From the European Academy of Paediatrics, Don’t Forget the Bubbles, and LOW
In April this year, the UN published a policy brief on the impact that COVID was having on children. It highlights key areas of concern, affecting the safety, education, and welfare of children around the world. In its conclusion, it calls for more information, more solidarity, and more action.
We, paediatric leaders from across Europe, urge European leaders and national governments to take urgent and unified action to follow that lead, helping to mitigate the risks identified, to ensure the best possible future for our most precious asset – our children.
The UN Convention of the Rights of the Child enshrined the principles that we should follow when making decisions about children and young people. In particular they state:
- In all actions concerning children, the best interests of the child shall be a primary consideration (Article 3)
- All children and young people have a voice and the right to participate in decisions that affect them (Article 12)
- All children and young people should have access to information required to make informed decisions with respect to their health and well-being (Article 17).
We have addressed three areas of concern – PROTECTION, PLAY, and EDUCATION – where we believe intervention is most needed. For each area we have defined a number of specific issues, providing evidence of the problem, recommending what we believe should be done, and finally suggesting how progress might be measured.
Some evidence remains uncertain, nowhere more pertinent than in the simple questions about how susceptible and how contagious children are compared to adults. Trials of novel therapies need to include studies in children, as physiology and pharmacokinetics can vary substantially. Careful psychological studies need to assess the true impact of the disease on vulnerable groups.
Much research is needed, and that needs coordinated funding across Europe. Some analysis will take years before it can answer some of the key questions, and so the funding needs to be sustained. In this document however we look at the policies that need to be urgently put in place that will help define the questions and direct that research.
Protection
1. Vaccination and routine screening
Vaccination rates have fallen during the pandemic with risk of infectious diseases increasing, vaccine delivery is compromised, the low levels of uptake before the pandemic multiply the risks that any further reduction in coverage has on outbreaks
We call for:
- Pan-European cooperation on vaccine supply
- Funding allocated to train health care providers to vaccinate
- Active campaign across Europe to publish international vaccine strategies, to raise awareness about vaccines and to address vaccine hesitancy
What does success look like?
Increase of vaccine uptake on a European and worldwide level, with all European countries reaching measles free status.
2. Physical and emotional safety
The risk of death from COVID is extremely low in children. Isolation of households has increased the risk of violence and injury, presentation may be severe or late, Children with chronic disease may have suffered through this period. There is evidence of late presentation of medical emergencies to hospitals and routine surgery and clinic appointments have been postponed. Young carers have been exposed to greater risks during lockdown.
Depression and anxiety are more common, normal peer support groups are lost. Those living in more violent households are more prone to depression. Other ‘guardians’ (teachers etc) are not seeing children with referral rates to protection agencies falling. Increased financial pressure on families may increase tensions. For adolescents social distancing and lockdown can be especially difficult.
We call for:
- Increased provision of psychological support for children (especially adolescents) and families
- Funding for better training in recognition of family dysfunction from health care workers
- Prioritised health care access for children with chronic conditions
- Young people should be given power and leadership to decide for themselves how to make up for not being able to do these things in person.
What does success look like?
A reduction in the incidence and severity of abusive injuries
All children protected from harm, as set out in the UN Convention of the Rights of the Child
National registers of the incidence of neglect and emotional abuse
Reduced self-harm/suicide
Improved outcomes in chronic conditions
3. Long term dangers
Financial impact of pandemic over a generation, loss of education and future employment possibilities (see below), vulnerable families (socio-economic, BAME, being in care, in youth justice systems) have fewer resources to cope with both with effects of illness and effects of lockdown; consequently all poor outcomes from the pandemic will affect them disproportionately. Deliberate exploitation (grooming, trafficking etc), including evidence of pamphlets showing how to target children during the pandemic.
We call for:
- Poverty reduction targets in all countries for vulnerable children and poor families
- A ‘child health in all policies’ approach to all policy development
- Targeted resources for at risk families
What does success look like?
Improving social equality across Europe
Stable unemployment figures without increasing poverty
Play (and exercise)
1. Child
Play is critical for early cognitive and social development, has been affected by COVID, and provides support networks for families, especially those in vulnerable groups. Obesity is likely to increase, social development affected.
We call for:
- Improved education for families, encouraging explorative play
- Focused funding for vulnerable families
- Relax social distancing rules for children
- Promote and facilitate exercise in children, with regular structured exercise at school
- Increased provision of child friendly sport and leisure access
What does success look like?
Reducing levels of obesity
All schools open and functioning normally
2. Adolescent
Adolescents have distinct developmental needs compared to children and adults. They are very much invested in social connections and in separating from their parents. COVID social distancing requirements is particularly challenging for them.
We call for:
- Involvement of young people in policy development
- Specific policies developed for adolescents
What does success look like?
Direct involvement of adolescents and young adults in policy development.
Education
1. School attendance
School closure affects families directly by requiring child care, and affecting the parents’ ability to work. It has a disproportionate effect on the underprivileged, including the loss of support such as free school meals. There is a significant effect on children regarding their well-being and (psychological) health due to the loss of interactions with peers.
We call for:
- Open schools for all ages.
- Support the development of internet access and online teaching resources
- Training for teachers and parents to recognise psychological problems (mental health support teams)
What does success look like?
Optimal psychological, educational and health development of all children.
2. Examinations
Many children do not work through lockdown and lose valuable education time. 11% European families have no access to the internet or to equipment and technology. There may be a long-term effect on children due to under-education and reduced opportunities for further education and training, with fewer job-possibilities, affecting low income families disproportionately.
We call for:
- Provide resources and funding to allow catch up education
- Ensure full internet coverage for all areas of Europe
What does success look like?
Full internet accessibility for children and schools
3. Higher education
Young people lose daily structure and motivation for learning. Exam results are devalued. Motivation is reduced; loss of long-planned events such as graduation can be very depressive. Loss of daily structure affects their ability to schedule effectively, and work efficiently.
We call for:
- Improve career guidance support in higher education establishments
- Support with scheduling teaching and self-directed learning
What does success look like?
Increasing employment levels and job satisfaction
