In this pandemic, children will suffer far more than we realise

We are told, quite correctly, that one of the few bright spots of the Covid-19 pandemic is that children are at significantly lower risk of being infected, and less likely to have a severe illness should they become infected. But this is only part of the story.

It is well documented, but less well appreciated, that when natural disasters occur, children suffer the most. Studies of the consequences for children of floods, earthquakes and the 2004 tsunami showed: the immediate death rate was higher in children; their access to health care was reduced; children who lost their parents were vulnerable; they were more prone to infection from disease and contaminated water and the psychological effects were long lasting. In the 2004 tsunami, one third of deaths were in children.

The impact of the Covid-19 pandemic on children is another reason why it was good to hear the recent announcement that former New Zealand Prime Minister, Helen Clark will co-chair an independent enquiry into the origins and responses to the coronavirus outbreak. She is well qualified to do so, having led a team for the Lancet Commission that has just published its report on the serious effects of Covid-19 on children in the prestigious medical journal, Lancet.

The Lancet Commission’s projections suggest that over a million preventable child deaths might occur during this pandemic due to decreased access to food and disruption of essential health services. Covid-19 has so far prevented continuous education for over 1·5 billion children and young people. In addition, hundreds of millions of children around the world who rely on school meals to maintain adequate nutrition are deprived of this crucial service. For similar health and nutrition reasons, the children who make up more than half of the world’s refugees, face particularly dire consequences.

The Commission points out that children are at serious risk in other areas in addition to education and malnutrition. These include emotional distress and missing out on educational opportunities even when some schooling is available. The problems for children posed by the pandemic are particularly severe in poorer nations, but also apply in Australia. Because of the extra burden on medical services as well as parental anxiety about exposing their children to medical facilities where they may perceive a higher risk of infection, Australian children are at risk of missing out on preventive care and timely management of illness and injury. Some children are experiencing reduced access to social services support as well as being exposed to witnessing increased rates of domestic violence. School closures have been an important control measure but have the potential to worsen the learning gap since children from wealthier families continue schooling with up to date digital technology, whereas poorer children may fall further behind. While this is a greater problem in developing nations, it also applies in Australia, particularly our indigenous communities.

The Lancet Commission recommends that national leaders should put child health and well-being at the centre of all Covid-19 recovery plans, that they should include experts in child health and welfare in relevant task forces and ask children and adolescents what changes they would like to see. This may be a radical concept for many leaders, but the recommendations come from a respected source and are difficult to dispute on factual grounds.

It concludes there is good evidence that what is good for children is good for societies, that investment in children’s well-being provides benefits that are immediate, long term, and inter-generational. It recommends that while the pandemic is putting severe strain on public finances, there should be no return to the austerity policies following the 2008 financial crash, which escalated health and social crises in Europe and elsewhere.

In view of her experience leading the Lancet Commission on the effects of Covid-19 on children, it is expected that the independent enquiry about to be undertaken by Helen Clark into the Covid-19 origins and responses will include the needs of children in the section on responses. This will be good for children.

It is easy to overlook children in a crisis where the major impact is on adults. It is now important to look beyond the immediate impact, to understand that Covid-19 has serious, but less obvious, consequences for children, to include their needs in recovery plans and to really appreciate, as Helen Clark’s Commission points out, that what is good for children is good for society.

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Kim Oates is an Emeritus Professor of Paediatrics, a former CEO of the Children’s Hospital at Westmead, a former President of the International Society for Prevention of Child Abuse and Neglect and an elected Founding member, International Academy of Quality and Safety.

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