Child scalding during COVID-19

Since lockdown measures were implemented towards the end of March, the Burns Centre at Birmingham Children’s Hospital, Birmingham, UK, has received a 30-fold increase in the number of scalds directly resulting from steam inhalation.

On average, the unit admits two patients per year with scalds related to steam inhalation. Over the past month alone, they have admitted six children with burn injuries due to this mechanism, with the youngest child aged 2 weeks, and the most severe case involving 8% of the child’s total body surface area, requiring excision and skin grafting. The mechanism is most frequently accidental spillage of boiling water from a bowl or from a kettle. Children have occasionally been left unsupervised.

The team surveyed Burns Services across England. With an 86% response rate, they found that 50% of centres have had an increase in scalds relating to steam inhalation. This correlated with regions of England with higher prevalence of COVID-19 (London and South East; West Midlands; North West). Two-thirds of centres reported an association with Asian ethnicity (Indian, Pakistani, Bangladeshi, or Other).

Steam inhalation is traditionally used as a home remedy for common colds and upper respiratory tract infections. The evidence base of the practice is weak, with unproven theories that the steam loosens mucus, opens nasal passages, and reduces mucosal inflammation, or that the heat inhibits replication of viruses. Social media and home-made tutorials from unverified sources have a role in misleading parents into practising this dangerous habit.

Scald injuries are the commonest cause of burns in children. Steam inhalation is a hazard to children. Resulting scalds can ultimately lead to hospital admission, surgery, and life-long disfigurement.

Parental education is paramount to preventing these injuries. Clinicians should actively discourage steam inhalation and educate parents about alternative treatments for their child.

Go to the Lancet to read Steam inhalation and paediatric burns during the COVID-19 pandemic

Call for case studies – Making history: health visiting during COVID-19

iHV is working collaboratively with Public Health England to capture the stories, workarounds, innovation and rapid learning that has taken place in the health visiting service since the country went into lockdown in March.

We plan to publish these in a special edition of our case study series as a record of this time when history is being made. Capturing your experiences in this way will help us celebrate your successes, learn from each other and provide a legacy for future generations to reflect on.

We invite you to be part of this by submitting your experiences in a variety of ways listed below.

Tell us what it has been like for you

Demonstrate why health visiting matters

Whilst working in a pandemic has presented numerous challenges for the health visiting profession and the families that we work with, it has also provided a unique opportunity for the profession to demonstrate its crucial role, supporting children and families across the breadth of clinical, social and statutory need.

The pace and scale of change has been second to none and health visitors have risen to this challenge with professionalism and autonomy, flexing and developing innovative service “workarounds” to ensure that families receive the best possible support. Different areas have responded in different ways. No doubt some innovations have worked better than others – it is only by testing and refining that we can really learn and drive quality improvement.

It is imperative that we capture this learning to ensure that we are better prepared for any future pandemics.

What do we need to celebrate? and what have we collectively learned to strengthen future planning?

To avoid reinventing the wheel, or investing time in ideas that have been proven not to work elsewhere, it is important that we all learn from our collective successes as well as our failures.

Help us to capture this by submitting:

Service level case studies that describe your journey and the ways you adapted your service. We are particularly interested to include case studies which detail the ways you managed social distancing, including use of PPE and technology.

What issues did you face locally? What were the most pressing needs of the families in your area? How did you address these? What did you learn along the way (what worked – what didn’t/ benefits and limitation)? What was the impact/ outcomes (include any data/ direct service user feedback and quotes).
(Your case study should be written following the PHE case study guidelines for standard format, and the additional information listed in the iHV case study template – 1800 words maximum)

Family stories – families have faced considerable challenges – tell their story. What challenges did they face, why did this matter? what did you do? and how did your intervention make a difference? – what would the outcomes have looked like without health visiting input? We are interested to receive submissions from the breadth of the health visiting role outlined in the 15 High Impact Areas in the iHV Vision (800 words maximum)
Creative submission – for those of you with a creative flair – have you captured your experiences of working in a pandemic in an artistic way? A poem, a piece of art? We would love to share your stories of working during a pandemic through a variety of mediums.

How to submit

If you would like the work that you are doing to be considered for this publication, please complete your application following the guidelines (please use the iHV case study template).

We welcome the inclusion of photographs which capture your experiences and the ways that your service has adapted during the pandemic. Please ensure that you have gained consent from all subjects in the photographs (service users and staff) for their use within the iHV case study publication.

Please send your completed application to [email protected] by midnight on Monday 29 June.

All submissions will be peer reviewed and applicants will be notified of the outcome within 3 weeks of the closing date.

If you would like to talk through your ideas – please contact Alison Morton [email protected]

Download iHV case study template

iHV co-signs letter to Prime Minister to act now to improve babies’ wellbeing

At the start of Infant Mental Health Awareness Week, the leaders of nearly 80 organisations, including the Institute, have signed a letter to the Prime Minister calling on him to make the youngest children a national priority in order to mitigate the secondary and potentially long-term impact of the COVID-19 crisis.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“Health visitors have seen at first hand the impact of COVID-19 and the lockdown on new families, and therefore support this important call for much more attention to be placed by government onto the earliest days. There is no other time in the lifespan where investment will save so much on later fiscal spend. It is not only the right thing to do, it also makes sound economic sense and we hope that the prime minister will want to support this call.”

The letter from the First 1001 Days Movement argues that, as politicians decide on COVID-19 relief and recovery packages, there is an opportunity now to invest in the wellbeing of babies and toddlers and the parents that care for them, as part of efforts to build back a better Britain.

The signatories, which include major children’s and mental health charities and professional bodies who are all part of the First 1001 Days Movement, ask the Prime Minister to champion a cross-government strategy for improving outcomes for all children. This should set out a vision for how families will be supported to recover from the impact of COVID-19 and how the Government will begin to ‘level up’ and close gaps in outcomes which have widened during the pandemic.

Download First 1001 Days Movement letter to Prime Minister

Making history: health visiting during COVID-19

Call for Case Studies

We invite you to be part of this by submitting your experiences in a variety of ways listed below.

Tell us what it has been like for you? Demonstrate why health visiting matters?

Whilst working in a pandemic has presented numerous challenges for the health visiting profession and the families that we work with, it has also provided a unique opportunity for the profession to demonstrate its crucial role, supporting children and families across the breadth of clinical, social and statutory need.

The pace and scale of change has been second to none and health visitors have risen to this challenge with professionalism and autonomy, flexing and developing innovative service “workarounds” to ensure that families receive the best possible support. Different areas have responded in different ways. No doubt some innovations have worked better than others – it is only by testing and refining that we can really learn and drive quality improvement. It is imperative that we capture this learning to ensure that we are better prepared for any future pandemics.

What do we need to celebrate? and what have we collectively learned to strengthen future planning?

To avoid reinventing the wheel, or investing time in ideas that have been proven not to work elsewhere, it is important that we all learn from our collective successes as well as our failures.

We are looking for:

Service level case studies that describe your journey and the ways you adapted your service. We are particularly interested to include case studies which detail the ways you managed social distancing, including use of PPE and technology.

Family stories – families have faced considerable challenges – tell their story. What challenges did they face, why did this matter? what did you do? and how did your intervention make a difference? – what would the outcomes have looked like without health visiting input? We are interested to receive submissions from the breadth of the health visiting role outlined in the 15 High Impact Areas in the iHV Vision (800 words maximum)
Creative submission – for those of you with a creative flair – have you captured your experiences of working in a pandemic in an artistic way? A poem, a piece of art? We would love to share your stories of working during a pandemic through a variety of mediums.

How to submit your case study:

If you would like the work that you are doing to be considered for this publication, please complete your application following the guidelines (see iHV case study template).

We welcome the inclusion of photographs which capture your experiences and the ways that your service has adapted during the pandemic. Please ensure that you have gained consent from all subjects in the photographs (service users and staff) for their use within the iHV case study publication.

Please send your completed application to [email protected] by midnight on Monday 29 June.

All submissions will be peer reviewed and applicants will be notified of the outcome within 3 weeks of the closing date.

If you would like to talk through your ideas – please contact Alison Morton [email protected]

iHV joins global call to put Public Health at centre of COVID-19 recovery

The Institute of Health Visiting joins over 40 million doctors, nurses and other health professionals from 90 countries, including many working on the frontlines of the COVID-19 pandemic, in sending a letter today to G20 leaders urging them to put public health at the centre of their economic recovery packages, to help avoid future crises and make the world more resilient to them.

In the biggest health community mobilisation since the run-up to the 2015 Paris climate agreement, over 350 medical groups representing health professionals (including the World Medical Association, the International Council of Nurses, the Commonwealth Nurses and Midwives Federation, the World Organization of Family Doctors and the World Federation of Public Health Associations) have signed the letter on behalf of their members, along with thousands of individual health professionals.

The letter asks governments to prioritise investments in public health, clean air, clean water and a stable climate in the economic stimulus packages currently under consideration. Such investments would reduce air pollution and climate-warming emissions, which damage human health, build greater resilience to future pandemics, and simultaneously create more sustainable jobs.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“The world has the opportunity now to ensure that the next generation is not inhibited by the mistakes of the last. By tackling climate change and ensuring better preparedness for any future pandemics, babies can be given the opportunity for a long and healthy life where they have the health, wellbeing and opportunity to contribute to their economy, to future economies, and to the wellbeing of their descendants.”

To achieve this healthy recovery, leaders of the G20 countries must involve their medical and scientific community in developing the stimulus packages. These stimulus decisions must also take into account medical and scientific assessments of how the measures will impact public health in the short- and long-term.

The COVID-19 pandemic has exposed doctors, nurses and other health professionals to death, disease and mental distress at levels not seen in decades. The scale of this pain could have been at least partially mitigated by adequate investments in pandemic preparedness, public health and environmental stewardship, the letter states.

As the COVID-19 pandemic has made very clear, the economy suffers when human health is compromised. A science-based approach to a healthy recovery from COVID-19 must lead to decisions to reduce both air pollution, which weakens the lungs, hearts and other organs, and greenhouse gas emissions, which cause drought, extreme heat, flooding, wildfires and other life-threatening disruptions. This should be alongside ensuring every baby is given the best possible start in life and access to education and their parents supported.

A healthy recovery requires governments to invest in sustainable and innovative industries, jobs, food production and food supply chains. In doing so, leaders will encourage healthier diets, more renewable energy, more walking, cycling and zero-emissions public transport, a radical regeneration of trees and nature and other changes that will underpin human, economic and planetary health well into the future.

This letter is supported and promoted by the Global Climate and Health Alliance, Every Breath Matters, and the World Health Organization in service of the global medical and health community.

Go to full list of letter signatories

NMC announces a further extension of revalidation periods due to COVID-19

The Nursing and Midwifery Council (NMC) has announced a further extension of revalidation periods because of the Covid-19 pandemic. It had already announced earlier this year that nurses and midwives due to revalidate from March to June 2020 would have a further three months to complete revalidation.

Registrants due to revalidate from July onwards can request a three-month extension and, after that, a further three-month extension may be allowed if the individual can demonstrate a valid reason.

Health visiting on BBC Radio 4’s Woman’s Hour today

Dr Cheryll Adams CBE, Executive Director iHV, joined BBC Radio 4’s Woman’s Hour today to discuss extending maternity leave for those who are new parents during the COVID-19 pandemic.

Recently, parents of a six-month old baby launched a petition asking the government to extend maternity leave by an extra three months. They believe that the lockdown has meant parents have missed out on the usual things you’d do on maternity, putting them at a disadvantage. This lead to a House of Commons Petitions Committee discussion where Dr Adams contributed some evidence and raised the profile of the work of health visitors during COVID-19 (see our news story on this). The the signatures for the petition are still coming in – it’s not know yet whether it’ll be debated in the House of Commons but there id due to be another Q&A session on Thursday this week.

Dr Adams says:

“There are challenges for new parents under lockdown due to COVID. There’s been so much attention on hospitals and needing to treat people, that the needs of families have perhaps been forgotten – this has been a big concern of the Institute.”

And in response to concerns about the reported increase in perinatal depression, Dr Adams commented:

“My advice is that GPs are open, health visiting services are open, midwives are there, so if anyone is feeling anxious, please, please pick up the phone and call.”

The news item on extending maternity leave starts at the beginning of today’s Woman’s Hour programme and runs for about 10 minutes. You can listen to Dr Adams between 5.39 and 10.03 on the BBC Radio 4 link below:

Go to Woman's Hour podcast 19 May 2020

Executive Director writes to the Prime Minister on behalf of children

Dr Cheryll Adams CBE has written to the Prime Minister, Boris Johnson MP, to ask him to start to strengthen the health visiting profession now so that it can play its part to help all UK children to be given the opportunity to have the very best start in life. The Institute is particularly concerned by the growing rates of poverty and widening of health inequalities in the UK, both pre and during the COVID-19 pandemic, and their impact on babies, all children and their parents. This has happened alongside a significant loss of health visitors and development of unwarranted variation in the service across the UK over the past five years.

In the letter to the Prime Minister, the Institute is calling for a national strategy to start to rebuild the health visiting service now, so that it will be able to respond to a range of problems that are expected to be found when families come out of lockdown. These include missed developmental delays, maternal and paternal mental illness, and growing levels of reported domestic violence. Science has shown that, if not recognised promptly, all can have a significant impact on an infant’s growth and development and their functioning in the future.

Dr Adams has offered the Institute’s recently published Vision document as a framework for new developments for health visiting alongside their expertise.

NSPCC – Many new parents may be ‘suffering in silence’ during lockdown

On Maternal Mental Health Awareness Day (6 May), the NSPCC highlights rising concern that many new parents may be ‘suffering in silence’ during lockdown.

The Institute was pleased to support an NSPCC virtual roundtable looking at the effects of the COVID-19 crisis on new mothers’ mental health, and the risk of potential long-term consequences on babies’ health and development. The panel said their services had adapted to support parents digitally, but they shared concerns about the effect of the COVID-19 crisis on mothers and babies.

The NSPCC reported an increase of 28% in calls to its helpline about parental mental health in the first three weeks of lockdown.

Before the pandemic, up to one in five mothers and one in 10 fathers experienced perinatal mental health problems, the charity said.

Eileen O’Sullivan, a specialist health visitor in Warwickshire, said:

“Supporting mothers digitally can be challenging and there is a concern that some may be suffering in silence, too scared to share how they are really feeling over video.

“I am also seeing that my colleagues are being extra vigilant because we don’t want to miss anything.”

The NSPCC cited data from the Institute of Health Visiting, which found in some areas of England at least 50% of health visitors, including some from perinatal mental health and parent-infant teams, were redeployed into other health services in the initial period of the lockdown.

The NSPCC is urging the Government to ensure support is provided to parents as the country comes out of lockdown, and to come up with a plan to rebuild health visiting and perinatal services after the crisis.

Andrew Fellowes, public affairs manager at the NSPCC, said:

“At the NSPCC we know that, if undetected and untreated, perinatal mental health problems can have a devastating impact on women, partners and babies, both immediately but also long after the COVID-19 situation has passed.

“It is imperative that families continue to have access to services during the lockdown so that mental health problems can be identified and specialist support provided if needed.”

The iHV continues to support health visitors, our perinatal mental health champions and specialist health visitors in perinatal and infant mental health to deliver their services to families who may be adversely affected by the lockdown, particularly with respect to safeguarding and mental health issues. We have produced specific guidance to help which can be found in our COVID-19 (coronavirus) guidance for health professionals webpage: https://iHV.org.uk/COVID-19

Updated resources on childhood immunisations during COVID-19

As part of World Immunization Week 2020, our resources on childhood immunisations have been updated with the latest information and advice during the current COVID-19 pandemic – two Parent Tips and one Good Practice Points for Health Visitors.

The two updated Parent Tips:

one providing some basic information on the childhood immunisation programme, explaining how vaccines work, how they are regulated and why it is important to ensure your baby receives all the recommended immunisations
the second, provides answers to “Frequently Asked Questions” and has been written by leading national experts. It covers getting your baby immunised and what to expect, including information on things such as soothing your baby
during and after vaccinations, and what to do if they are poorly on the day of their appointment.

Just to reassure you that despite the current COVID-19 pandemic, it is still recommended that your child receives their vaccines as this protects them against other serious diseases that can still cause them harm.

Parent Tips - Childhood Immunisations 1: An introduction to childhood immunisations

Parent Tips - Childhood Immunisations 2: Frequently Asked Questions

These updated Parent Tips, together with those published last week and yesterday, can be found in our **Parenting Through Coronavirus (COVID-19)** webpage

The Good Practice Points for Health Visitors:

The immunisation programme is a key component of the Healthy Child Programme. It is important for health visitors to be aware of current research and practice to promote immunisation uptake and know where to go for information. Uptake of childhood vaccines in the UK is is generally high, although uptake of the MMR is a concern and the UK lost its ‘measles-free’ status last year. There are also concerns about the impact of the COVID-19 lockdown on immunisation uptake.

Go to GPP - Promoting the Uptake of Childhood Immunisations

COVID-19 webpages

For Health Visitors– This updated GPP is available in our GPP resource section of our website and can also be found on our COVID-19 (coronavirus) guidance for health visitors webpage – https://iHV.org.uk/COVID-19
For parents and families– These updated Parent Tips are available in the Families Parent Tips section of our website as well as our Parenting through Coronavirus (COVID-19) webpage – https://iHV.org.uk/ParentingCOVID19

We have waivered our usual restrictions on resources for members and the COVID-19 sections of our website are “free access” to all to support the national response to this pandemic.