• Dr Andy Raffles

Baby and Child Care in an Era of Pandemic

Updated: Jan 21

We are living in, and through, a very challenging and unprecedented time, due to the COVID-19 pandemic. The pandemic has had a great impact on child health and healthcare all over the world, in many ways much less from the medical aspect, but more from the social/family, psychological, economic, and educational aspects. All these elements in the care of babies and children have presented to us all in one way or another and we and you need to recognise and deal with them properly to avoid their short and long-term consequences on an individual baby, child, and their family.


There's little doubt that the COVID-19 pandemic has been hard on many children and adolescents just as it has been difficult for adults. The disruption of routines, reduced contact with friends and the wider family, concern over getting ill, possibly experiencing bereavement and financial turmoil suffered by many families is exacting a toll on our mental health – but the resilience of childhood and adolescence appears to be holding out well.


All the sensational news reports and experiences from the four corners of the world indicate that infant and child health has been changed to variable degrees, and much of what we took for granted, or were familiar with may never be the same, sometimes for the better!


Psycho-social Impact

Pandemic related lockdowns have resulted in significant degrees of social isolation for families. Some new parents have experienced an entire pregnancy and the first few months of having a new baby at home in social isolation. Babies born from March 2020 have often only seen a parent, and in almost the first year of life other contact has been via a computer screen or at a social distance. This imposed isolation can be beneficial for some, bringing parents closer to their babies and children, and may in fact have stimulated some aspects of development, especially secure attachments. This may have positive benefits in the future.


Early years educational opportunities may have been lost but catch up will certainly be possible. Homeworking has resulted in additional contact with a parent who may have been usually away working. However home working itself poses other issues, especially where there are other children needing homeschooling, whilst a parent continues to work from home.


Parental isolation and loneliness when bringing up children at any age, and which is not uncommon even without the current circumstances is a significant issue that can be helped if parents access community and professional support.


Lack of recreational opportunities is another major restriction – and although sensible in preventing the spread of the infection, has reduced socialisation opportunities for many babies and children. Children, even those attending schools are not allowed to meet their friends and other relatives and if they are locked down at home the daily routine can be quite a chore. Under such circumstances, children may possibly demonstrate anxiety, fear, and other psychological manifestations. However, many of these symptoms may simply have been uncovered rather than caused by the requirement for social distancing and isolation from familiar routines. Children may experience negative feelings and thoughts such as fear of being hospitalised, fear of their family member loss, or even their own death. This may present as behavioural disturbances, loss of appetite, sleep problems, nightmares, and many other stress-related disorders. Similarly, adolescents are also affected but possibly to a lesser extent than younger children. Although adolescents seem to express an excellent ability to manage situations of insecurity and may adapt better to the changing circumstances there is growing evidence of sleep and eating behaviours being adversely influenced, and referrals to child and adolescent mental health services are increasing.


Safeguarding and Domestic Abuse

Children are not only obliged to stay at home for long hours and become more vulnerable to domestic violence and other safeguarding issues, but also there appears to be an increase in reporting of child safeguarding cases which includes sexual, physical, and emotional abuse. Adding other adverse factors such as parental unemployment and economic burdens will challenge parents and carers to provide a safe healthy environment for the children to stay in.


Economic Aspects

Many families are struggling with their daily lives. Parents and caregivers being out of work or have already lost their jobs during the pandemic do not have enough financial resources to cope with the many changes occurring. On the other hand, the basic needs of infants, children, and adolescents must be fulfilled. For many families, the challenge of feeding and caring for their children is stress, which must be acknowledged, and for many families, in this situation, the need to access benefits is something they have found difficult to come to terms with. Support from local resources, neighbours, and friends is essential, even considering the circumstances.


Avoiding Rumours

During the various phases of the pandemic, we have become increasingly aware of rumours and false information, and especially now as vaccines are developed and being rolled out confirmation of the information credibility is essential for healthcare professionals and the public in general and we will do our best to ensure the information we provide you is up to date and as accurate as possible, given the rapid speed with which progress is being made.


During a crisis, rumours and false stories, misleading information, and unreliable data are sadly shared via social media leading to uncertainty amongst parents and carers and causing mistrust in the healthcare providers. You should rely on trusted sources of evidence-based information from reliable credited sources of updated information and we will willingly share these with the families in our practice.


Healthcare Systems for Babies, Children, and Young People

In the UK access to Routine General Health Care for all has been severely disrupted for almost a year. In that time over 750,000 babies have been born, and for a significant proportion of new parents’ access to Midwifery services, Routine Health Visiting, and Routine Vaccinations have been interrupted or significantly changed. Local Baby Clinics, where new parents previously could share experiences have been closed, or reduced contact arrangements due to social distancing have meant that important sources of help and advice have not been readily available. The National Childbirth Trust (NCT) and other support systems have moved online, and although serving a very useful purpose is no substitute for face-to-face contact and a friendly chat.


This has created marked congestion and unpreceded chaos in the healthcare facilities, especially in cities. In London alone there has been the closure of children’s emergency departments, in part due to huge falls in numbers of parents presenting their children with acute illnesses. Although the majority of such presentations are for self-limiting illnesses, amongst these ‘lost’ children will be a few with significant illnesses presenting later than would usually be expected, and a good example of this is the children with newly diagnosed diabetes. There is good evidence that they are presenting to specialists later and more unwell as a direct result of reduced access.


This has its adverse impacts and many people and particularly infants and children were and still unable to get the proper medical care they actually need.


Healthcare delivery and Telemedicine

We have experienced and overcome, by novel and imaginative ways of working, the challenge of how to provide the required healthcare needed by infants and children in good time and in a place avoiding the possibility to catch the infection if they go to seek medical advice at hospitals or healthcare facilities. The mandatory precautions including the fundamental physical distancing and infection control requirements will affect the traditional routine medical care. Another observation is that many parents and carers are afraid to leave homes or do not want to take their child to a medical care facility with a possibility to be infected.


We have encouraged parents and carers to share their worries with their Paediatricians via phone calls, e-mails, or other social media applications which include remote consultations.


Telemedicine – remote video consultation has been dramatically expanded in the past few months as a useful tool for long-distance clinical care. Telemedicine can be used for education, counselling parents, and health management and its role is professionally enlarging in many regions such as the USA and Europe. Using Remote consultation does need close attention to some issues such as patient safety, confidentiality, and missed clinical information. Our own experience with telemedicine is that it has been a very effective way of assessing health issues, and also developmental issues and has proved to be an effective way to help our parents and patients during the present pandemic.


Vaccinations

It is estimated that millions of infants and children worldwide have just missed and will continue to miss their required essential vaccinations with a fear that some vaccine-preventable diseases may come back as measles and poliomyelitis. Immunisation is a core health service that must be offered to children. Special planning and extraordinary efforts by community colleagues needed to be applied quickly for vulnerable children who are at increased risk of illness, including children undergoing care for long term health conditions and also child refugees and looked after children. Many baby vaccination clinics were temporarily halted or postponed in order to follow recommendations on maintaining proper physical distancing and infection control precautions required to minimise the risk of children and their carers to infection.


For many parents, we have offered home vaccination, especially early in the pandemic, with our home vaccination service using personal protective equipment at all times.


Babies and children who need hospitalisation for issues other than COVID-19

The overwhelming current COVD-19 pandemic should not make us forget other serious medical and surgical diseases and emergencies that children may suffer. GP’s and Paediatricians and hospitals admitting acutely ill children must continue to provide rapid, efficient, and safe medical management accordingly. The UK’s Royal Colleges of Paediatrics and Child Health, and the Royal College of General Practice have both strongly recommended that the primary care - General Practice - and hospital resources for children must be maintained during the current COVID-19 pandemic, in order to meet the health and mental well-being of babies, children and adolescents and providing specialist health services for children with more severe COVID-19 manifestations.


Nutritional Aspects

Staying at home for a long time and closure of sports clubs and lack of physical activities may eventually result in marked weight increase in children and adolescents and the development of obesity problem with all its negative consequences. Paediatricians have to alert parents and caregivers for this increasing health problem during lockdowns. It also needs to be recognised the economic adverse effects may result in a marked decrease in the families’ abilities to ensure enough food for their children resulting in poor nutrition. An adequate and balanced diet has to be offered to every individual. Proper nutrition and hydration are vital to maintaining good health.


Did you know?: Virtual library gives free book access available for children in England

https://www.bbc.co.uk/news/education-55692137



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