Child development checks in a time of pandemic

Parents know their child best is a mantra that all good health professionals adhere to these days but that’s not to say we don’t like to be reassured sometimes that we’re right in thinking all is well – or not as the case may be.

That’s a comfort the scheduled early-childhood development checks bring to new parents, whether it’s their first or fifth child. After all, every child is different.

More importantly it’s also better for the child, and in turn the health system, if issues can be picked up early and addressed before they start to generate an accumulation of other problems.

But for many families, these routine appointments at their local public health clinic are yet another casualty of pandemic life. Normally, according to the Health Service Executive schedule, every child should be seen by a public health nurse, or community medical doctor, for development checks at: three months; nine to 11 months; 18 to 24 months and between 3¼ and 3½ years of age.

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Over the past year, more than 150,000 children would have been due at least one if not two of these checks, to make sure they are thriving physically, there are no ear or eye problems, and cognitive and language development appears to be in line with expectations.

Whether these screening checks are going ahead for children depends, it would seem from anecdotal sharing of parents’ experiences, on where you live and what arrangements your public health team have made under Covid-19 restrictions. Development checks have been cancelled or delayed, or conducted over the phone, or done through an online video link, or carried out in person in clinics.

Local priorities

There is no clear or consistent national picture because, as the HSE confirms, local teams in the community are being supported to prioritise services as they see fit in the current difficult circumstances.

Mother-of-two Kristen Cavagnet, who lives in Galway city, was concerned when her son’s three-month check was cancelled last January due to the post-Christmas surge of Covid-19 cases. “It is such a reassuring thing to know that everything is okay, especially for first-time mums. I am a second-time mum and I was very upset by that.”

However, as her son was a very unsettled baby who had problems with reflux, Cavagnet had already been able to bring him to the public health nurse, who was seeing what were considered emergency cases. On that occasion, he was weighed and measured, but that was the most routine thing done, she says. “I needed to be seen as there was lot going on with him.”

Now she is wondering will her 23-month-old daughter miss out on her next check that is due between 18 and 24 months. If she is not called, Cavagnet will be contacting the public health nurse again because she is worried about the pace of her daughter’s speech development. “I know there are certain milestones that have to be achieved. But I don’t know what’s okay and what’s not. My daughter is not talking yet, is that something to be concerned with? She doesn’t have real words, that is something I would love to get checked.”

Normally these appointments bring peace of mind. Now, if they’re cancelled or postponed, “I think it is 10 times worse because you are not even getting surrounding family’s opinion on your child, you’re so isolated,” says Cavagnet.

“I am not from here. I am from the States. My husband’s family are not around either and we can’t see anybody so there is nobody checking in on you.”

There is no chance to socialise with other mothers talking about what their children are doing at similar ages, she points out. “There are things I am not sure I should be looking out for and that is the point of these, making sure they are hitting these markers.”

She thinks online checks through Zoom would have been better than nothing, if in-person visits were not possible. “It is a bit of a disaster and I feel bad for first-time mums. It is distressing for us.”

Refer to the book

Fiona is a first-time mother, whose son was born last May and he hasn’t had any checks since the six-week one with the GP. (She asks that her real name not be used as she lives in a small Co Galway community.) She rang her local clinic at when he was three months to see if a check was being scheduled and was told it wouldn’t be possible because of Covid. Yet she knew women in the next town whose babies’ three-month checks had gone ahead.

“I rang up about it and said ‘I don’t feel there is a huge amount wrong with my baby but why is it like that in this town and not like that here? Why are they seeing them in the next county?

“There really was no answer,” she says, except for being referred to the My Child book, which is given to all new mothers. Any possibility of her being able to go to another clinic that was carrying out checks was ruled out.

Fiona felt it was very condescending, to be told “go and look at the book and if you really think there is something wrong contact us”.

While she didn’t think there was anything wrong, she said “I’m not a medical professional and I am not going to know the intricacies.”

She understands we’re living through a pandemic but believes more could be done to support new mothers. Right at the start, she wasn’t allowed to have her birth partner in theatre when she needed an emergency Caesarean section.

Then, after leaving hospital on day four, she was told she couldn’t bring her baby to the clinic in her nearest town for his heel-prick test, which must be done within five days of birth, but must instead go to a town 45 minutes’ drive away.

A lone parent, who obviously couldn’t drive after the C-section, she believed that was unreasonable, even though she had friends willing to drive her, and she protested. When asked if she was refusing, she said yes, and was then told she could go to the nearest clinic after all.

More recently, she was informed her baby wouldn’t be seen at nine months either but that there would be a check via a phone call. Acknowledging it wasn’t the caller’s fault, Fiona asked for an email address to which she could send a complaint.

Chase it up

A face-to-face appointment has been scheduled since, due to rules being changed, she was told. “If you’re not interested in chasing things up, you will fall through the system,” says Fiona, who acknowledges that she was consistently told that if she thought there was anything wrong with her baby, she could come in.

However, “if there was a woman struggling and she didn’t want to say it, that is quite serious”.

On the other side of the country, first-time mother Jennifer Kealy has been given appointments for all her son’s scheduled screening checks so far, albeit a little delayed. He was born just over a year ago and, despite the pandemic, the development checks were conducted in person, at her local clinic in Swords, Co Dublin. “We had a check at 5.5 months. We had the nine to 11 months when he was 50 weeks (11.5 months). And I was told he will have one at 22 months,” she reports.

In a written response to questions from The Irish Times, the HSE first points out how the ongoing pandemic has required significant rearrangement of services including redeployment of staff. Progress made in returning staff to core duties was disrupted by the second and then the third wave of infections, as staff were once again deployed as a result of increased testing and to provide support in residential centres for older people.

Greatest need

In supporting local decision-making on the operation of services, the HSE statement continues, “this approach will ensure that services will be focused on identifying and supporting patients who have the greatest need and enabling staff to be deployed where necessary to support these patients. It is the intention of Community Services that full services would return as soon as is safe and practicable.”

As regards child development checks, the only statistic shared by the HSE is that “in the full year 2020, a total of 28,172 children reaching 10 months have had their child development health screening on time or before reaching 12 months of age”. On the basis of a current annual rate of approximately 60,000 births in Ireland (59,796 in 2019, according to latest CSO figures), that would be just under half of that particular age cohort.

“The HSE continues to prioritise these developmental checks” it adds. “However, any parent who has a concern regarding their child should contact their local Public Health Nursing Office or GP.”

At each check a child is weighed, and measurements taken of length and head circumference, to ensure growth progress is being maintained. Fine and gross motor movement is assessed for any signs of neurological issues.

One of the more serious issues that might be identified include developmental dysplasia of the hip not previously detected. Ultrasound screening for this would generally only be done on a newborn with risk factors such as breech delivery or family history.

If not evident at the six-week GP check, it would be unusual for parents to be able to spot this themselves later on. But if this hip issue goes undetected, the child will be late to walk or walk with a limp.

The steps public health nurses go through at each of the four developmental checks are detailed on mychild.ie

Read: Speech acquisition: Key development stages for children