During this period of reduced movement, it is important that medical care offered to children is continued. This includes preventative activities, such as vaccination and well-baby follow up, as well as curative activities, such as regular appointments for children with chronic conditions and treatment of acute conditions. Children may also get injured while at home. Some injuries require examination by a doctor and investigations if indicated. Delay in such cases could endanger the child’s life.

What fears do parents have on bringing their children to hospital?

Parents fear is that bringing the child to a hospital exposes them to Coronavirus disease. The fear however needs to be weighed against the risk that one is taking. There are many medical conditions that have higher mortality rates than COVID 19. If for example your child has malaria or pneumonia, and doesn’t get treated, the risk of severe complications and even death is higher than the risk of death for a child with COVID19. If a child has diarrhea and vomiting, they can easily get dehydrated with very severe consequences while one is deciding whether to take them to hospital or not.

Parents are encouraged to learn simple first aid measures that one can use before taking a child to hospital but we must avoid an unhealthy fear that impairs the caregivers judgement concerning when to take a child to hospital.

What is the effect of postponing clinics for children with existing conditions?

Children with existing medical conditions require regular follow up clinics. Depending of the child’s condition, these are spaced out differently. When such clinics are postponed, the patient’s condition may be compromised. Some medication doses need to be adjusted depending on the child’s condition such as epilepsy. Some medications need to be slowly tapered off if the child is doing well such as asthma medication. Some doses need to be adjusted as they are calculated based on weight and the child has grown.

There are also medications that are not available except at hospital pharmacies. If the patient is not brought for the clinic, some of the medications are not available and are therefore substituted. In all these instances, the patient’s condition is compromised. In the case of medications, a number of hospitals have facilitated delivery of medications to their patients.

Another category of children that we need to look out for are children with mental illnesses. The confinement and change in routine may have already affected them negatively. It is critical that their regular medications are maintained and any changes in their mental state communicated to the doctor.

What is the effect of postponing vaccinations?

The timing of vaccines is important in the immunity that they offer the patient. When a patient get one dose and then stays for a longer time than the recommended period before the subsequent dose, this affects the efficacy of the vaccine. If the interval time is too long, one may need to start the vaccination schedule for that specific condition again.

Vaccination sessions also act as well baby clinics. This is when we find out if the baby is feeding adequately and if the milestones are as expected. Without this opportunity, babies who have failure to thrive would take longer to be identified and the specific issue dealt with.

Growth monitoring is crucial to the care offered to an infant. Nutritional counselling at different stages ensures the child is getting the correct feed for the child’s developmental stage. When introducing complimentary foods, it is important to understand the food groups and how to introduce them to the child’s diet. Given that there is reduced movement currently, first time parents have less chance of getting help from their own parents or their older siblings. They are therefore left to experiment on their own.

What are the precautions parents should take while in hospital with their child to protect them?

Parents should ensure that children above 2 years wear a mask. Talk to the children about hygiene and demonstrate regular washing of hands or sanitizing them. Keep the social distance while in hospitals and avoid touching surfaces unnecessarily. Children copy what the adults around them are doing so make sure who are walking your talk. We do not recommend masks for children under 2 years, however, they should practise regular hand washing and avoid touching any part of their mouths.

Some hospitals offer teleconferencing facilities for those parents who are uncomfortable going to the hospital. This is a consultation with your doctor electronically. It may be done via a phone or via a video platform. Some hospital services can also be offered at Outreach Clinics is one is more comfortable going there than the main hospital.

There are a number options available for one to seek a medical opinion. Parents should therefore feel free to discuss these options with their doctor.

What are Hospitals doing to ensure the safety of parents and children:

At Aga Khan University Hospital, a number of measures have been put in place to ensure the safety of parents and children.

• All visitors and staff to the hospital are screened daily to pick out anyone who has a fever.
• Patients are attended to by staff with appropriate personal protective equipment. For patients without symtoms of COVID19 these are masks, gloves and eye shields.
• Examination procedures that require the doctor to stand very close to the patient are withheld unless deemed necessary given the presenting complaints. In paediatrics, these include examination of the throat.
• The staff regularly wash their hands appropriately and the surfaces are cleaned regularly.
• Sitting arrangements have been modified to ensure that patients keep the social distance when waiting for services.
• All admitted patients are day care patients are screened for COVID-19. This ensures a safer working environment for the staff and a safer living environment for the patients.
• The hospital is conducting free Covid-19 testing for all patients requiring admission.
• To minimize on face to face contact, we are also offering teleconsultation services for our patients, delivery of medications at home as well as collection of blood samples from home.

Generally, if a child needs medical attention, speak to your healthcare provider about the options available to ensure that the child’s health is not compromised during the Coronavirus pandemic. If they need to come into hospital, choose a convenient time to avoid too much waiting and take the necessary precautions. The hospitals have taken necessary precautions to ensure prevent infection within the hospital.

By Dr Waceke Ng’ang’a, Programme Director in the Department of Paediatrics, Child and Adolescent Health, and Consultant Paediatric Gastroenterologist at Aga Khan University Hospital