiry. Clinging, inattention, and irritability were the most severe psychological conditions demonstrated by the children in all age groups .
A Chinese survey  conducted during COVID-19 directly involved primary school students and reported higher rates of depressive (22.6%) and anxiety (18.9%) symptoms compared with the prevalence in other surveys.
Italy was the first European country to implement a national lockdown to contain the spread of severe coronavirus disease 19 (COVID-19) and related strict domestic quarantine policies.
To date, only a few studies [8-10] have drawn attention to the psychological impact of lockdown on Italian children’s mental health.
A recent study has examined the psychological effects of the quarantine in youth from Italy and Spain. Data were collected through a survey completed by parents and found that their children had different symptoms such as: difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of loneliness (31.3%), uneasiness (30.4%), and worries (30.1%). Moreover, the results show that children of both countries used monitors more frequently, spent less time doing physical activity, and slept more hours during the quarantine .
The findings of an online survey , completed by parents of 2 to 14 year old children, showed that factors such as living in an area more at-risk for contagion or being in closer contact with the virus’ effects, do not relevantly affect parents’ and children’s well-being. Similarly, the quality of the environment, such as the physical characteristics of the living space, is not associated with parents’ and children’s psychological symptoms. It was the parents’ individual perception of the situation, however, and, more specifically, how much they found it difficult to deal with the many strains the quarantine imposes, that was significantly associated with parents’ stress and children’s psychological problems, and that indirectly impacts on children’s behavioural and emotional problems.
One in four children (26.5%) showed the regressive symptom of the demand for physical proximity to their parents during the night, and almost one in five (18.2%) manifested fears that they had never had before. Half of the children (53.5%) showed increased irritability, intolerance to rules, whims and excessive demands, and one in five presented mood changes (21.2%) and sleep problems, including difficulty in falling asleep, agitation, and frequent waking up (20 %). One in three (34.3%) displayed nervousness about the topic of the pandemic when it was mentioned at home or on TV. Almost one in three (31.4%) seemed more calm and one in two (49.6%) seemed more wise and more thoughtful. Almost all (92.6%) seemed able to adapt to the pandemic restrictions, although one in two (43.3%) seemed more listless to the activities they used to perform before the pandemic, including playing, studying, and gaming .
Students are facing very different experiences with home learning. School closure is almost certain to increase educational inequalities. In particular, many parents of both primary and secondary school students report struggling with supporting home learning .
The social distancing and stay-at-home orders issued in cities across the globe obviously reduce the opportunities for physical activity among children, particularly for children in urban areas living in small apartments. Isolation and shielding could result in increased sedentary behaviours and food consumption, which are likely to impact weight and consequently health and sleep over time [12,13].
During the pandemic, prevalence of physically inactive students increased extensively, from 21.3% to 65.6%. Overall screen time increased considerably during the pandemic and screen time during leisure was also prolonged, indicating that nearly a quarter of students engaged in long screen time for leisure .
To date, the majority of knowledge available from research related to the health needs and experiences of young children has been based on the perspectives of parents and/or paediatric health professionals. A growing number of researchers in the health care field have begun to capture the perspectives of children through qualitative interviews [14,15].
For this reason, we decided to directly involve children and adolescents with video-interviews to convey their experiences and to more fully understand their needs.
To our knowledge, this is the first study that directly investigates the effects of the COVID-19 lockdown on children’s and adolescents’ changes in routine and mental health from their own perspective. In particular, the added value of the study is the fact that it directly involved students with video-interviews, letting them share their needs and opinions.
The present study aims to analyse the impact of the quarantine on students’ life in Milan, one of the Italian cities most affected by COVID-19. In particular, we focused our attention on changes in routine during the lockdown: distance learning, eating and sleeping habits. Psychological distress such as anxiety and mood symptoms, disease concern, and fears were examined.