Missed care in the community a major concern

My granddaughter Millie was born on 5 February 2020. As expected, the public health nurse called to see her twice in the first two weeks after she came home from hospital and this was very much appreciated.

Millie had her six-week checkup with her mum at their GP clinic and has attended there for the necessary vaccinations by appointment (as required) since.

She has now celebrated her first birthday but has had no developmental checks in the past year.

Those are meant to happen at three months and again between seven and nine months, but the pandemic has put paid to that.

Thankfully, there isn’t a problem with Millie but what if you were worried about your child?

What if he or she wasn’t turning their head and eyes towards light by two months of age, or pulling themselves up to a standing position around the age of nine or 10 months?

Where can you turn for help?

If you have concerns, it could be a long time until the COVID-19 pandemic eases. So what exactly is happening in relation to public health nurses (PHNs) doing these checks?

The Irish Nurses and Midwives Organisation (INMO) said that staff shortages and missed care in the community have been a major concern for quite some time but that COVID-19 has exacerbated the issue.

Missed care in the community was already a major concern

“The INMO has been highlighting the extreme pressure public health nursing has been under for several years due to considerable staff shortages in the sector.

“Missed care in the community was already a major concern but COVID-19 has exacerbated this problem. As a result, vulnerable people in the community are not receiving the care and attention they require.”

Where possible, PHNs are working over the phone

Public health nurses carry out vital postnatal and early childhood checks.

“They’re a vital service for parents and children and can help deal with any problems early on,” the INMO says.

“Where possible, PHNs are working over the phone and through other means to ensure they can reach as many of their patients as possible,” they add, “however, nothing can replace face-to-face care.

“This scenario is evidence of the dire need for PHNs and community RGNs to receive the COVID-19 vaccination as soon as possible so staff can commence clinics and home visits. Even once we overcome this pandemic, staffing is still going to be the central challenge facing public health nursing.”

Parentline

Parentline (parentline.ie), a national helpline for parents, has said that calls to their service increased by 40% last year (as compared to 2019) and calls about developmental tests were a worry facing many parents.

Parentline’s CEO Aileen Hickie says: “Yes, there have been many calls from parents about checks across the board during the pandemic,” she says. “Whether this is child developmental testing or lack of/reduced screening and diagnosis for any spectral disorders or neurodevelopmental differences, which can impact on a child socially or educationally.”

HSE statement

In a statement, the HSE says: “Between January and November 2020 a total of 26,029 children reaching 10 months have had their child development health screening on time or before reaching 12 months of age.”

It’s worth noting, however, that over 59,000 babies were born in Ireland in 2019. Because of COVID-19 they said that many staff had to be redeployed and certain services had to be prioritised for those most in need.

“Where services are curtailed or reduced,” they added, “this will be in line with clinical approval, a shared national position and with an appropriate risk assessment and communication with providers, service users and families.”

For any parents who are concerned about their child’s development, the HSE recommends they contact their GP or local health nurse.

“All new parents should also have received a copy of the My Child: 0 to 2 years book from their PHN, which includes information on child safety, vaccinations and overall health and wellbeing,” they added.

Given the lack of child developmental testing, Wexford County Library is taking some steps to fill the gap – at least partially.

They are running a talk entitled Parenting Today 2021: Developmental Checks and Care for Babies at three months and nine months with Wexford PHNs on 4 March at 8pm on Wexford Public Library’s YouTube channel.

“The last 10 months have been challenging for both PHNS and parents of babies and toddlers,” the HSE’s publicity for this event says.

“We are conscious that, at times, there has not been the normal levels of engagement that both PHN’s and parents would like or the opportunity to ask questions, from: ‘How do I know when my baby is ready for solid food?’ and ‘When can I expect my baby to sleep through the night?’ to ‘What is tummy time and why is it so important?’”

There will be two talks, one for parents of babies aged three months and under and the second for parents of babies of approximately nine months of age.

Developmental checks are meant to happen at:

Each child is different. For each milestone there is a wide range of ages when children may reach it.

The My Child: O to 2 Years book is given free to all new parents and available to download in pdf format from the HSE website.

It includes the full list of developmental milestones, some of which we’ve listed below.