COVID-19 and Child Health

as lot of people are dying due to covid-19, leading many children to be orphans. The mental health of such kids and the obstacles which they are going to face are beyond imagination. if the children are not given in the safe hands, their health both physical and mental, education, etc. will be affected, leaving the utterly dark future for them. they maybe involved in trafficking, slavery, abuse etc. their education will be affected, leaving them illiterate and poor or null opportunities in future.

government should make a policy, in which special care is give to children who lost their families due to covid-19. complete care should be taken of their health, routine vaccination, shelter, food and education. A child counsellor must be provided to recover the mental health of the children. if they are being adopted or given to any relatives, it should be make 100% sure that they are being handed to right people.

This topic is very relevant to the context. Doctors and Scientists are warning on the 3rd wave, it is going to hit us and children will be much affected. It will be a disaster as we don’t have vaccine, facilities and children hospital to deal with this. The new strain in Singapore detected in children is creating havoc and it is setting alarm that children going to be affected and we are not having  facilities for children. Country need to be prepared, do vaccine trials and immunise children before it hits us hard. Special hospitals for children need to be developed and paediatricians need to be trained,prepared to tackle on the preventive awareness, parenting, bcc intervention required. AWC and school need to be closed to avoid gathering and the lock down need to continue in case any place reports such case. Flights from Singapore need to be stopped as new strain found in Singapore in children is highly infectious.

In the informative paper Challenges of COVID-19 in children in low- and middle-income countries the potential impacts of COVID-19 on global child health particularly in LMICs have been well-discussed. With the downscale of routine child and maternal health services, there has been a grave situation of compromised immunization along with antenatal and nutritional programs resulting in high morbidity and mortality from diseases like TB. As part of the social distancing restrictions, local travel restrictions and curfews have contributed to reduced access to health care facilities especially among young children and pregnant women who are most in need of health care. Therefore, pandemic lockdown strategies should maintain vital access to care and should be tailored according to the needs of the community. Also fear of contracting COVID at healthcare facilities has led to delay in seeking care for ill children and reduced rates of childhood immunization. With school shutdowns, child nutrition has further compromised as children from impoverished communities are dependent on regular school feeding schemes for their sustenance.

The collapse of vital acute care including oxygen supply, medications, PPE kits, preventive services and programs like immunization, maternity care, breastfeeding and nutrition programs should be prevented. There should be maintenance of workforce designated for maternal and child health which can empower the community at the local level which will be helpful in benefiting children with COVID-19 along with other illnesses and can save lives of more children. There is an urgent need to understand pediatric COVID-19 for which we need to establish surveillance systems and scaling up of testing children with respiratory issues including pediatric contacts of adult cases. Also, separate clinics can be established especially for preventative care services and home vaccination visits to execute children immunization programs successfully.

An Interesting read: Protecting children in low-income and middle-income countries from COVID-19

In continuation to the impact and disruptions in childhood immunization programmes due to COVID-19, the possibility of spread of vaccine-preventable infections in prone populations and regions around the globe has become quite vulnerable and is being neglected more ever since the pandemic began. Hesitation, regional lockdowns, travel restrictions, social distancing norms, limited healthcare services and the fear of transmission of COVID-19 has broken the chains of routine immunization - one of the greatest public health intervention is preventing various deadly diseases in infants and adolescent populations. Data from UNICEF suggests how the administration of fundamentally recommended vaccine for children – DPT across the world has been affected with the advent of COVID-19, especially depicting steep fall in the South-east Asian region as compared to the rates of immunization in 2019. 

Strategies to possibly control future outbreaks of vaccine-preventable diseases shall include shift of focus on guidelines by organizations like WHO as well CDC, who have been insisting countries to continue routine immunization for children, with COVID-19 appropriate behavior in line for vaccinators and children along with accompanying parents while visiting vaccination centres. With the implementational directives from policy makers or governing bodies, awareness at local levels and efficient communication between parents and healthcare providers can be enhanced to alleviate the barrier and gap of regular vaccination for children. Action plans for later vaccination of children who couldn't get vaccinated during the pandemic, can also be worked upon by healthcare providers. 

Reference publications:

1. Ener Cagri Dinleyici, Ray Borrow, Marco Aurélio Palazzi Safadi, Pierre van Damme & Flor M. Munoz (2021) Vaccines and routine immunization strategies during the COVID-19 pandemic, Human Vaccines & Immunotherapeutics, 17:2, 400-407, DOI: 10.1080/21645515.2020.1804776

2. //data.unicef.org/topic/child-health/immunization/

The second wave of COVID 19 has hit India very badly, in some of the states the test positivity rate among children is also alarmingly increasing. Different state governments have taken adequate actions to support children who tested positive and those who lost their parents due to COVID 19. Sometimes, the loss of parents could affect the emotional and cognitive growth and may affect their mental health and may lead to anxiety and depression, poor academic performance etc.  There is a need of creating a policy for helping children who are affected with COVID 19. The emotional and physical wellbeing of children is also as important as any other age group.

The COVID‑19 pandemic is harming health, social and material well-being of children worldwide, with the poorest children, including homeless children and children in detention, hit hardest. School closures, social distancing and confinement increase the risk of poor nutrition among children, their exposure to domestic violence, increase their anxiety and stress, and reduce access to vital family and care services. Widespread digitalisation mitigates the education loss caused by school-closures, but the poorest children are least likely to live in good home-learning environments with internet connection. Furthermore, increased unsupervised on-line internet use has magnified issues around sexual exploitation and cyber-bullying.

Immediate government measures need to ensure that children have access to good food, receive protection against child abuse and neglect, have continued access to child physical and mental health services, and can navigate safely on the internet. Policies also need to support parental employment since it is key to fighting child poverty.

The Second wave of Covid 19 has worsen the situation in India. The impact on economies, societies and health is still unknown and unfolding every day. Children and Adolescents are at an increased risk of exposure to violence under lockdown conditions.  All these factors can negatively impact child and adolescent health in the immediate and longer-term. For other illnesses also many people and children are not able to reach to the healthcare facility due to limited transportation or fear of getting in contact with the covid positive patient. 

Adults across the world, including India, are reporting a four-fold increase in anxiety and depressive symptoms. The new normal has brought many changes and is affecting mental health of children as well. Due to complete lockdown they can not go out to meet friends or play, no schools, no social gatherings. Man is a social animal and all the aspects are getting affected.Adolescents and young adults in the age range of 18 to 25 are exhibiting even higher rates of emotional distress, as well as a marked increase in substance misuse, suicidal thoughts and behaviours.

Attached is the Paediatric Guidelines for COVID: //www.mohfw.gov.in/pdf/ProtocolforManagementofCovid19inthePaediatricAgeGroup.pdf

The life of all the human beings has been affected during these unprecedented times. Children with disabilities have been impacted more as they have not been the focus of discussion during the pandemic.  Children with disabilities are not only more vulnerable to get affected due to their disabilities but also the inability to practice preventive measures makes them more prone to infections. Apart from their underlying health conditions, they have always been in social isolation. Their daily visit to special schools is the only hope in their lives where they get to meet kids like them and avail the services available at these centers. Due to the closure of educational and child care centers, their already limited outdoor visits have come to a halt affecting their mental health much more than before. Parents of these kids losing jobs have further accentuated the condition of such kids due to lack of adequate resources.

Even the children with mild disabilities have been worse hit due to the lack of inclusive Virtual learning platforms. Though, schools rapidly changed their teaching prodigy and adapted the virtual teaching but not much have been thought about such children.

There is a need of creation of digital interventions for addressing the needs of special children for maintaining their quality of life, catering their mental health needs and providing them educational services. For the effective implementation of such interventions there is a need of training the care givers at home. There is also a need of designing training modules for parents/care givers and also the disabled children for teaching hygiene practices to these children through various interactive modes. 

A good read below

//content.iospress.com/articles/journal-of-pediatric-rehabilitation-medicine/prm200769

COVID 19 have shaken everyone's life starting from children to the old age people

In this situation, we leave the children unnoticed ie. Parents are so busy like pulling ourselves from the bad news from our friends and family members instead of spending time with them. Children don't understand what is really going on. Since we don't hear much about their small things their words remain unheard. They are actually terrified and confused inside. This confused state of children may cause physiological health problems, like anxiety, fear of death, fear of parents' death, and fear of being isolated in the hospital.

Poor children have increased risk of being exploited and become victims of violence and abuse.

During lockdown, many schools have offered online courses to students. However, this opportunity is not available to children from poor families or orphans.

As lockdowns are amended the children are unable to go outside so they are engaged so much with ELECTRONIC GADGETS rather than going out and playing outdoor games. Due to overuse of these electronic gadgets they may have many physical and mental health issues.

We have also got some assumptions from our health care workers that the 3rd wave will have a greater effect on children let's try our best to keep them protected by boosting their immunity and educate them for proper handwashing, wearing masks, and to avoid junk foods.

So let's try to understand the children thoughts and help them in this pandemic situation.

Covid 19 crisis has a lot of impact on child health and child health care, not only from medical aspects but also from social, psychological, educational and economical aspect as there is a drastic change in routine. We could say that children are unable to fully grasp the concept of their own mental health and wellbeing. The awareness to their age group is limited and they are literally confused and unable to understand the new protocols that are imposed on society. Because of this many of them are also unable to physically, mentally escape from the challenges caused. As they are not able to cope up with this strategies, it is hard for them to communicate their feelings easily. More miss interpretation can happen.
Major difficulties faced by children:
•Shift to online schooling. Nowadays, even adolescent are unable to adapt to the method of online classes which destroyed the school environment in which we can learn a lot in different aspects.So, if we see children, they are more vulnerable in tackling the situation.
•Isolated learning environment
•Suppression of class activities
•No proper physical activities like playing outside
•No proper and well balanced food intake

These all may increase anxiety and depression. Obesity can also be taken into account since there is decline in the physical activity. Briskness and regular activities of children decreased. The time spent on mobile phone, video games, online classes on digital sources has increased a lot. So, they can make the time spent on these in a effective ways by interacting with their friends and stay connected. Regularly spending time with their families may solve this situation.The main responsibility goes in hands of the parents. They need to be affectionate, kind and spend time with their children and talk to them freely as a friend so that they can open up their feelings and the difficulties they are facing during this pandemic.

Child health doctors and professionals should advocate for the rights of all children protection, survival, participation, and development to be upheld within global and national actions. They should ensure the effect of covid 19 on the health of children should be visible in the data and real-time data should be captured. so that right decision-making and surveillance can be strengthened. and the extension education cab be done to the grassroot level. 

must ensure the impact of the pandemic on children’s health and experiences is visible in data and in decision making by strengthening surveillance of the indirect effects and communicating this to the wider public. 

COVID-19 might not have effected children too much in terms of the virus impacting their health, however, it has some serious implications on their mental health as well as physical well-being. Due to the pandemic, Lockdowns were put which led to shutting down of schools and play grounds both. The education system has been severely disrupted as the only means of providing education was online via computers, laptops and phones. Face to face interactions with teachers are a must a child’s proper development as there they can learn how to conduct themselves and also it develops their entire personality. Online education is the only available alternative but that can only provide the study material to children and not work on any other skills. Children’s screen time has increased a lot leading to eye problems and obesity due to sitting in front of the screen for such long hours. Not only this but there are several children who cannot afford mobiles or computers which led to them falling way back in their education. Another point to be mentioned here is that there are also a lot of unfortunate children who have become orphan due to this virus taking away their parent’s lives. WHO also mentions how the routine immunisation of kids has been disrupted.

Ref: //www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/covid-19-and-children

The COVID-19 pandemic has changed and will continue to change our way of life as well as the world scenarios in the coming years. At the same time, COVID-19 will surely be throwing a horrific impact on child health in the very near future. Visits to health care centers are declining due to lockdowns, imposition of movement controls, and transport disruptions, and on top of those, the community remains fearful of coronavirus
infection along with frustration for the future.

Reduction in health services:

Health services for children have decreased significantly due to the COVID-19 pandemic. COVID19 outbreak will adversely affect the condition of children, particularly the lives of the most vulnerable children. This includes disruption to their healthcare, nutrition, protection, education, and overall mental well-being, including social interaction with friends, peers, family members, caregivers, family planning, antenatal and postnatal care, child delivery, vaccinations, and preventive care and curative services. The uptake of maternal and newborn health services has decreased approximately by 19 percent. In addition, key maternal health services such as antenatal care visits and postnatal checkups in health facilities have decreased substantially, and deliveries in facilities have decreased by 21 percent from January to March 2020 compared to October-December 2019. Critical health services for under-five children also have decreased significantly due to the COVID-19 pandemic. The service utilization for children under 5 years of age in March 2020 was down to 25 percent compared to March 2019.

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