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Health Visiting 2020: Helping babies to thrive, not just survive through the COVID pandemic

10th June 2020

During Infant Mental Health Awareness Week (#IMHAW2020), we are delighted to share a Voices blog by Alan Stein, Professor of Child & Adolescent Psychiatry, Professorial Fellow, Linacre College, University of Oxford.

Alan Stein, Professor of Child & Adolescent Psychiatry, Professorial Fellow, Linacre College, University of Oxford

This week is Infant Mental Health Awareness Week (7-12 June). As families around the world continue to manage the effects of the COVID-19 pandemic, it has perhaps never been more relevant to think about the impact on the mental health of infants, young children and their families.

As many as 43% of children under 5 globally were already at risk of not achieving their developmental potential before the COVID-19 pandemic. Although evidence is only just emerging about the effects of the current pandemic on infant mental health, we know from other natural disasters and pandemics that there can be profound effects on early childhood development.

As the infant brain rapidly develops, it is particularly sensitive to environmental adversity. The realities of social distancing, separation, loss and quarantine mean that infants and their families may be isolated from social networks. Infants will be deprived of social and cognitive stimulation outside of their home during a key period of development.

Infants may be also born during an unusually challenging period. The COVID-19 crisis is expected to lead to a rise in poverty, food insecurity and maternal mortality and morbidity. Early evidence from the United States suggests that parents may be experiencing a rise in mental health problems. These stressors may undermine caregivers’ ability to provide consistent nurturing care.

However, parents can also provide a buffer between external crises and infants’ experiences. Parents, caregivers and the family are the critical drivers of infants’ health, growth and development, and supporting them will be key to determining the severity of the pandemic’s impact on infants now and in the future.

For households that experience loss or serious illness in a caregiver, the approach to communicating this to the family should be evidence based. Caregivers might avoid talking about difficult issues such as illness and death, especially when they are distressed themselves. However, research shows that children as young as 2-years old are aware of changes around them, get upset when a caregiver leaves, and seek their return. It is important that children are given coherent explanations that are clear, simple, concrete, taking into the age and level of understanding, with reassurance that they will not have to manage alone. Sensitive and effective communication has considerable benefits for the family’s long-term psychological wellbeing.

Health visitors play a key role in supporting infant mental health during and after the COVID-19 crisis. Through their contact with parents, health visitors are well poised to raise awareness around support for parental wellbeing, responsive caregiving and early childhood development. Assessments of the basic psychosocial needs of the infant should include parental stress, anxiety and depression to identify those parents who are struggling. Services, where possible, should be sensitive to the financial and social needs of families, particularly those which have experienced bereavement related to COVID-19.

Particular support is needed for the most vulnerable families, which will require unprecedented coordination of services. Our hope is that these coordinated actions and shared responsibility may not only build recovery, but better, more resilient and equitable societies to address current and future global crises.

For more information:

Recent paper on: Effects of the Global COVID-19 Pandemic on Early Childhood Development: Short- and Long-Term Risks and Mitigating Program and Policy Actions: https://www.jpeds.com/article/S0022-3476(20)30606-5/fulltext

Resources on communicating loss or serious illness related to COVID-19: https://www.psych.ox.ac.uk/research/covid_comms_support

Alan Stein, Professor of Child & Adolescent Psychiatry, Professorial Fellow, Linacre College, University of Oxford