Supporting Children Who are Infected or Affected by COVID Pandemic
It is the role of Palliative Care Community to ensure basic needs of children to be satisfied, support their emotional needs, and guide parents/ care givers on how to talk and support children through- out the COVID-19 pandemic; said the experts participated in the echo series on Supporting Children Who are Infected or Affected by COVID pandemic. This was the 6th in the series of ECHO Sessions organised by Indian Association of Palliative Care (IAPC) with the support of Hyderabad Centre for Palliative Care and Two Worlds Cancer Collaboration, Canada. The program was held on 7th May 2020 from 6:30 AM to 7:30 AM.
Dr. Megan Doherty of TWCC led the session. According to Dr. Doherty, Children are more vulnerable compared to adults and stress from separation or parental loss is huge and can affect child with lasting effects. She emphasized the role of Palliative Care Community in ensuring the care needs of children with serious illness. The needs should be met during the pandemic as these children may suffer collateral damage due lack of medication, isolation in home, and due to lack of usual clinic visits/care.
Listening to children and exploring their understanding about the COVID pandemic, understanding their thoughts and worries are important because children are very imaginative and they may have fearful or frightening ideas that we can clarify and reassure them with truthful and age appropriate information. There are 5 Cs of what children want to know: Did I CAUSE it?,Can I CATCH it?, Can I CURE it?, Who is going to take CARE of me?How will we stay CONNECTED?”, explained Dr. Doherty. Booklets for children to understand COVID-19 were shared by Dr. Doherty.
Dr. Lulu Mathews a pediatrician and Program Director, Academics, Institute of Palliative Medicine explained details of providing care to new born babies of mothers with suspected/ confirmed COVID-19 infection.
In the case of mothers with suspected infection, feeding is allowed with precautions. Mother should wear a triple layer mask, hand and breast hygiene to be strictly followed- explained Dr. Lulu Mathews.
The mother’s face to be turned away from the baby if she has to cough or sneeze.
If the mother has COVID-19 (confirmed), expressed breast feeding is advised.Baby should be isolated from the mother. There should be a carer, who should follow all hygiene practices like wearing masks, hand hygiene etc.
The carer can feed the baby with the expressed milk.
Immunization including BCG to be given to child after the isolation period, ie, once the mother is tested negative. If there is a COVID patient at home (supected/confirmed – in home quarantine) no immunization should be given to the child. All immunization can be given after the patient is tested negative.
If there is a COVID patient at home, provide seperate space for the child. limit the movement of child inside the home. Allow ventilation in common areas like kitchen and toilet.
Do not share utensils and bed line provided to the patient. A distance of 1 metre to be maintained from the bed of the patient (if there is no seperate room available in the house).
Dr. Hariprasad, a pediatrician working at Cochin Medical College, shared his experience in treating children with COVID. Kids with confirmed infection were provided separate rooms in the hospital and their parents were allowed to stay with them. “But keeping the child inside the room during the treating period was a challenge. The solution was to engage the kids with computer or phone- said Dr. Hariprasad. The screen addiction is a challenge here.
Kids with suspected infection were advised to stay under home quarantine, and keeping the child inside a room again became a challenge in home setting.
“The third set of children who are affected by this pandemic are children with chronic conditions – who are diabetic, or with renal disorders etc. Due to the pandemic their regular hospital visits are being restricted, they couldn’t get the free supply of medicines, financially affected parents cant afford to buy medicines from nearby private medical shops and all these causing issues for children.” – said Dr. Hariprasad.
Dr. Sushma Bhatnagar, President, IAPC and Head of the Department, Palliative Care and Onco Anaesthesia, All India Institute of Medical Sciences (AIIMS), New Delhi shared her experience in managing infected mothers and their new born babies and children admitted in COVID-ward for treatment.
In the case of an infected mother whose new born baby was COVID negative, the family decided to keep the baby away from the mother. They were not ready to allow breast feeding and it was a situation which caused stigma. “We had to meet the mother every day and ensure that her baby was well.” – said Dr. Sushma.
Dr. Sushma said that their hospital could set up a play area
for children below 10 years who were under treatment for COVID- 19 inside the ward with lots of toys, and they could play together happily till they tested negative and got discharged. This made their days less anxious during treatment.
The echo series is available below.