Background: Few studies investigated COVID-19 pandemic psychological effects on pediatric healthcare staff. The aim of this study was to evaluate sleep quality and psychological effects of pediatric healthcare workers during COVID-19 epidemic in Italy and to evaluate potential differences between Primary and Secondary Care operators. Methods: Pediatric healthcare workers were involved in an online survey aimed to characterize responders and to define their clinical expertise in the management of suspected or confirmed COVID-19 patients during pandemic. Using validated scores, the online questionnaire assessed sleep quality, stress and anxiety level, self-efficacy and social support in pediatric healthcare workers. Results: During COVID-19 outbreak, 67.43% of our population were suffering sleep disturbance, and we found a positive correlation between sleep disturbances with stress and anxiety. Furthermore, 19.42% of subjects were suffering anxiety and 53% were at risk of developing an acute stress disorder. Stress resulted inversely correlated with self-efficacy and social support.Secondary care operators were more affected than family pediatricians by sleep disturbances, stress but especially by anxiety. Social support was considerably higher in secondary care operators compared to family pediatricians.Conclusions: Despite the less exposure and the less infection probability, much of pediatric healthcare workers were suffered sleep disturbance, anxiety and potential stress disorder. In the Pediatric Units, these psychological effects could be related to other factors compared to frontline departments, such as the early confused situation, the difficulties in workplaces managing and in finding personal protective equipment, as well as the subsequent sense of helplessness and frustration.