During the pandemic, children’s health has been affected by lockdowns, school closures and self-isolation, as Victoria Goldman explains… 
 
 
In the British Paediatric Surveillance Unit’s April snapshot survey of 4,075 paediatric consultants in the UK and Ireland a third of respondents reported delayed presentations, particularly for new diagnoses of diabetes mellitus, diabetic ketoacidosis and sepsis.1 
According to a review in the Archives of Disease in Childhood in June, children’s health will continue to suffer if the long-term impacts aren’t given proper consideration.2 
As children return to school after the summer break, both healthcare professionals and parents will need to be vigilant for any signs of ill-health, and make sure children are getting the support and healthcare they need. 
 
Fevers and infections 
Public Health England (PHE) revealed in June that colds and flu cases remained unusually low during the pandemic, along with other common infections including acute middle ear infections and chickenpox.3 
However, also in June, emergency departments across the UK reported seeing high numbers of young children for the time of the year because of a rise in infections usually seen in the winter months. Many parents hadn’t seen fever in their child – particularly if they were born during lockdown – and were taking them to A&E rather than seeking help at pharmacies, from their GP or via NHS 111. 
Dr Andrew Raffles, consultant paediatrician at The Portland Hospital, part of HCA Healthcare UK, says that during lockdown children haven’t been exposed to different bacteria and viruses, so they haven’t been able to develop immunity to them. 
“The normal winter virus which causes bronchiolitis in younger children – respiratory syncytial virus (RSV) – is currently causing lots of young children to have fever and cough,” he says. “This tells us that the lockdown has made a group of children more susceptible to circulating viruses.” 
Dr Sharryn Gardner, paediatric emergency medicine consultant and clinical adviser for child health app Juno, recommends that parents have junior paracetamol or ibuprofen at home and encourage children to take plenty of fluids at the first sign of infections. 
“Paracetamol and ibuprofen are for pain or distress with a temperature – not a temperature per se,” she says. “Parents can prepare themselves by understanding that there are likely to be more infections than normal and that these may run in together rather than one ongoing infection. Regardless, if they are worried, they should seek advice.” 
 
Childhood vaccines 
Dr Raffles says that some parents and carers may need to make additional efforts to ensure children catch up on important childhood vaccinations that may have been missed. 
Research in December 2020 indicated that parents and guardians found it harder to arrange vaccinations for their children during lockdowns, with difficulties in booking vaccination appointments and not receiving vaccination invites and reminders.4 
While baby immunisations have continued through primary care, uptake was reportedly down, with data suggesting that measles, mumps and rubella (MMR) vaccinations in England fell by nearly 20 percent during early lockdown compared with previous years.2 
School-aged vaccination programmes were stopped in line with national guidance, prompting concern, particularly for children in marginalised groups with historically low vaccine uptake.2 
 
Head lice infestations 
In January, researchers in Buenos Aires found that the prevalence of head lice decreased significantly during Covid-19 lockdown, due to low movement of children outside their homes and the absence of regular classes.5 
However, according to Ian Burgess, director of the Medical Entomology Centre in Cambridge, the pandemic hasn’t had such an effect here, and the number of head lice cases is nearly back to normal.  
New international recommendations on head lice infestations, published in the International Journal of Dermatology in March, recommend the use of fine-toothed combs for diagnosis and treatment, and state that only anti‐louse products that have been specifically approved by local health authorities should be used as treatments.6  
“Insecticides are generally not recommended now, since they encourage resistance,” says Daniel Brash, a Leeds pharmacist, co-director of Pharmcare Ltd and managing director of Healthcare4all. 
“Non-pesticide lotions and shampoos such as Hedrin and Lyclear, or Full Marks Solution are thought to be effective in 80-90 percent of cases. Physical removal with combs, such as the wet-combing technique alongside conditioner, works well, and battery-operated combs have been around for several years.” 
 
Mental health 
In May, the latest Co-SPACE (Covid-19 Supporting Parents, Adolescents, and Children in Epidemics) study, led by experts at the University of Oxford, found that children and young people experienced their highest levels of mental health issues in June 2020 and February 2021, when restrictions were most stringent.  
Overall, primary school children have had greater changes in levels of mental health difficulties throughout the pandemic compared to secondary school-aged children. 
“Repeated self-isolation when someone in their bubble tests positive has been a real rollercoaster and very disruptive to learning and social relationships,” says Dr Sharryn Gardner. 
“Many children have developed anxiety, and in particular separation anxiety from family, as well as tics (including Tourette’s). There have been big increases in attendances for all mental health presentations, such as eating disorders and deliberate self-harm.” 
Children may be nervous about returning to school in the autumn after a long summer break. “If problems persist, parents may need specialist help,” says Dr Tom Micklewright, associate medical director at Push Doctor. “This is especially so if they begin to notice a negative impact on school, appetite or sleep, or if their child seems at risk of harming themselves or others. 
“In these cases, they should speak with their GP, who can arrange a referral to Child and Adolescent Mental Health Services, and to their child’s school. Special educational needs coordinators will now often lead on mental health and wellbeing initiatives in schools, so will be able to offer additional support.” 
 
Diet and exercise 
Childhood obesity is likely to worsen after Covid-19 lockdowns, according to research published in the British Medical Journal in April.7 Over 20 per cent of UK households are worse off financially now than before the pandemic, and families are more likely to buy cheaper and more calorie-dense foods. 
According to Sports England’s ‘Active Lives’ children’s survey, published January, looking at the academic year 2019-2020, there was a reduction in the number of active children and young people of 2.3 percent – or just over 100,000 – compared to the same period 12 months before. 
School sites were closed to most pupils and many physical activities were either severely restricted or delivered in a different way. Girls fared better than boys while those from black and mixed backgrounds saw notable drops in activity levels.  
 
Eye health 
Children’s eye health has deteriorated during the pandemic too. According to Bhavin Shah, myopia control consultant, behavioural optometrist and director at Central Vision Opticians in Finchley, London, there has been a large increase in the number of children who have become myopia (short sighted). 
“I’ve seen four times as many children in 2021 compared to 2019,” he says. “Also, the average change [in vision] is twice the amount as before. This is likely to be caused by an increase in screen time, especially from remote learning and a decrease in the amount of outdoor time and activities.” 
 
 
References 

1. Lynn RM, Avis JL, Lenton S, et al. Delayed access to care and late presentations in children during the COVID-19 pandemic: a snapshot survey of 4075 paediatricians in the UK and Ireland. Archives of Disease in Childhood 2021;106:e8. https://adc.bmj.com/content/106/2/e8

2. Hefferon C, Taylor C, Bennett D, et al. Priorities for the child public health response to the COVID-19 pandemic recovery in England. Archives of Disease in Childhood 2021;106:533-538. https://adc.bmj.com/content/106/6/533

3. RSC Communicable and Respiratory Disease Report for England. Week number/year: 22/21. Week Starting – Ending: 31/05/21 – 06/06/21. Royal College of General Practitioners. https://www.rcgp.org.uk/-/media/Files/RSC/WeeklyReport_Winter_wk22_2021.ashx?la=en

4. Bell S, Clarke R, Paterson P, Mounier-Jack S (2020) Parents’ and guardians’ views and experiences of accessing routine childhood vaccinations during the coronavirus (COVID-19) pandemic: A mixed methods study in England. PLoS ONE 15(12): e0244049. https://doi.org/10.1371/journal.pone.0244049

5. Galassi F, Ortega-Insaurralde I, Adjemian V, Gonzalez-Audino P, Picollo MI, Toloza AC. Head lice were also affected by COVID-19: a decrease on Pediculosis infestation during lockdown in Buenos Aires. Parasitol Res. 2021;120(2):443-450. doi:10.1007/s00436-020-07038-y https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787699/

6. Mumcuoglu KY, Pollack RJ, Reed DL, et al. International recommendations for an effective control of head louse infestations. Int J Dermatol. 2021;60(3):272-280. doi:10.1111/ijd.15096 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984059/

7. Patterson R R, Sornalingam S, Cooper M. Consequences of covid-19 on the childhood obesity epidemic. BMJ 2021; 373 :n953 doi:10.1136/bmj.n953 https://www.bmj.com/content/373/bmj.n953