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Infant mental health in times of the COVID-19

Infant Mental Health in times of the SARS Corona-2 pandemic

By Kai von Klitzing, University of Leipzig, Germany, President of WAIMH 
 
I live in Europe, in one of the hot spots of the Covid 19 pandemic. In the hospital in which I work, life has changed dramatically. The changes affect infants and parents dramatically. For example, in the department of obstetrics, the largest maternity clinic in town, fathers were not allowed to be present at deliveries of their babies for weeks in order to protect the hospital staff from the virus. Currently, mothers are obliged to wear face masks when nurturing their newborns. Furthermore, no visitors are allowed to see mother and the newborn:  no fathers, grandparents, or siblings. 
 
In the whole country, playgrounds have been closed off. All social support interventions for parents and infants are currently stopped. Child protection services are not going out for home visits and treatments can only be executed via video or telephone. The child psychiatry and pediatric in-patient unit can only treat emergency cases and parents are allowed to visit their children only one hour per week. This reminds us of times in the first part of the last century in which parents were generally excluded from children’s hospitals before pioneers like Spitz, the Robertson’s, Bowlby, and Winnicott pointed to the dramatic harm caused by this praxis of separating young children from their parents.  At that time, those infant researchers induced a dramatic change of the practice in Western industrialized countries. 
 
The Robert Koch Institute, the central institution of the German Federal Government for the monitoring and prevention of diseases, has prescribed the following recommendations: 
 
Children should like adults keep a distance of more than 1.5 meters to others. Children should also not meet more than two persons at the same time. Children who cannot constantly keep a distance to other persons should stay at home. 
 
When we realize these restrictions, we have to admit that especially young children bear a major burden of the societies’ measures to fight the pandemic. A child in its first years urgently needs close body contact, in the first months to his/her closest caregivers, but later on also to the siblings, peers, other important adults etc. The moment of delivery is essential in the life cycle, and the newborn baby needs the early close contact not only to his/her mother, but also to the father. Loneliness is one major restriction which can cause problems of early parent-child relationships. Especially young parents need support, for example by their parents, their community etc. Still the situation of infants in industrialized Western countries might by bearable when we compare it with the situation of infants (and parents) in regions in which there is poverty, war, and in which large populations live under the conditions of migration. Furthermore, children with handicaps and chronical diseases suffer most.
 
What can we say? Do young children and their parents bear such a burden facing the humanitarian corona crisis because we have to protect them most attentively from the infection? No, the contrary is the case! There is overwhelming evidence that infants are less vulnerable towards the detrimental influence of the Corona virus as compared to adults, especially elderly people and persons with pre-existing chronic diseases like diabetes, high blood pressure, or oncological conditions. Infants are vulnerable with respect to detrimental environmental shortcomings like neglect, maltreatment, or social economic instability, but they usually do not fall seriously ill when they catch the corona virus (as long as they are in a good enough nutritional state). Scientists and medical doctors believe that this lower vulnerability is due to a more flexible immune system and/or to the immaturity of their ACE 2 receptors where the SARS Corona virus might primarily dock. 
 
Also, pregnant women do not seem to have an increased risk of a severe course of the illness. In most cases, children of Covid positive mothers do not show symptoms after delivery. Only a few cases of newborn illness as a possible sequela of an infection in the mother’s body have been reported. To date there is no evidence for the existence of the SARS-CoV-2 virus in the breast milk. In summary, according to our current state of knowledge, the symptoms of Covid19 are markedly less severe in newborns, infants, and older children as compared to adults.
 
When we know that the virus is of low risk for young children, why do we expect the youngest in our societies to tolerate the highest restrictions, which can put them at risk on their part? Restrictions such as:  
  1. Reduced contact possibilities after birth, especially to fathers. 
  2. Emotional exchange with caretakers restricted by mask. 
  3. Reduced corporal contact with siblings and peers. 
  4. Interruptions of their nursery settings. 
  5. Reduced child protection services. 
  6. No freedom of movement. 
  7. Closed playing grounds; and 
  8. No contact with grandparents, etc. 
It is not because we want to protect them, but it is because we adults want to protect us. Young children usually do not seriously fall ill but they can be infected by the virus, bear the virus and they can transmit the infection to other children and adults. A pediatric colleague compared the role of young children in the pandemic with a Trojan Horse. They can look harmless, but they can bring you the evil! Suddenly we adults are afraid of children and we think they can infect us. 
 
I think morally it is justified to expect young children to make certain sacrifices for the health of adults, diseased, and elder persons. However, we have to admit that it is an act of solidarity what we request from the young generation towards the old generations. When we bring this to our mind, we have to be very careful in reflecting the limitations of our request. Furthermore, we should ask ourselves: 
  1. Are we grateful enough towards the children in our societies and enough for those caring for them? 
  2. Are we willing to repay solidarity to them? 
  3. Are we ready to stop wasting environmental resources, which they would need for their future lives? 
  4. Are we willing to stop conflicts, no matter whether in our families, neighborhoods, or between our societies, because young children suffer most from such circumstances? 
  5. Are we acknowledging and respecting enough, the rights of infants all over the world; and  
  6. Are we attentive enough towards the relational and emotional needs of young children?
The pandemic represents a true worldwide humanitarian crisis. However, as in all crises there is also an opportunity arising from the current situation: the opportunity of carefully reconsidering fairness and solidarity between the generations in our global world.