The impact of the COVID-19 pandemic on children with medical complexity

  1. Catherine Diskin
  2. Francine Buchanan
  3. Eyal Cohen
  4. Tammie Dewan
  5. Tessa Diaczun
  6. Michelle Gordon
  7. Esther Lee
  8. Charlotte MooreHepburn
  9. Nathalie Major
  10. Julia Orkin
  11. Hema Patel
  12. Peter J. Gill

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Abstract

Background

Descriptions of the COVID-19 pandemic’s indirect consequences on children are emerging. We aimed to describe the impacts of the pandemic on children with medical complexity (CMC) and their families.

Methods

A one-time survey of Canadian paediatricians using the Canadian Paediatric Surveillance Program (CPSP) was conducted in Spring 2021.

Results

A total of 784 paediatricians responded to the survey, with 70% ( n  = 540) providing care to CMC. Sixty-seven (12.4%) reported an adverse health outcome due to a COVID-19 pandemic-related disruption in healthcare delivery. Disruption of the supply of medication and equipment was reported by 11.9% of respondents ( n  = 64). Respondents reported an interruption in family caregiving (47.5%, n  = 252) and homecare delivery (40.8%, n  = 218). Almost 47% of respondents ( n  = 253) observed a benefit to CMC due to COVID-19 related changes in healthcare delivery, including increased availability of virtual care and reduction in respiratory illness. Some (14.4%) reported that CMC were excluded from in-person learning when their peers without medical complexity were not.

Conclusion

Canadian paediatricians reported that CMC experienced adverse health outcomes during the COVID-19 pandemic, including disruptions to family caregiving and community supports. They also describe benefits related to the pandemic including the expansion of virtual care. These results highlight the need for healthcare, community and education policymakers to collaborate with families to optimize their health.

Article activity feed

  1. Version published to 10.1186/s12887-022-03549-y
  2. ScreenIT

    SciScore for 10.1101/2021.12.02.21266765: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We conducted a one-time survey of Canadian paediatricians and subspecialists using the Canadian Paediatric Surveillance Program (CPSP).
    Canadian Paediatric Surveillance Program
    suggested: None
    Analysis: Microsoft Excel (version 2015) was used to tabulate responses, and statistical analyses were descriptive.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Homecare is essential to the lives of many CMC and their families,11,12 but limitations regarding its delivery were described before the pandemic.13 We also describe disruptions in family caregiving, highlighting the emotional and financial stress involved in caregivers of CMC.14 The impacts of the pandemic as related to family caregiving and community services interact with previously existing challenges, highlighting the vulnerability of this subgroup of children and their families and a pressing need to recognise the stressors CMC and their families are experiencing. Canadian pediatricians reported major disruption to the educational system during the COVID-19 pandemic, including the well-known reduction in attendance at in-person class.15 School closures exert a greater influence on vulnerable children, including those with disabilities.16 Before the pandemic, many families of children with developmental disabilities, would highlight school holidays as times of increased stress.17 School is not simply an academic pursuit for many children, including CMC, but a place of therapy, nursing, respite, learning, and socialization. When access to such services are interrupted, it becomes the responsibility of family caregivers to step in. For families of CMC, this can be an additional burden to already overburdened caregivers. As the 2021-2022 academic year starts, considering the entire experience with an inclusive lens is necessary with collaboration and flexibility between tra...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.12.02.21266765v1 on medRxiv