Five ways health and social services can support babies, toddlers and the people who care for them through the Covid-19 pandemic

This brief is part of our series on ways to limit the impact of Covid-19 on babies, toddlers and the people who care for them. We will be updating these briefs as we collectively learn more. We’d love to hear your examples, ideas and feedback at info@bvleerf.nl.

This policy brief was updated on 27 August 2020 and is also available in Spanish.

The pandemic is showing us how crucial health and social services are

According to UNICEF, an estimated 60% of all children worldwide are living in countries where a full or partial lockdown was in place. As countries emerge from lockdown, children and families have to adjust to the new normal of uncertainty. With most countries either in a prolonged phase of infections or beginning to move into a second wave of infections, healthcare, social services, childcare and work have to deal with rapidly changing policies from governments.

In some countries, the lifting of physical distancing measures are allowing caregivers to reconnect with their usual support networks, and young children to meet their peers and family members in other households. However, the looming threat of a second lockdown put Parents under tremendous pressure and unsure how best to support their children through this unprecedented time.

For young children and their caregivers, the impacts of the Covid-19 crisis are not only immediate — they will also have long-term consequences for children’s development. Policymakers and practitioners need a long-term mindset.

This brief outlines the greatest challenges and highlights some promising actions.

One last note — the pandemic starkly demonstrates how critical health and nutrition services, childcare, child protection and violence prevention measures are for many families. Especially families who are already vulnerable due to issues such as poor-quality housing, low income or food insecurity. Often undervalued and underfunded, these services must be protected from the austerity measures that may be implemented to repair public finances.

How can health and social services support babies, toddlers and caregivers during Covid-19?

1. Prioritise early years health and nutrition services.
2. Continue to provide parent coaching and support through remote means.
3. Support the continued provision of childcare services.
4. Provide mental health services to caregivers and families with young children.
5. Invest in preventing and addressing domestic violence.

1. Prioritise early years health and nutrition services.

With essential basic health services being redirected to address the pandemic, many young children and caregivers are missing out on prenatal and postnatal care, vaccinations and routine health checks. Some countries are separating mothers with Covid-19 from their newborns: there is little research yet on transmission risks, but such policies will certainly be having an impact on mother-child bonding and breastfeeding, for which the first few hours are crucial.

Food insecurity has become more of an issue for many vulnerable families, as food supply chains are interrupted and lockdowns cause loss of income.

Who’s doing what so far?

• In Bangladesh, BRAC has kept its maternity centres open with additional training and support provided to workers.
• In Mozambique, PATH reorganised waiting lines at its health facilities to enable social distancing and quickly scaled up a project to encourage handwashing through “tippy taps”, a low-cost solution first introduced in cholera prevention efforts.
• Midwives in the Netherlands and the United States started to hold Centering Pregnancy peer group pre-natal visits virtually.
• In Tanzania and Zambia, electronic immunisation registries previously set up by PATH are helping health workers to keep providing immunisation clinics.
• UNICEF and USAID Advancing Nutrition developed a counselling package, Infant and Young Child Feeding Recommendations when COVID-19 is Suspected or Confirmed. Based on recommendations from WHO and UNICEF, it includes pictorial counselling cards for use in low-literacy communities in different contexts.
• In the Democratic Republic of the Congo, the Ministry of Health provided guidance on the adaptation of Vitamin A Supplement (VAS) provision during the Covid-19 pandemic. Together with precautions of crowd control, protective equipment, increased hygiene and physical distancing measures, frontline workers also utilised various social mobilisation and communication methods to reach parents. The National Nutrition Program was able to continue its VAS provision reaching 83% of targeted children aged 6 months to 5 years.

2. Continue to provide parent coaching and support through remote means.

Evidence shows that parent coaching and support programmes in the early years can have long-lasting impacts on a child’s health, cognitive and socioemotional outcomes. Such programmes are typically delivered in-person, though home visits or group sessions.

Who’s doing what so far?

• In Jordan, the Queen Rania Foundation adapted an ongoing parent education programme for WhatsApp. Groups of 20 mothers and two educators are holding one-hour discussions every morning over eight weeks, with educators constantly refining the curriculum to make the content more suitable for this new medium.
• In Mumbai, India, Mobile Creches made individual phone calls to the migrant worker families they serve, to ensure they are aware of available support from the government and civil society organisations. They also collaborated with those organisations to provide that support, such as food distribution and health checks.
• The municipality of Tel Aviv, Israel, has filmed and shared short workshops on their app, Digitaf, with tips for parents on interacting positively with their children.
• Triple P in the Netherlands released parenting tips in six languages — shared by the municipality of Amsterdam — and organised online platforms to support parents and professionals.
• In Brazil, the Criança Feliz home visiting programme replaced face-to-face training for home visitors and supervisors with online courses.
• In the Netherlands, TNO developed videos to help parents be alert to early signs of developmental delay which they could share with health professionals through virtual appointments.
• The Nigeria Centre for Disease Control developed a set of educational and informative picture books to help young children understand what Covid-19 is and how to keep themselves healthy and safe.
• In Vietnam, UNICEF has procured ‘Pad and Puck’ packages (tablets and Wi-Fi) to help vulnerable groups continue learning and maintain peer-to-peer communication.

3. Support the continued provision of childcare services.

The closure of childcare centres and kindergartens — coupled with enforced isolation from extended family networks — has left many parents struggling to juggle childcare and work commitments, and made clear how critical childcare services are to both a functioning society and a productive economy.

High-quality, affordable childcare not only allows caregivers to work — it can also be an important early learning opportunity for babies and toddlers. Interaction with others provides learning opportunities that are key for brain development. Learning resources on the internet are only a partial substitute. Excessive exposure to screens can be a risk, and many families do not have internet access.

In many countries, childcare is not universal. While schools are trying to keep in regular contact with families of school-age children, there is often no similar mechanism to identify families of pre-school age children who may need additional support.

The cost of childcare is significant for many families, but childcare provision is typically not a high-margin business. Evidence is emerging in many countries that some childcare providers may not be able to recover financially from the current interruption to their business without further governmental support.

In addition, childcare workers are disproportionately female, often with young children themselves. The closure of childcare facilities signifies a loss of income for them. Alternatively, continuing to work presents additional risks for them and their families due to the significant increase in external contact and the inability to be physically distanced within the workplace.

Who’s doing what so far?

• The Austrian government has temporarily waived conditions on childcare benefits, such as obligatory health checks, to ensure no parents miss out on support.
• Countries such as the Costa Rica, Netherlands and Singapore have allowed childcare centres and schools to remain open for the children of essential workers.
• In Australia, the government has committed to paying 50% of childcare fees for all families for six months, providing some stability for childcare providers. Similarly, the Netherlands will be compensating parents for childcare fees paid from March to May while centres were closed.
• Many US states are providing and sometimes paying for childcare for essential workers.
• In Ukraine, the Ukrainian Step by Step Foundation provided additional support to educators and childcare centres through a series of online consultations and technical trainings.
• The World Health Organisation (WHO) has released technical guidance on how to protect the frontline health and early childhood workforce. Furthermore, the Early Childhood Workforce Initiative has also released a key position statement which outlines the actions that governments and civil society organisations should take to support and protect the early childhood workforce.
• In the Republic of Korea, the government has supported a shift from centre-based daycare, to a model of home-based care during their lockdown period.
• In Malaysia, the Ministry of Education launched a massive open online course (MOOC) to train teachers in the use of digital platforms. This includes age-specific skills which equips preschool teachers to work with their students.

4. Provide mental health services to caregivers and families with young children.

Prolonged high levels of stress can severely impact the mental health of both young children and their caregivers. Parental depression and anxiety are connected to various negative child outcomes such as poor cognitive development and a greater risk of ill health.

The mental health impacts of pandemic are varied — from anxiety over health and money worried to loneliness and limited access to nature. In the UK, anxiety levels have doubled during lockdown. It is crucial that organisations and governments locate individuals in need and provide appropriate mental health support — in virtual form where in-person support is no longer possible.

Who’s doing what so far?

• In Uganda and Zambia, Strong Minds facilitators are making phone calls to past and current patients. Strong Minds has also created an online and radio campaign to help people identify anxiety and suggest simple ways of coping.
• In Lebanon, the National Mental Health Programme has developed a Covid-19 action plan that includes tips for caregivers on taking care of their mental health, child-friendly protocols for children who need to be quarantined, and guidance for public health teams to identify people in emotional distress for referral to support services.
• In the UK, the government has launched a round-the-clock individualised mental health support for the frontline healthcare workforce. In addition, the NHS has launched a mental health campaign, Every Mind Matters, providing information and a helpline for individuals, parents and educators to support their wellbeing and mental health.
• In China, various medical institutions, universities, and academic societies established free 24-hour online psychological counselling services through WeChat, a popular communication platform. These services covered all 31 provinces in mainland China and included both self-help content and professional counselling support.
• The New Zealand government launched a set of tools, titled ‘Sparklers at Home’, to support parents in addressing issues related to the mental health of young children and themselves as caregivers.
• The Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings has published a children’s storybook which caregivers and educators can read with young children to support their understanding of the Covid-19 pandemic. It has been translated to 37 other languages to support families and children globally.

5. Invest in preventing and addressing domestic violence.

Violence against children is commonly perpetrated by family members. Restrictions on movement have trapped women and children inside their homes with abusive partners around the world, and multiple reports globally indicate that violence against women and children is on the rise. During the first lockdown, in China’s Hubei province, reports of domestic abuse nearly doubled.

Lockdowns are challenging governments and civil society organisations to provide suitable checks on at-risk families and alternative avenues for women and children to leave dangerous home situations.

Who’s doing what so far?

• In the Canary Islands, the Institute for Equality launched the ‘Mascarilla-19’ (Mask-19) campaign, which has since been adopted across Spain, as well as in France, Germany, Italy, Norway and Argentina. Women who are experiencing violence at home are encouraged to go to their local pharmacy to request ‘Mascarilla-19’, and pharmacy staff will alert emergency services.
• In India, the Uttar Pradesh police launched a special hotline number to report domestic abuse, publicised through front-page newspaper advertisements.
• In Canada, Quebec and Ontario designated domestic violence shelters as essential services that must remain open during the lockdown. Canada has announced a $50 million aid package to support those shelters.
• In Indonesia, Malaysia and the Netherlands, the governments have either opened a new hotline for parents or expanded the capacity of existing domestic violence hotlines.
• The UK government has launched a taskforce and pledges £76 million toward supporting vulnerable children and victims of domestic violence. The funding will help community-based services that work in England and Wales and includes the recruitment of additional counsellors and provision of safe accommodation.

Additional resources

Stress, Resilience, and the Role of Science: Responding to the Coronavirus Pandemic
https://developingchild.harvard.edu/stress-resilience-and-the-role-of-science-responding-to-the-coronavirus-pandemic/
Understanding stress, resilience and the role of science in early childhood development.

Babies in Lockdown
https://babiesinlockdown.info/
A UK-focused report reviewing the impact of COVID-19 and subsequent measures on those pregnant, giving birth or at home with a baby or toddler.

Caregiver Mental Health — Knowledge Sharing Series
https://caregivermentalhealth.org/resources/
An annotated selection of resources as a part of the Caregiver Mental Health Knowledge Sharing Series, including topics on: COVID-19 and Mental Health, Intervention Approaches, Organizations and Networks, Guidelines and Tools, and Selected Research and Publications.

Centre for the Developing Child — COVID-19 Resources
https://developingchild.harvard.edu/resources/covid-19-resources/
A comprehensive list of US and international resources that help with a variety of concerns.

Child Hub — How to include marginalized and vulnerable people in risk communication and community engagement
https://childhub.org/en/system/tdf/library/attachments/covid-19_communityengagement_130320.pdf?file=1&type=node&id=42459
Guidance on engaging marginalised and vulnerable communities through the pandemic.

Child Trends — During the COVID-19 pandemic, telehealth can help connect home visiting services to families
https://mailchi.mp/999356a38426/during-the-covid-19-pandemic-telehealth-can-help-connect-home-visiting-services-to-families?e=ccd99fab22
Exploring alternative modes of delivery to continue home visiting support to families.

Child Trends — Ways to Promote Children’s Resilience to the COVID-19 Pandemic
https://www.childtrends.org/publications/ways-to-promote-childrens-resilience-to-the-covid-19-pandemic
Outlining five protective factors which promote resilience in young children during the Covid-19 pandemic.

Early Childhood Workforce Initiative — Emergency Child Care: Issues to Consider
https://www.earlychildhoodworkforce.org/content/emergency-child-care-issues-consider
Outlining the ten issues to address in emergency childcare provision

Home Visiting Applied Research Collaborative — COVID-19’s Early Impact on Home Visiting
https://www.hvresearch.org/wp-content/uploads/2020/04/COVID-19s-Early-Impact-on-Home-Visiting.pdf
Initial findings on the impact of Covid-19 on home visiting programmes.

OECD — Combatting Covid-19’s effect on children
https://www.oecd.org/coronavirus/policy-responses/combatting-covid-19-s-effect-on-children-2e1f3b2f
A consolidation of immediate and longer-term policy responses on how governments are protecting young children

Overseas Development Institute — Covid 19 — why gender matters
https://www.odi.org/blogs/16856-Covid-19-why-gender-matters
Taking a gendered lens to the impact of Covid-19 and the corresponding responses.

PMNCH compendium of COVID-19 related partner resources on women’s, children’s and adolescents’ health
https://www.who.int/pmnch/media/news/2020/guidance-on-COVID-19/en/
A comprehensive list of resources for various stakeholders.

Quick Tips on COVID-19 and Migrant, Refugee and Internally Displaced Children (Children on the Move)
https://www.unicef.org/media/67221/file
Ensuring the inclusion of migrant, refugee and internally displaced children.

15 Ways to Support Young Children and their Families in the COVID-19 Response
http://documents.worldbank.org/curated/en/963051586986115651/pdf/15-Ways-to-Support-Young-Children-and-their-Families-in-the-COVD-19-Response.pdf
Existing interventions which can support young children as part of a Covid-19 response.

Situation tracking for Covd-19 socioeconomic impacts
https://data.unicef.org/resources/rapid-situation-tracking-covid-19-socioeconomic-impacts-data-viz/
UNICEF database tracking the impact that Covid-19 has on the health and nutritional needs of children and families in specific countries.

Read our other briefs on supporting babies, toddlers and their caregivers during and post-Covid-19:

Six ways cities can support babies, toddlers and their caregivers during the Covid-19 pandemic and beyond

Five ways Covid-19 economic recovery plans must invest in the next generation