An estimated 200,000 babies were born between 23 March and 14 July 2020, during the first lockdown.
These infants joined an accidental social experiment created by the Covid-19 pandemic. Their first 1,001 critical days were to be shaped by an absence of in-person contact beyond immediate family. Children who started Reception last September would have been aged one to two in the first lockdown, and many two-, three- and four-year-olds in nursery currently will have been born in lockdown, with restrictions on social contact only finally easing in July 2021.
Around 110,000 women in London are believed to have given birth without a partner’s support in 2020. Some women reportedly opted for a caesarean to ensure their partner was able to be present.
This climate meant that the health and wellbeing of the youngest children were at risk from far more than the virus itself.
Alison Morton, chief executive of the Institute of Health Visiting (iHV), recalls, ‘The majority of families reported negative impacts linked to social isolation and lack of access to services and support.’
Health visiting checks could not be relied upon to happen face-to-face, which Morton says led to missed opportunities for early intervention, baby and toddler groups closed, and breastfeeding support dropped away – all contributing to a sense of new parents and babies being forgotten by the system.
The then Children’s Commissioner for England Anne Longfield urged the Government to monitor referrals to children’s social care amid reports of a dramatic drop in rates, highlighting the tens of thousands of families with babies under one affected by domestic abuse, drug and alcohol problems and severe mental illness.
Weakened safety net
‘Need increased across the board, at the same time as services were scaled back,’ says Morton. Some local areas lost half of their health visitors to redeployment.
Morton cites huge local variations in fulfilment of the mandated five health visitor checks, from late pregnancy to when children are aged two-and-a-half.
She says, ‘It is the only service that proactively and systematically reaches out to young babies and children. Health visiting is a safety net, but during the pandemic, they weren’t seen or were seen virtually.’
She highlights how, at the extreme end, ‘Covid safe’ contacts (typically where face-to-face home visits or booked appointments were replaced by telephone calls or virtual visits) had a ‘significant impact’ in 16 of 43 cases of child death or serious incidents, as reported in 2021 by the Child Safeguarding Practice Review Panel. Morton explains, ‘We know this is more likely to be a child under the age of two as nursery settings and schools are protective.’
Unanalysed data from the iHV suggests most health visitor appointments have now returned to face-to-face, a tacit acknowledgement that remote checks, at least the mandated ones, are not generally in patients’ best interests. However, one council has recently advertised for a ‘virtual health visitor’. The iHV has reported this to the Government.
Health outcomes hit
The NHS and councils were under pressure before Covid. Health funding was effectively flat for a decade under austerity. The health visitor workforce has dwindled by 40 per cent since 2015, when local authorities took over the Healthy Child Programme.
The challenge of meeting need is undeniably greater since the pandemic, according to Morton, who says, ‘Despite health visitors’ best efforts, families are getting less support as there aren’t enough health visitors to meet the scale of need.
‘This has knock-on consequences – we’ve seen soaring rates of A&E attendance in children aged birth to one year. The majority of this increase is for conditions that would have been managed by the health visitor, such as infant crying, feeding problems and minor illnesses.’
Another consequence of the health visitor shortage flagged by Morton is more children starting school with undiagnosed conditions, developmental delay and SEND. Paediatricians have told the iHV they are seeing children later than they were pre-pandemic.
‘This makes it harder to do early interventions, which can make a huge difference to outcomes,’ says Morton.
Some 85 per cent of respondents to the iHV’s last survey of health visitors, published in January 2023, reported that there was not enough capacity in other services to pick up referrals, including for child speech and language therapy.
As well as the lack of health capacity, parents struggling to deal with pandemic-related stress has also created new mental health pressures. Ben Yeo, clinical advisor for charity the Parent-Infant Foundation, who also works as an NHS child psychotherapist, says, ‘The quality of the parent-infant relationship shapes babies’ development in the short term as well as their lifelong health and emotional wellbeing.
‘Given the very stressful circumstances associated with Covid, it would have also affected parents’ capacity to bond with the baby. I certainly saw that clinically – high levels of anxiety, stress and isolation, and all of these risk factors led to difficulties in parent-infant relationships and in babies themselves.’
On a daily basis, professionals working with children witness the fallout, compounded by poverty and lost income, as reported in Casting Long Shadows, a report by the First 1001 Days Movement and the iHV published at the end of 2022.
More than 40 per cent of those surveyed a year or more after the end of the last lockdown said the youngest children continued to be affected by ‘parental anxiety, stress or depression due to the pandemic’. They said this was ‘affecting bonding and responsive care’.
And according to the latest OHID data, rates of children meeting all five key areas of development at the two- to two-and-a-half year review have fallen year on year since the pandemic.
The proportion of toddlers achieving as expected across communication, gross motor, fine motor, problem-solving and personal social skills dropped from 82.9 per cent in 2020/21 to 81.1 per cent in 2021/22 and to 79.2 per cent in 2022/23.
Widening inequality
Morton says a ‘significant and growing minority’ of young children are falling behind with their development, with children from the poorest backgrounds most affected.
This is echoed by professor of public health David Taylor-Robinson in his expert report Child Health Inequalitiesfor the ongoing UK Covid-19 Inquiry.
The fallout for the sector also continues, with the Early Years Alliance warning in summer 2023 of closures of baby and toddler groups amid the cost-of-living crisis, furthering the social isolation experienced in the pandemic.
CASE STUDY: before and after lockdowns
Tilly Sadler, married Reception teacher with two children: Bobby (born August 2019) and Barney (born June 2023)
Bobby was very uncomfortable from birth with cow’s milk allergy. He would scream most of the day and night.
I started a process of being treated for anxiety, and the referral came through as the pandemic hit. I was treated for PTSD. I felt very alone. Pre-pandemic, I was able to get out once a week to a baby massage and sensory group. I met another parent whose child had the same allergies. I began making connections. Then it was all taken away.
I had no mum friends. That’s something I feel the most bitter about. I didn’t get the experience that I saw others have before Covid. I lost all contact with my health visitors. It worried me that I hadn’t heard from anybody. I’d gone from being able to get him weighed weekly – his treatment was so weight-related that if that went wrong, it didn’t work. I ended up going through my doctor’s surgery. I had to be a persistent mum because of the need for the medication.
The bond I had with Bobby was under strain, I didn’t feel able to meet his and my needs. I relied a lot on my husband. This time around with Barney, family and friends have noticed how different I am.
