Many adult physicians may be envious of the pediatrician right now. Overall, our patients fare quite well when infected with this virus, in fact, only about 2% of cases reported in the US have been under the age of 18. While we consider this a great blessing, there are concerns about the effects of this pandemic among our adolescents and children that go beyond the infection. Since awareness and communication are the first steps towards solving any problems, I am going to highlight two of these concerns below.
Let us start with the youngest of our patients, the newborns. It is unclear whether this virus can cross the placenta. Initial studies suggest that it cannot be transmitted in utero and that newborns that have become infected did so immediately after birth. For that reason, it has been recommended by the CDC that upon delivery, babies who are born to a COVID positive mother be separated from their mother until she is no longer contagious. Since it is possible for babies to develop serious coronavirus disease, avoiding infection is certainly a priority. However, it must be balanced with the needs of Mom and baby, breast feeding (which has been shown to be safe in the presence of COVID 19 infection), and overall safety of the baby. The American Academy of Pediatrics has advised that the decision be made on a case to case basis taking into account the level of mother’s illness, plans to breast feed, availability of healthy support systems, and the hospital’s ability to isolate both Mom and baby.
These are complex decisions that require input from the obstetrician, nursing, pediatrician and most importantly the parents. This mindful approach is exactly how the pediatric health care providers of this county intend to solve this dilemma. Social media has been filled with claims that babies will be taken away from mothers for long periods of time, that Children and Youth will be called if mother’s do not comply, and that breast feeding will be discouraged. None of these are true. No one cares more about healthy mothers and babies than the people who have dedicated their lives to neonatology and pediatrics. COVID 19 has put us in a position of having to make decisions with a lack of research, and without the benefit of experience. Based on the information available at this moment many things need to be considered when deciding about separating Mom and baby. Maternal bonding, breast feeding, and the health and well being of the mother baby couplet are the priorities.
Many pediatric healthcare providers are beginning to brace for an increase in child abuse during this crisis. Based on studies of natural disasters such as hurricanes, times like these can lead to an increase in abuse in the home. Parents are under a great deal of stress, and they do not have their usual resources including schools, religious institutions, and governmental agencies to support them. Children are home and could be trapped in a 24/7 abusive or neglectful environment. According to government statistics from 2017; 40% of all child abuse reports come from educators, child services, or medical personnel, all people who are not having the day to day contact with children due to the pandemic.
Beyond abuse, there is poverty and instability in the homes of many children which has only worsened during these uncertain times. Children in foster care may find themselves being displaced as foster families struggle to cope. Supervision is likely to be an issue for many families where the parent is still working, and the children are home. While we all struggle right now to keep our children occupied and entertained, imagine if sheltering in place means that all the support systems a child relies upon are gone? Professionals must take their cues from teachers and begin to reach out online, by phone, or in any socially distanced manner. If concerns about abuse arise the Child Hotline is available and investigating all reports. And we must be prepared to wrap these children in support and love as soon as we can see them again. This support will come in the form of therapies to prevent long term damage from traumatic events, medical care needed due to neglected problems, educational support as they catch up, and social support systems that bring food, housing, and yes, even fun, to kids of all ages.
As community members this is the time to reach out to any parents who could use an extra hand. You can read to a child via face time, you can deliver groceries or cook a meal, and most importantly you can listen to allow parents to feel connected and supported. Little actions such as these can prevent child abuse.
One last point: recently there has been a spike in pediatric poisonings from ingestion or aerosol exposure to cleaners and disinfectants. While it is important to clean surfaces frequently to prevent the spread of coronavirus 19, it is critical that we do this safely. Remember to clean only when your children are not around, to avoid using sprays in poorly ventilated areas such as bathrooms, and to keep all cleaning supplies, including hand sanitizer, out of reach to children. If you are concerned about an exposure call poison control immediately.
There will be much to say about the long-term effects of this pandemic. However, most of the discussions have many unanswered questions currently. More than ever, I am confident we will emerge from this as better doctors, teachers, parents, and community members, and that will only benefit every child.