Tag: Child Health

Impact of COVID-19 on primary care contacts with children and young people in England

During the COVID-19 pandemic, health systems globally shifted towards treating COVID-19 infection in adults and minimising use of health services for other patients, including children and young people (CYP), who were less susceptible to severe COVID-19. In March 2020, the NHS recommended remote triaging before any face-to-face contact to reduce infection risk.

The UK Government announced a nationwide lockdown in England from 23 March 2020, and the public was advised to stay at home to limit transmission of COVID-19 and avoid strain on health resources. GPs were asked to prioritise consultations for urgent and serious conditions, and suspend routine appointments for planned or preventive care.

Children’s access to primary care is highly sensitive to health system changes. We examined the impact of COVID-19 on GP contacts with children and young people (CYP) in England. We used a longitudinal trends analysis was undertaken using electronic health records from the Clinical Practice Research Datalink (CPRD) database.

GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1–14 years had greater falls in total contacts (≥50%) compared with infants and those aged 15–24 years. Face-to-face contacts fell by 88%, with the greatest falls occurring among children aged 1–14 years (>90%). Remote contacts more than doubled, increasing most in infants (over 2.5-fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote contacts, mitigating the total fall (31%).

In conclusion, CYP’s contact with GPs fell, particularly for face-to-face assessments. This may be explained by a lower incidence of respiratory illnesses because of fewer social contacts; changing health-seeking behaviour; or a combination of both. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.

The study can be read in the British Journal of General Practice.

How is the Covid-19 lockdown impacting the mental health of parents of school-age children?

The Covid-19 pandemic has affected educational systems worldwide, leading to the near-total closures of educational institutions in the UK. As of 6 May 2020, schools were suspended in 177 countries affecting over 1.3 billion learners worldwide, and in many cases closures have resulted in the universal cancellation of examinations. UNICEF estimated that almost 4 months of education will be lost as a result of the first lockdown.

School closures have far-reaching economic and societal consequences, including the disruption of everyday behaviours and routines. In the UK, over 2 million workers have already lost their jobs, and although the long-term impact of the pandemic on education is not yet clear, the pre-existing attainment gap between the poorest and richest children7 may widen significantly as a result of COVID-19. Children and young people make up 21% of the population of England,10 and by the time they returned to school after the summer break, some would have been out of education for nearly 6 months.

In a paper published in the journal BMJ Open, we explored how the lockdown affected the mental health of parents of school-age children, and in particular to assess the impact of an extended period of school closures on feelings of social isolation and loneliness.

We collected data for 6 weeks during the first 100 days of lockdown in the UK and found that female gender, lower levels of physical activity, parenting a child with special needs, lower levels of education, unemployment, reduced access to technology, not having a dedicated space where the child can study and the disruption of the child’s sleep patterns during the lockdown are the main factors associated with a significantly higher odds of parents reporting feelings of loneliness.

We concluded that school closures and social distancing measures implemented during the first 100 days of the COVID-19 lockdown significantly impacted the daily routines of many people and influenced various aspects of government policy. Policy prescriptions and public health messaging should encourage the sustained adoption of good health-seeking self-care behaviours including increased levels of physical activity and the maintenance of good sleep hygiene practices to help prevent or reduce the risk of social isolation and loneliness, and this applies in particular where there is a single parent. Policymakers need to balance the impact of school closures on children and their families, and any future risk mitigation strategies should ideally not be a further disadvantage to the most vulnerable groups in society.

DOI: http://dx.doi.org/10.1136/bmjopen-2020-043397

Data-driven, integrated primary and secondary care for children: moving from policy to practice

Despite the best efforts of clinicians, traditional healthcare models often struggle to meet the increasingly complex needs of children and young people under the age of 18 years, as well as 21st century challenges such as obesity and mental health problems. Policy makers and clinical leaders have argued that greater integration of primary and secondary care has the potential to meet the ‘Quadruple aim’ of better population health outcomes, patient and family satisfaction, provider satisfaction and reduced costs. More integrated services and improved data sharing across organisations are key enablers of child health improvement. However, there is sparse literature on how more integrated care for children and young people might work in practice or contribute to achieving these goals. We present the experience of developing a new model for integrated care delivery for children and young people in North West London, based on a common system of clinical records or dashboards across all providers. It includes case studies that illustrate the development of strong relationships and shared learning experiences between primary and secondary care. The article was published in the Journal of the Royal Society of Medicine.

DOI: https://doi.org/10.1177%2F0141076820968781

Telling the truth about antibiotics: benefits, harms and moral duty in prescribing for children

In a paper published in the Journal of Antimicrobial Chemotherapy, we discuss key issues in applying an evidence-based approach to the prescribing of antibiotics to children.

Antimicrobial resistance is a growing threat to global health, yet antibiotics are frequently prescribed in primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations.

Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents. Provision of accurate, accessible information about the benefits and harms of antibiotics is key to an ethical approach to antimicrobial stewardship and to supporting shared decision making. Openness and honesty about drivers for antibiotic requests and prescribing may further allow parents to have their concerns heard and help clinicians to develop with them an understanding of shared goals.

All this requires adequate time in the consultation; for both a thorough clinical assessment of the child; and a full discussion with the parents about the appropriateness, benefits and risks of antibiotic treatment.

DOI: https://doi.org/10.1093/jac/dky223