PIMS-TS: the COVID-19 linked syndrome affecting children – information for Health Visitors

Most children and teenagers do not become seriously ill with COVID-19, but doctors have seen a very small number of patients with an unusual condition which seems to be linked to the virus. Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is very rare; it occurs in less than 0.05% of children with COVID-19. Most children with the condition will not be seriously affected but, in some cases, it can be serious.

This news story has been written in collaboration with Dr Sanjay Patel (paediatric infectious disease and immunology consultant – Southampton Children’s Hospital) to raise awareness of this condition and provide some helpful links to trusted sources of information to support you in your work with families.

Signs and Symptoms of PIMS-TS:

fever, which persists over several days
there’s a very wide range of other symptoms that children might have, including abdominal pain, diarrhoea, vomiting, rash, cold hands/feet and red eyes. These symptoms can be found in other illnesses too.

Children and young people who are seriously affected will have symptoms which are very similar to other life-threatening conditions such as sepsis or meningitis. Some of the symptoms of PIMS-TS can overlap with other rare conditions, such as Kawasaki disease and Toxic Shock Syndrome. Kawasaki disease tends to affect children under five, whereas PIMS seems to affect older children and teenagers.

While most children won’t be seriously unwell, some children may be severely affected by the syndrome. Experts advise, the most important thing is to remember that any child who is seriously unwell needs to be treated quickly – whatever the illness.

Laura is mother to Oliver, and she is raising awareness of PIMS and the symptoms to look out for:

“Oliver tested positive for Covid with no symptoms in March. Four weeks later, he lost his appetite, became lethargic and developed tummy pains. I took him to A&E, where he was diagnosed with tonsillitis and sent home. Over the next few days, Oliver developed a persistently high temperature, a blotchy rash, swelling, deep red lips, palms and eyelids and bloodshot eyes and was admitted to hospital. Oliver’s blood pressure kept dropping and his heart function was deteriorating so he was transferred to the paediatric intensive care unit. Oliver was then diagnosed with PIMS-TS. Thankfully, Oliver has made a good recovery after 5 days in ICU and 2 weeks in hospital, we were able to return home. There appears to be no long-term heart damage, although he still needs regular heart check-ups”.

(Shared with permission from Laura)

Children from all ethnic minority backgrounds have been affected by PIMS. A greater proportion of children from Black and Asian backgrounds appear to be affected by PIMS-TS, although it is still not clear what the reason for this is. Nonetheless, it is important for families from all ethnic backgrounds to be aware of the signs and symptoms of the condition, however rare.

Dr Sanjay Patel said:

“The good news is that effective treatments are readily available for treating PIMS-TS and the vast majority of children make an excellent recovery.”

The Royal College of Paediatrics and Child Health has developed a series of posters and information for parents and young people to help explain when and how to seek medical help for their child:

Further information and answers to commonly asked questions can be found on the Healthier Together website for parents and professionals:

https://what0-18.nhs.uk/popular-topics/coronavirus

New advice to help new parents during the pandemic

Paediatricians, health visitors and GPs have joined forces to produce guidance for parents who are worried about their new baby.

The Royal College of Paediatrics and Child Health (RCPCH) has joined forces with the British Association of Perinatal Medicine (BAPM – part of the RCPCH), the Institute of Health Visiting (iHV), and the Royal College of General Practitioners (RCGP) to produce a ‘fridge’ poster which signposts when and where parents should seek help for babies aged three months and under.

Over the summer, paediatricians reported that a small number of children may have become seriously ill because of delays in accessing health services*. Health professionals are concerned that such delays could happen again this winter as some paediatricians are reporting seeing far fewer children than they would have expected.

Parents may not know they are still able to have face-to-face consultations, may find it difficult to get an appointment quickly when worried, or may be concerned about COVID transmission. Added to this, new parents in some parts of the country have not had the usual access to health visitors (many of whom were redeployed into other roles during the pandemic), and lockdowns have meant some have not been able to see their extended families, friends and other parents.

Dr Helen Mactier, President of BAPM, said:

“Being a new parent can be daunting at any time, but having a new baby during a pandemic can throw up a lot of additional challenges for many families – even more so under lockdown.

“Many parents haven’t had the usual access to routine face-to-face appointments with a healthcare professional or been able to discuss a change in their baby’s appearance or behaviour with other new parents or their own friends and family. That can be really worrying.

“We want to let parents know what should or shouldn’t be of concern with regard to their baby’s health, and to put their minds at rest that the NHS is here for them if their baby is unwell.”

Dr Cheryll Adams, Executive Director of the Institute of Health Visiting, said:

“We’re delighted to support the publication of these new information posters and will be distributing them widely to health visitors and parents. COVID-19 has shone a light on the challenges for new parents who may not be sure whether a change of behaviour or appearance in their new baby suggests that they are unwell. These posters make clear when they should seek help which will be very reassuring.”

Professor Martin Marshall, Chair of the Royal College of GPs, said:

“Children rarely become ill with COVID-19 but there are other conditions which can be serious if left untreated. We want parents of young children to seek medical help when they are concerned about the health of their child – and to know that despite lockdown restrictions, general practice services are available, although they might be delivered in a different way than usual. Where necessary, face-to-face appointments will be facilitated in as safe a way as possible. This guidance will help people to decide when they should get help as well as when they don’t need to worry.”

Download Guidance for parents of babies age three months and under

*https://adc.bmj.com/content/early/2020/11/02/archdischild-2020-320565

https://adc.bmj.com/content/early/2020/06/24/archdischild-2020-319848

iHV welcomes RCPCH comments on health visiting

We are delighted to see the support of Professor Russell Viner, President, Royal College of Paediatrics and Child Health (RCPCH), for the health visiting profession.

Redeployment during lockdown means many families are missing out, says Professor Viner

Professor Russell Viner, President, Royal College of Paediatrics and Child Health

Read Professor Russell Viner's opinion article in Nursery World - Health visiting is in crisis

Also read RCPCH news item - Redeployment of health visitors has left vulnerable children at risk

Health Visitors and Paediatricians publish advice for parents about the six-week postnatal check during COVID-19

All babies have a routine physical examination between six and eight weeks, but these important appointments may be missed due to the impact of COVID-19. The Institute of Health Visiting (iHV) and the Royal College of Paediatrics and Child Health (RCPCH) have published a guide for parents about signs to look out for if they have been unable to get an appointment, or if it has been delayed.

At the 6-8 week check, babies have a thorough physical examination – this is usually done by a GP. Babies’ eyes, heart, hips and, for boys, testicles are checked – and they also have their weight, length and head circumference measured to ensure that baby is developing as they should.

Dr David Evans, Consultant Neonatologist and Vice President at RCPCH said:

“All newborns have a physical examination after birth. This picks up most, but not all, of the problems we look out for in the first weeks of life. That’s why it’s so important for babies to have a six-week check, which is usually carried out by a GP.”

Dr Cheryll Adams CBE, Executive Director of the Institute of Health Visiting said:

“We really want parents to attend this check-up, but we know that it may not always be possible due to the impact of COVID-19. If you’re a new parent who has struggled to get an appointment, or if it’s been delayed, we’ve produced some easy to follow signs to look out for while you wait to see a GP.

“The iHV is asking every health visitor to share this important guide with all parents when they are first in contact with them after the birth of their baby.”

The guidance says, if your baby does not have a six-to-eight-week check, you should ask yourself the following questions. If the answer to any is “yes”, you should contact your health visitor or GP.

Eyes

Do you think your baby can’t ever fully open both eyes?
Do you think your baby doesn’t make good eye contact and hold his/her gaze at you?
Do you think that your baby doesn’t follow your face if you move your head from side to side when standing near him/her (less than one metre)?
Do you think that your baby’s eyes shake/flicker/ wobble? Do you think there is something unusual about, or in, your baby’s eyes, for example, the dark central area (pupil) looks cloudy or the eyeball is an unusual shape or size?
Are the whites of your baby’s eyes yellow?

Hips

When you change your baby’s nappy, do you find that one leg cannot be moved out sideways as far as the other?
Does one leg seem to be longer than the other?
Do you have any other concerns about your baby’s hips?

Heart

(If the answer to either of these is “yes”, you should speak to someone the same day)
Does your baby seem breathless or sweaty, at any time, especially when feeding?
Does your baby have blue, pale, blotchy, or ashen (grey) skin at any time?

This guidance is published as an iHV Parent Tip and is available here:

Go to PT -Routine screening reviews at 6-8 weeks during COVID-19

RCPCH responds to recent reports on COVID-19 and children

Further to a reported small number of cases of a COVID-19 related condition emerging in children (a novel presentation of multisystem inflammatory disease), the Royal College of Paediatrics and Child Health has made a statement.

Commenting on reports of a COVID-19-related condition emerging in children, Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, said:

We already know that a very small number of children can become severely ill with COVID-19 but this is very rare – evidence from throughout the world shows us that children appear to be the part of the population least affected by this infection.

New diseases may present in ways that surprise us, and clinicians need to be made aware of any emerging evidence of particular symptoms or of underlying conditions which could make a patient more vulnerable to the virus.

However our advice remains the same: parents should be reassured that children are unlikely to be seriously ill with COVID-19 but if they are concerned about their children’s health for any reason, they should seek help from a health professional.

The recent reports said that some hospitals have been treating severely sick children with unusual symptoms – this includes “multi-system inflammation” with flu-like symptoms. However, it is important to highlight that, both in the UK and in other countries, there have still been very few cases of critically unwell children with COVID-19 admitted to paediatric intensive care units.

Parents should be reassured by this, but if they are concerned about their children’s health for any reason, they should seek help from a health professional.

Download RCPCH - guidance for parents on symptoms and seeking advice

Go to iHV Parenting through COVID-19 resources

New resources on managing the most common childhood illnesses

While the impact of COVID-19 on children is thought to be minimal, evidence is emerging that children and families are unsure about how to manage common childhood illnesses and when/ where to seek medical advice.

The Royal College of Paediatricians and Child Health (RCPCH) has raised concerns that families are worried about the risks of infection from COVID-19 and are not accessing medical advice as soon as is needed. To support parents, the RCPCH and “Healthier Together” have produced a guide, “Advice for parents during coronavirus”.

Download Advice for parents during coronavirus

The iHV has also been working with “Healthier Together” and today we are launching five new “Parent Tips” on managing the most common childhood illnesses, with signposting to further advice for parents to help ensure children get the right care at the right time and right place.

PT - Wheeze and breathing difficulties

PT - Fever / high temperature

PT - Rashes: When should you worry?

PT - Diarrhoea and Vomiting (D&V)

PT - Head injury

We have also developed a new Good Practice Point to support health visitors make the best use of these Parent Tip resources and provide evidence-based advice when parents are unsure what to do when their child is unwell.

GPP - Managing childhood illnesses

Acknowledgement and thanks:

The content of these Parent Tip advice sheets was developed by “Healthier Together” and adapted by the Institute of Health Visiting with permission from Dr Sanjay Patel. More information on the full range of Healthier Together resources and what to do if you are worried that your child is unwell are available here:

Go to Healthier Together

iHV welcomes RCPCH State of Child Health 2020 report

iHV welcomes today’s publication of the Royal College of Paediatrics and Child Health (RCPCH) report, State of Child Health 2020, the largest ever compilation of data on the health of babies, children and young people across all four UK nations.

The report shows that for many measures of children’s health and wellbeing, progress has stalled, or is in reverse – something rarely seen in high income countries.

Across most indicators, health outcomes are worse for children who live in deprived areas. Inequalities in some outcomes have widened since the last State of Child Health report in 2017. Progress has also been seriously affected by deep cuts to local authority budgets – used to finance public health initiatives and community services.

Commenting on the launch of the State of Child Health 2020, Dr Cheryll Adams CBE, Executive Director of the iHV, said:

“The results of this report make very sad reading. They build on the evidence base from the recent Marmot 10 years on report and our own latest published research with the health visiting workforce. The State of Child Health 2020 recommendations are excellent and now need to be implemented by ministers. You don’t get a second chance with children – those most disadvantaged today, will be drawing disproportionately on health and wellbeing services tomorrow.

“If the government has any ambition to leave the country in a better place than it was in when they picked up the reins, they must listen and respond quickly to all these recent reports. Our most vulnerable citizens are becoming more vulnerable and only government can change that. Children really can’t wait. Already, many children face uncertain futures as their families haven’t received vital support during their early years.

“It is positive to see health visiting identified as a solution in the RCPCH report. Yes, it is a solution, but very urgent action is required to reinvest into public health before the implications of not doing so become even more stark.”

State of Child Health 2020 brings together 28 measures of health outcomes, ranging from specific conditions – such as asthma, epilepsy, and mental health problems – to risk factors for poor health such as poverty, low rates of breastfeeding, and obesity.

The authors make a number of policy recommendations for each nation. For England, these include:

Introduce a cross-departmental National Child Health and Wellbeing Strategy to address and monitor child poverty and health inequalities.
Restore £1 billion of real-terms cuts to the public health grant for Local Authorities.
Ensure future investment in public health provision increases at the same rate as NHS funding and is allocated based on population health needs.
Implement in full commitments from the prevention green paper, Advancing our health: Prevention in the 2020s.
Implement commitments to provide a Youth Investment Fund, with protection of the committed £500m funding.
Provide health-based support for children throughout education, including funding for increased numbers of school nurses and school counsellors.
Provide renewed investment in services for children and families, which support the child’s school readiness.
Ensure that health visiting services are protected, supported and expanded with clear and secure funding.

Go to RCPCH State of Child Health website for more information

Putting children’s oral health on everyone’s agenda – free webinar

RCPCH free webinar 16 October 2019 at 12.00 BST

Children’s oral health has recently been gaining attention in the media. Dental extractions are now the most common reasons for a child aged 5-9 years to be admitted to hospital in England and Wales.

Join RCPCH for this free webinar – register on the link below.

The target audience for this webinar is any health professional (GPs, paediatricians, health visitors, school nurses etc) who may need to provide advice for families.

By the end of the webinar, attendees will:

understand the issue of dental caries at a population and patient level
understand the key messages for delivering better oral health
have an awareness of professional interventions being carried out throughout the UK
understand the role of paediatricians in encouraging good oral health in children and young people

The webinar is aimed at a UK audience.

Please register on the link below. After registering, you will receive a confirmation email containing information about joining the webinar.

Child health in England falling behind other European countries

A new report, published today by The Royal College of Paediatrics and Child Health (RCPCH) ,warns that child health in England is lagging behind other European countries, with child mortality potentially 140% higher than other comparable nations by 2030 and reported mental health problems set to increase by 60%.

The ‘Child health in 2030 in England: comparisons with other wealthy countries’ report compares England with European and other western countries known as the EU15+. With the combination of England’s current poor standing for key outcomes in line with the averages in the EU15+, and our slower rates of improvement for key outcomes, the report finds that child health outcomes in England will not only compare very poorly to similar countries in 2030, but that we will be falling even further behind. The marked health inequalities between the most and least deprived children in most key outcomes are also set to widen over the next decade – presenting real challenges for health services in ensuring and improving access to those who need them most.

Dr Cheryll Adams CBE, Executive Director at the Institute of Health Visiting said:

“It feels very timely for the RCPCH to produce this report – ‘State of Child Health 2030’ to alert MPs and policy makers to the risks of not taking action now to strengthen all services for children. Health visitors are already very concerned by the impact of current issues for children such as increasing childhood poverty, mental illness and obesity set against a decommissioning of essential services such as health visiting and school nursing due to recent reductions in public health budgets.

“These challenges faced by children and families are not just worrying for their impact on the life course of those affected. We also now have good evidence that they will also be having significant impacts on the economy now and in the future. We recommend ministers heed the advice of Nobel prize winner James Heckman and invest into the very early years to reduce later fiscal expenditure. We believe that the benefits to the economy would quickly be felt by government.”

Amongst the report’s key findings are:

Mortality rates may be 140% higher for infants in England than in comparable wealthy nations by 2030
Reported mental health problems are set to increase by 60%, based on current trends
1 in 3 of the most deprived boys in England will be obese by 2030 without urgent implementation of the Childhood Obesity Plan and additional measures
A&E attendances for children may increase by 50% and outpatient attendances by 48%

In response, RCPCH is urging NHS England to develop and implement a Children and Young People’s Health Strategy as part of its long-term plan. They believe that a holistic CYP Health Strategy is essential to drive forward the ambitious actions, coordination and leadership needed to address the complex factors underpinning their findings. The long-term plan offers a critical opportunity to put children and young people at the heart of our health service, at every level, and the report demonstrates the risks of not taking action as soon as possible.

Download RCPCH State of Child Health short report: Child health in 2030 in England: comparisons with other wealthy countries

Download State of Child Health short report: Child health in 2030 in England - Recommendations

Excellent breastfeeding conference!

Dr Cheryll Adams opening the breastfeeding conference

What an amazing day we had at the breastfeeding conference, held on Thursday 19 April 2018 in London! Lots of great information shared and we’ve received some fab feedback from #breastfeeding2018. Breastfeeding: a public health priority was joint hosted with the Royal Society of Public Health (RSPH) and supported by the World’s Breastfeeding Trends Initiative (WBTi).

Professor Russell Viner, RCPCH, addressing the conference

Professor Viv Bennett addressing the conference.

A huge thank you to all the exceptional speakers – it was a very dynamic day with masses of learning and collaboration.

In addition, Jonathan Ashworth MP, Shadow Secretary of State for Health, announced a pledge to introduce an additional mandated health visit at 3-4 months, as part of Labour’s commitment to making Britain’s children the healthiest in the world. See our previous news story on this.

Jonathan Ashworth MP, Shadow Secretary of State for Health addressing the breastfeeding conference

For those of you who could not either join us on the day or could not follow the #breastfeeding2018 hashtag on Twitter, we’ve collected and made a little “Storify” of the tweets so you can follow some of what was shared.

Go to Storify - Breastfeeding