Caring for children in a new world

This month’s cover image was part of a larger exhibit, “Brave New World.”¹ The exhibit’s title is based on the novel published by Aldous Huxley in 1932.² The book portrays a dystopian future with stark societal inequities, arguably bearing similarities to the world we are living in today. Our cover image of Kane and his father reflects the theme of this issue, child health. Fortunately, thus far, children have been largely spared from the more severe outcomes of coronavirus disease 2019 (COVID-19). But, youth are not immune to the pandemic. My 6-year-old nieces attend classes online. Many teenagers cannot go to their high school graduations—one of the most important events in their lives to date. Job loss experienced by many parents directly affects the health of their children.

The full effects of the pandemic will likely not be known for years, so monitoring child development in the time of COVID-19 is especially important. This issue (page 488) highlights the 2020 edition of the Rourke Baby Record (RBR),³ originally published in Canadian Family Physician in 1985.⁴ It was developed by family physicians James and Leslie Rourke. Not only were they married, but they were partners in medicine. They developed numerous flow sheets to help direct clinical care in their family practice, including a guide for tracking development of children. Realizing that the guide was helpful to colleagues and locum physicians, they embarked on publishing it. The RBR has since undergone several updates, in collaboration with colleagues across the disciplines of family medicine, pediatrics, and nursing.

The 2020 version includes revisions that are particularly relevant during the pandemic. For example, while screen time should continue to be avoided for children younger than 2, video chats are now considered acceptable in this age group because this type of communication can help children develop and maintain connections with family and friends. For alternatives to screen time, reading to children is still highly encouraged, but singing has been added as an important activity that can help with child development.

The RBR also recommends that screen time for parents and caregivers be minimized. In the 2020 guidelines published by the Canadian Society for Exercise Physiology, it was recommended that adults limit their recreational screen time to less than 3 hours per day.⁵ Although these recommendations refer to limits on recreational screen time, excessive screen time of any kind could result in negative health consequences. Most adults I know (including myself these days) exceed this threshold, especially with our migration to practising medicine remotely.

Virtual medicine poses further challenges when it comes to the physical examination. The updated RBR recommends examining the heart, lungs, and abdomen at all visits, and other updates are intended to better help with the early detection of autism spectrum disorder and cerebral palsy. The care of such patients is also examined in this issue (page 506),⁶ but what important nuances could be missed with the reduction of in-person assessments?

The revised RBR also includes validated questions to identify poverty and food insecurity. Assessing social determinants of health in primary care is crucial in family medicine with particular effects on children.⁷ With the pandemic, many of our patients have suffered from financial hardship; asking these questions is all the more important. It is also important to reflect on societal injustices and violence. Dr Leason’s article in this month’s Third Rail section (page 525) discusses the history of the forced sterilization of Indigenous women, many of whom had their right to have children taken away from them.⁸

Whether it has been shifting to virtual care, communicating through the barrier of personal protective equipment, or recognizing racial injustices, the past year and a half has led to many changes in policies, behaviour, and mindsets. Medicine has had to adapt. Interestingly, adaptability is a characteristic that I have witnessed in many children as they have shifted to learning at home, wearing masks, and coping with varying levels of lockdown.

Our new world indeed requires bravery. But it also requires adaptability. As adults, we try our best to be role models for the children in our lives. But children also provide inspiration and lessons for us. It is a privilege to be able to care for children as part of our profession. And they need us now, just as much as we need them.

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