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Changed expectations for child health and wellbeing

By Dr Suzanne Crowe - 05th Feb 2024


The strong public reaction to the wave of RSV infection in small children is heartening

With so much talk about RSV (respiratory syncytial virus) in the last few weeks, a friend asked me is RSV a new virus, as she didn’t remember ever hearing about it before. It’s a good question and the answer tells us a lot about the public’s view on children’s health in the era of rapid advances in medicine and technology solutions.

RSV is certainly not new; it’s a nasty virus that has been causing illness in small children for decades. It also causes havoc in the delivery of medical care to other children, as they get displaced by a predictable wave of sick babies every winter. Post-pandemic, we have a greater awareness of both viral infections and the positive impact of vaccination, so we may be filtering this year’s viral onslaught with that heightened awareness.

There’s something else though. Our expectations for the medical and social care that our children receive have dramatically changed over recent decades. These altered expectations colour the demands that are placed on childcare, education, and healthcare. The public easily access information about medical diagnoses and treatments available internationally and expect the same quality care for their children. Fundraising campaigns can bridge the shortfall in novel treatments only available in a small number of centres abroad, but this is less and less acceptable to many parents. At this stage, most people just assume that standard surgical interventions and medications are provided by the State to children in a timely and equitable manner. We also assume that children with disabilities will be supported with sufficient resources. Discovering that this is not universally the case is genuinely surprising to younger generations. When it comes to a troublesome virus like RSV, the public correctly ask if there is a vaccine to prevent illness, and what steps have been taken to reduce the spread and impact of infection. As healthcare providers, we are expected to be ready.

Courageous testimony from adults who were treated abominably as children in schools, orphanages, and hospitals have led people to say, ‘never again’ and ‘not for my child’. Parents are now very aware of the multitude of harms caused against children and young people in our education and health system in the past – even thinking about that happening to your own child or grandchild is the stuff of nightmares. The Department of Children, Equality, Disability, Integration and Youth has taken a strong stance with their ‘Children First’ national guidelines for social workers, healthcare professionals, and health and social organisations. It mandates the reporting by professionals working with children of suspected child neglect and ill-treatment. Regular training in the reporting guidelines is compulsory. However, the rape of ‘Emily’ in 2020 in a nursing home and the murder of infants by the neonatal intensive care nurse Lucy Letby in the UK, starkly demonstrates that those at risk, such as children, people with intellectual disability, and the very elderly remain vulnerable to deliberate harm and that raising the alarm may occur too late or worse, go unheeded.

Greater awareness of the challenges experienced by older generations in Ireland not only makes neglect of children unacceptable, but it also means that it is widely believed that every child deserves a chance to thrive in a loving home and benefit from education and social support. The solidarity with sick children and their families witnessed during the Late Late Toy Show has become a normal part of the run-up to Christmas – people want to help children achieve their potential. Unfortunately, in certain circumstances the State must step in and provide a nurturing environment for a child, which should be of the highest standard.

This altruistic spirit sits in conflict with what we know about the conditions experienced by children in direct provision or homelessness. A variety of NGOs and charities, such as One Family, consistently raise our ambitions by pointing out the uncomfortable truth of the scale of deprivation experienced by some children. The Children’s Rights Alliance published a report recently on their End Poverty Week 2023 to wrap up their pre-Budget awareness campaign. They had called for a children’s Budget, designed to break the cycle of poverty. Budget 2024 included some key measures to do this, including expanding free schoolbooks up to the Junior Cycle of secondary school, as well as an extension of the ‘hot school meals’ programme to non-DEIS primary schools beginning in April 2024. These and similar organisations collect data, share information, and give a voice to children and young people, a group in society that have little political force. They have contributed much to our collective expectations for the health and wellbeing of children.

The public reaction to the wave of RSV infection in small children is heartening. It suggests a country that has begun to prioritise children, a societal development which is overdue. Unaccompanied and accompanied child migrants, children in homeless families and children with disabilities continue to be a massive concern in terms of access to adequate resources to achieve what we want for every child. As we expect and push for improved and fairer access to healthcare, early childhood education, and social care for children, we must ensure that all children are cherished equally.

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The Medical Independent 20th February 2024

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