On Saturday, the Mail revealed the devastating toll of the pandemic on children’s development, with classrooms of five-year-olds still in nappies, unable to feed or dress themselves or make themselves understood. In the concluding part of her investigation, Harriet Sergeant uncovers how health visitors and other vital services for new parents, babies and toddlers all but disappeared in lockdown and, more shockingly still, remain unavailable . . .
Aoife had three children under the age of four to care for on her own during lockdown.
After the birth of her younger daughter in 2020, Aoife did not get any of the reviews from a health visitor every child is meant to have (file image)
Well organised and attentive, superficially she coped very well.
When I visit her small house in Croydon, South London, it’s spotless. The room belonging to her two girls, Alesha and Chevelle, aged four and two, is a cocoon of pink, complete with a pink playhouse and a giant, cuddly unicorn in rainbow hues.
Meanwhile, her nine-month-old-son, Ajani, smiles and gurgles at his mother in his baby swing.
But her immaculate home does not tell the whole story. Under the surface Aoife struggled throughout the pandemic.
After the birth of her younger daughter in 2020, Aoife did not get any of the reviews from a health visitor every child is meant to have.
Like any new mother, she was concerned that Chevelle was putting on enough weight and breastfeeding properly. She emailed and called her GP and health visitor services a number of times but she received no reply, even when she explained: ‘I told them I was on my own here and had no family nearby.’
The same happened after Ajani was born last year. No health visitor contacted her then, either. When he was constipated for three days, in desperation she took him to A&E. ‘With a newborn you’re worried about every single little thing.’
Thankfully, all was well but, shortly afterwards, a social worker rang — alerted by the hospital, which was concerned about a possibly vulnerable mother.
‘I understand you’ve missed a lot of postnatal appointments,’ the social worker said.
‘Not for lack of trying,’ said Aoife, remembering her numerous phone calls.
‘Your daughter has not seen anyone since 2019.’
‘But she wasn’t born until 2020,’ said Aoife, thinking he meant Chevelle.
There was silence as the social worker absorbed that no professional had seen two of Aoife’s children until she had taken one to A&E.
‘That’s how little they cared,’ said Aoife.
The pandemic has hit all our lives but, as I explained in part one of my investigation, the devastating impact on young children is only just becoming clear, highlighted by how unprepared youngsters are when they start primary school.
In a normal year, teachers estimate about half of children will start reception unprepared for school.
Now, shockingly, it is almost all of them.
The many teachers I spoke to are exasperated by four-year-olds who can barely say their own name and still come to school in nappies.
They were quick to blame lazy parents. But as I will explore today, to understand why children are so ill-prepared it is vital to look at what happened over lockdown to the services and support parents of young children normally receive. And the devastating impact when those services disappeared overnight.
Nobody doubts the importance of the role played by mums and dads.
‘All the evidence shows that parenting has a bigger impact on a child’s life in the early years than education, wealth or class,’ says Cristina Odone, founder of Parenting Circle, a charity which supports parents.
‘Until the age of 13, parenting is the single most important influence.’
This was magnified during lockdown. In the absence of playgroups, nurseries, friends and relatives, parents found themselves having to become everything to their children. But while teachers hold lazy parents responsible for not teaching their children basic life skills, what they don’t take into account is how much parents were struggling themselves.
A survey carried out by the organisation found more than one in four health visitors across England are accountable for triple the recommended number of children
As Tess Bailey-Sayer, CEO of The Sea Change Trust, a charity working in Shropshire to transform young lives through specialist psychotherapy, explains: ‘Children are utterly dependent on their parents’ sense of wellbeing and stability for their own sense of wellbeing and stability. It is like their weather system. The child doesn’t have the resilience to cope on its own.’
But neither did many parents in the extraordinary circumstances of lockdown.
A key factor highlighted by reports carried out for the House of Commons Petitions Committee on the impact of Covid on new parents, published in 2020 and 2021, was that ‘new parents missed out on crucial support, with potentially harmful long-term consequences for parents’ wellbeing and their children’.
Many parents were left feeling abandoned, especially those living in challenging circumstances. For much of Covid, there was a national atmosphere of anxiety and fear.
For parents of young children, especially new mothers, that anxiety was exacerbated by not knowing where to turn for help and advice with their children.
The lockdown had an immediate impact on early-years provision. Parks and playgrounds closed. Drop-in baby and toddler groups, a great source of information and reassurance for mothers, ceased to function.And health visitors, a vital service and a lifeline for new parents, simply disappeared, as did many GPs.
Health visitors are specialist community public health nurses who work with families with children from newborn to five years old to reassure, provide information and identify health problems. They check if new mothers are suffering from post-natal depression or are having trouble bonding with their baby.
The five obligatory health visitor checks in England are ten to 14 days; three to five weeks; six to eight weeks; nine months to one year; and two to two and a half years. The last is key for spotting developmental problems that might require action.
These reviews are usually done in the baby’s home, then at a GP surgery, baby clinic or children’s centre. Their role is crucial because all the evidence shows that the first 1,001 days of a child’s life are the foundations for later wellbeing and success. Health visitors are in a unique position to identify families who are struggling and get them help before the issue worsens.
But when lockdown came nearly all visits and clinics stopped. Babies In Lockdown: Listening To Parents To Build Back Better was a report into the issues carried out by three children’s organisations. Its survey of 5,474 parents of newborns to two-year-olds revealed that, shockingly, only one in ten parents of under two-year-olds saw a health visitor in 2020.
This is despite the fact that doctors and children’s charities believe a baby’s wellbeing is best assessed face to face.
Contact was supposed to switch to phone or video calls. But many parents, like Aoife, appeared not even to have received those.
One mother told the survey: ‘We’ve not seen anyone. We had a Zoom call at the 12-month [health visitor] check-up. Of all my friends I was the only one that actually got a video call, which was shocking. They didn’t even get a phone call.’
The five obligatory health visitor checks in England are ten to 14 days; three to five weeks; six to eight weeks; nine months to one year; and two to two and a half years. The last is key for spotting developmental problems that might require action
A mother described the impact this lack of contact had on her: ‘It is not good [that] we are left alone, no contact from health visitors and I can’t see my family. I feel very isolated and frightened. This is my first child, I don’t know what normal is and I don’t know where to find help.’
Another mother commented: ‘The lack of support for us at the moment, lack of postnatal classes and postnatal checks, lack of socialisation for babies . . . I could go on . . . all of it has a massively negative effect.’
Unbelievably, the parent of premature twins recalled how they had seen just one midwife and one health visitor since leaving ICU, saying: ‘I feel like we [were] just given the babies and basically [told to] keep them alive.’
No wonder nine out of ten parents in the 2020 survey reported high levels of anxiety during lockdown.
Every mother wonders whether her baby is feeding properly, gaining weight as they should and, often, that crushing fear: do they have a disability? But without drop-in clinics or regular checks these concerns went unanswered.
One mother complained she had to learn how to breastfeed by Zoom. Not surprisingly she gave up, ‘I feel such a failure,’ she said tearfully, ‘and this has affected my relationship with my baby.’
There are all too many stories of GPs failing to step up. When one new mother’s episiotomy stitches burst and became infected, she found herself in a nightmare. Instead of seeing her in person, the GP insisted she provide images.
‘This felt completely wrong, a complete invasion of my privacy, as I was being asked to send an email containing photos of my vagina and perineum to a generic GP practice email address to ensure I could receive antibiotics for the infection.’
The reports for the House of Commons highlighted the drop off of professional support had led ‘to an increased likelihood of anxiety, depression and loneliness among new and expectant mothers’. And mental health services were also unavailable. One mum told the committee she had to wait a year just for remote counselling.
In a survey by the National Childbirth Trust, 25 per cent of new mothers reported not being asked about their mental health at all in their six to eight-week postnatal consultation with their GP.
Worryingly, seven out of ten parents in the survey of parents of newborns to two-year-olds in lockdown felt the changes were affecting their baby or young child. A quarter reported concern about their relationship with their baby and a third of those wanted help.
As one mum reported: ‘I feel detached from my baby. I feel as though she doesn’t see me.’
Tess Bailey-Sayer, who works in schools with young children affected by the pandemic, sees a clear link between parents, children and what is now taking place in schools.
‘Often, a child was on its own all day with a very angry, stressed and anxious adult,’ she says. ‘Young children cannot put their feelings into words. Instead, they show their distress through their bodies.’ They stop speaking or will not eat. Toilet training goes backwards. She sees children arrive in school, ‘either extremely anxious and withdrawn or completely wild’.
So it is extraordinary, in the face of this plethora of evidence about the importance of support for new parents, that many GPs and health visitors still remain unavailable.
The No One Wants To See My Baby report, carried out by the Parent-Infant Foundation and published in November 2021, discovered that over a quarter of health visitor contacts were still on the phone or online last year when lockdown restrictions were largely easing. Its survey of professionals and volunteers confirmed more than a third of health visitor drop-in clinics were no longer operating in their area.
A recent report by the charity Action For Children also found that two-thirds (67 per cent) of parents were unable to access essential early-years services.
The Government has signalled that GPs must return to face-to-face appointments, but has failed to do the same with health visitors.
Tess Bailey-Sayer, adds: ‘Health visitors are still not doing their visits around here in Shropshire. The baby clinics are not happening. The most basic forms of support are not there.’
In their defence, health visitors point out their numbers have tumbled over the past few years, leaving them overstretched and causing its ‘biggest workforce challenge in living memory’, according to Alison Morton, executive director of the Institute Of Health Visiting.
A survey carried out by the organisation found more than one in four health visitors across England are accountable for triple the recommended number of children.
One health visitor is supposed to look after 200 children, yet more than half were looking after 500 and one in four found themselves responsible for 750. As a result, only the ‘tip of the iceberg’ of need is being met for some families.
If urgent action is not taken by the Government, the shocking lack of readiness for school among the nation’s children is only going to become entrenched, with serious long-term implications for future generations.
As Sally Hogg, of the Parent-Infant Foundation, says: ‘There is a huge need to mobilise public services, voluntary services and communities to ensure that we do not lose those invisible children, or only find out about them when there are serious incidents or later down the line.’
It is a sad fact that the five-year-old who cannot ‘play nicely’ or speak properly is more likely to grow into the nine-year-old bully, the 13-year-old with poor school attendance, the 15-year-old who joins a gang and the 19-year-old behind bars.
And if that is the future now for a whole generation of children, it is a disaster for us as a society.