Parents’ experiences with a sick or injured child during the COVID-19 lockdown: an online survey in the Netherlands

ObjectiveTo assess the impact of the COVID-19 lockdown on parents’ health-seeking behaviour and care for a sick or injured child in the Netherlands.Design and settingAn online survey on parents’ experiences with a sick or injured child during the COVID-19 lockdown periods was disseminated through social media.ParticipantsParents living in the Netherlands with a sick or injured child during the lockdown periods from March to June 2020 and from December 2020 to February 2021 were eligible to participate.Outcome measuresDescriptive statistics and thematic analysis were used to analyse family and children’s characteristics, parents’ response to a sick or injured child, and the perceived impact of the lockdown on child’s severity of illness and treatment reported by parents. Analyses were stratified for children with and without chronic conditions.ResultsOf the 105 parents who completed the survey, 83% reported they would have sought medical help before lockdown compared with 88% who did seek help during lockdown for the same specific medical problem. Parents reported that changes in health services affected their child’s severity of illness (31%) and their treatment (39%), especially for children with chronic conditions. These changes included less availability of healthcare services and long waiting lists, which mostly led to worsening of the child’s illness. During lockdown, there was no change in health-seeking behaviour by parents of children with a chronic condition (N=51) compared with parents of children without a chronic condition.ConclusionParents in the Netherlands who completed the survey were not deterred from seeking medical help for their sick or injured child during the COVID-19 lockdown periods. However, changes in health services affected child’s severity of illness and treatment, especially for children with chronic conditions.

29 Caregiver-Reported Delay in Presentation to Pediatric Emergency Departments for Fear of Contracting COVID-19: A multinational cross-sectional study

Primary Subject area Public Health and Preventive Medicine Background Visits to pediatric emergency departments have decreased up to 75% during the pandemic, with corresponding increases in high acuity visits, inpatient admissions, and intensive care unit admissions compared to historical cohorts. Objectives To determine if caregivers of children presenting to pediatric emergency departments (EDs) during the COVID-19 pandemic are delaying presenting to care for fear of contracting COVID-19. Secondary objectives were to: a) evaluate potential predictors of delay; b) describe the proportion of children whose symptoms worsened during time to presentation. Design/Methods A multicentre cross-sectional survey study of caregivers accompanying their children aged 0-19 years old to 16 pediatric EDs in 6 countries, from May-June 2020. An anonymous online survey, completed by caregivers via RedCAP, included caregiver and child demographics, presenting complaints, if they delayed presentation and whether symptoms worsened during this interval, as well as caregiver concerns about the child or caregiver having COVID-19 at the time of ED visit. Results Of 1543 caregivers completing the survey, 287 (18.6%) reported a delay in seeking ED care due to concerns of contracting COVID-19 in the hospital. Of those, 124 (43.2%) stated their child’s symptoms worsened during the waiting interval. Caregiver relationship to child [mother] (OR 1.85, 95% CI 1.27-2.76), presence of chronic illness in child (OR 1.78. 95% CI 1.14-2.79), younger age of caregiver (OR 0.965, 95% CI 0.943-0.986), and caregiver concerns about lost work during the pandemic (OR 1.08, 95% CI 1.04-1.12), were independently associated with a COVID-19-related delayed presentation in multivariate regression analysis. Conclusion Almost one in five caregivers reported delaying ED presentation for their ill or injured child, specifically due to fear of contracting COVID-19 while in hospital. Mothers, younger caregivers, caregivers of children with chronic illness, and those concerned about lost work were at highest risk for delay.

DIVERGENT INTERPRETATION OF POST-CONCUSSIVE SYMPTOMS BETWEEN PARENT AND CHILD

Background: Self-report symptom scales are often given to both parents and the injured child to rate a child’s symptoms following concussion. Previous research has shown that individual symptom reporting may not reflect agreement between parent and child. While total calculated scores may reflect agreement, looking at the total number of items reported may provide more insight into consistency between parent and child symptom rating following concussion. Purpose/Hypothesis: To evaluate the degree of divergence in post-concussive symptom reporting between parent and child. It was hypothesized the parent would endorse their child as having more symptoms following their concussion than self-reported by the child. Methods: The concussed child and their parent completed the Post-Concussion Symptom Inventory (PCSI), a self-reported concussion symptom scale to document symptoms related to the injury. The concussed child completed the age-appropriate version (8-12 years-old or 13-18 years-old) of the PCSI while the parent reported their perception of symptoms experienced by the child. The parent version of PCSI has 26 items, the adolescent version has 25 items, and the child version has 23 items. The total number of symptoms endorsed were calculated by recoding each symptom as a 0 or 1 variable to account for the item differences on the scales. A difference in total items reported, between parent and child as well as parent and adolescent PCSI, were calculated. Results: A total of 36 patients, 15 males and 21 females aged 8-18 (13.8±12.1 years), filled out the PCSI with 10 patients filling out the 8-12 years-old version and 26 filling out the 13-18 years-old version. The 10 parents of children ages 8-12, endorsed 2.9±2.7 more concussion symptoms. Of the 26 parents to adolescents ages 13-18, 1.08±6.28 more concussion symptoms were reported. Conclusion: Current results suggest the parents endorse their child experiencing more symptoms following their concussion than what is self-reported by the child. A future study to investigate the impact of parents’ elevated PCSI score(s) (i.e. total score or endorsed items) when compared to patient’s duration of recovery is recommended. This research would provide more comprehensive guidelines for recovery by means of patient and parent education.

Pediatric Intraosseous Placement

Intraosseous access can be used to rapidly deliver fluids and medications when venous access is not feasible. The intraosseous space does not collapse (as can occur with large veins), making the intraosseous route particularly useful in a patient in whom venous access cannot be obtained readily by peripheral or central routes. In fact, the most recent American Heart Association/American Academy of Pediatrics guidelines for Pediatric Advanced Life Support state that in an emergency situation, “intraosseous (IO) access can be quickly established with minimal complications by providers with varied levels of training. Limit the time spent attempting to establish peripheral venous access in a critically ill or injured child.” Contraindications include underlying bone disease, infection at the site, or recent IO access in the same bone. Severe complications, including loss of bone or limb, have been reported; neonates are at higher risk for these complications. There are several options for devices for obtaining intraosseous access.

The Frequency of Random Findings on Abdominal / Pelvis Computed Tomography in Pediatric Trauma Patients

Aims: In this study, we aimed to find the percentage of random pathologies and abdominopelvic region anomalies that are not related to trauma in pediatric patients. Background: An abdominal assessment of an injured child usually involves computed tomography imaging of the abdomen and pelvis (CTAP) to determine the presence and size of injuries. Imaging may accidentally reveal irrelevant findings. Objectives: Although the literature in adults has reviewed the frequency of discovering these random findings, few studies have been identified in the pediatric population. Methods: Data on 142( 38 female, 104 male) patients who underwent CTAP during their trauma evaluation between January 2019 and January 2020 dates were obtained from our level 3 pediatric trauma center trauma records. The records and CTAP images were examined retrospectively for extra traumatic pathologies and anomalies. Results: 67 patients (47%) had 81 incidental findings. There were 17 clinically significant random findings. No potential tumors were found in this population. Conclusion: Pediatric trauma CTAP reveals random findings. For further evaluation, incidental findings should be indicated in the discharge summaries.

Child health

This chapter covers managing the acutely ill or injured child. It starts with taking a history from a child, and ways of communicating with the child. Direct questions to ask from carers are also listed. The assessment of children is detailed, and recognition of <C>ABC problems is covered, alongside the management of ABC emergencies. Paediatric emergencies and their treatment are explained, and life support of children is included. Trauma in children (the leading cause of death in children over 1 year of age) and management, consent, analgesia, and child abuse and neglect are all contained in this chapter. Finally, paediatric drug doses are tabulated.

Qualitative study of the needs of injured children and their families after a child’s traumatic injury

ObjectiveTo explore the needs of children and their families after a child’s traumatic injury.DesignSemi-structured qualitative interviews with purposeful sampling for different types of injuries and a theoretical thematic analysis.Participants32 participants; 13 children living at home after a traumatic injury, their parents/guardians (n=14) and five parents whose injured child did not participate.SettingTwo Children’s Major Trauma Centres (hospitals) in England.ResultsInterviews were conducted a median 8.5 months (IQR 9.3) postinjury. Injuries affected the limbs, head, chest, abdomen, spine or multiple body parts. Participants highlighted needs throughout their recovery (during and after the hospital stay). Education and training were needed to help children and families understand and manage the injury, and prepare for discharge. Information delivery needed to be timely, clear, consistent and complete, include the injured child, but take into account individuals’ capacity to absorb detail. Similarly, throughout recovery, services needed to be timely and easily accessible, with flexible protocols and eligibility criteria to include injured children. Treatment (particularly therapy) needed to be structured, goal directed and of sufficient frequency to return injured children to their full function. A central point of contact is required after hospital discharge for advice, reassurance and to coordinate ongoing care. Positive partnerships with professionals helped injured children and their families maintain a sense of hope and participate in joint decision making about their care.ConclusionThroughout the full trajectory of recovery injured children and their families need family centred, accessible, flexible, coordinated health services, with more effective harmonious, communication between professionals, the child and their family. There is a requirement for support from a single point of contact and a system that monitors the needs of the injured child and their family after hospital discharge.