I thank my lucky stars every day that I’m a paediatrician, because if coronavirus was affecting children as badly as adults, I don’t know how any of us would cope.
I work as a consultant at Children's Health Ireland at Crumlin. We're very lucky the virus itself hasn't been making our young patients very sick. In line with other countries around the world, we're not seeing huge numbers of kids with it. We've tested hundreds of children, and we've had very few positive test results and even fewer who have been sick with it. There are international studies emerging now also showing that kids are not the super spreaders they were thought to be at the start of all of this, which is reassuring.
However, on a practical level, because the symptoms of Covid-19 are so vague, nearly every child who comes in acutely unwell to hospital is presumed to be Covid-19 positive, until proven otherwise. Therefore we have to put on full PPE when treating them initially, to protect staff and other vulnerable patients as well.
As terrified as adults are of PPE, imagine what it is like for children. Most kids are terrified of coming into hospital in the first place. But now, your friendly smile or grin that sometimes might relax them, is hidden by a mask. A frightened child is more difficult to examine, and the PPE makes it harder to build up a rapport with them. You gain a lot from that rapport when examining children and babies. It feels very limited and restricted. This has been one of the biggest new challenges in my day to day work.
To help make thigs a little less scary for our patients, we have lots of child-friendly posters up around the hospital. We are doing everything we can to help them adjust to the new normal. But really, it isn’t normal at all.
While this is an extremely difficult time, everybody in the healthcare system is just getting on with it, because that’s what our patients need.
One of the positive changes to come from this experience is that we in Children's Health Ireland have had a successful mini test run before the opening of the new children's hospital. Back in March, the emergency department and inpatient services were temporarily relocated from CHI at Tallaght to Crumlin and Temple Street hospitals, to protect our patients and make additional capacity for adult Covid-19 cases at Tallaght. The staff who care for these children moved with them. It was a challenging time for everyone, but it has been heartening to experience firsthand the camaraderie and goodwill that will be carried forward to our new hospital.
Personally, the effect the pandemic is having on my family breaks my heart. When I come home from working on one of the Covid wards and open the front door, and my three-year-old runs towards me and I have to say, “Stop! Don’t hug me I have to shower first.” Last week I came downstairs afterwards and my son said, “Are you clean yet Mammy, can I hug you?”
That’s what worries me about all children. You see two- and three-year-olds actively avoiding people on the street. In their little heads, people are now “dirty” and to be avoided. The impact of this pandemic on children’s mental health terrifies me. Just because children aren’t dying and they’re not getting very sick, doesn’t mean the pandemic isn’t having a negative effect on them. I’m afraid they’re going to be forgotten.
We’re not getting many Covid admissions at CHI at Crumlin, but we are still seeing children with mental health issues, perhaps more than we’ve ever had before, and that’s worrying. Children who might otherwise have been managed in the community with appropriate support are unable, along with their families, to access the services they need, which is leading to an escalation in their symptoms. There is a wide variety in the cases presenting, from anxiety with associated symptoms like severe abdominal pain and headache, to the more severe end of the spectrum of mental health disorders.
Children are going to have to live the consequences of this disease longer than any of us. We have to make sure that from an educational, mental health and physical health point of view that they’re not forgotten, because they could potentially be dealing with the knock-on effects for the next 50 or 60 years. It is imperative that every action is taken to safeguard their wellbeing as we begin the process of reopening Ireland.
Dr Jean Donnelly is a consultant in General Paediatrics in CHI at Crumlin, and fellow of the Faculty of Paediatrics at the Royal College of Physicians of Ireland.
