How are the lockdown babies now?

My personal story | Anna Higham, Clinical Negligence

The experience of having a baby during lockdown was unprecedented and challenging for many parents, including Anna Higham from our Clinical Negligence team.

In this blog, Anna shares her personal story of having a baby in lockdown, detailing the delays and challenges in obtaining diagnoses for her daughter’s medical issues. Anna also explores the broader impact lack of baby services at that time had on babies and their families. Through her research, Anna discovered that her experience was far from unique; many parents faced similar struggles, leading in some cases to delayed or undiagnosed serious illnesses.

Despite the severity of these issues, there is currently no clear legal framework to address them. As these lockdown babies are now starting school, the long-term effects of the lockdowns are becoming evident. Anna is reaching out to hear from others who have faced similar challenges, hoping to spark a conversation and explore potential solutions.

My lockdown baby

On 29th February 2020 I welcomed my second daughter, Isabelle, into the world. Little did I know that within a few days, my Leapling (as babies born on the leap year are affectionately known) would become a Lockdown Baby. A year later, and we were still in a locked down world as I was preparing to return to work. The baby charity Best Beginnings, which had done a lot of research into the impact of the lockdowns on babies, asked me to do a blog piece for them on the challenges of returning to work after a maternity leave in lockdown.

When I wrote it, I could hardly believe that my Lockdown Baby was a year old. Yet within the blink of an eye, my Lockdown Baby is now preparing to go to school. This milestone seems a fitting time for another blog. I feel particularly grateful to be sending a healthy, happy little girl off to start her school life as I believe that the difficulties we faced accessing baby services during lockdown brought us very close to a different outcome.

This personal blog piece reflects on those difficulties and how some Lockdown Babies may not have been so fortunate in their outcome as Isabelle.

The impact of lockdown on the provision of baby services | My personal experience

As a first-time mum back in 2017, I had been amazed at the abundance and availability of baby services. Immediately after Isabelle’s birth in February 2020, things initially proceeded as I had expected; she had her five and 10 day checks as normal. However, on 20 March 2020, the day that nurseries closed, I got my first glimpse into how baby services were likely to be impacted by lockdown.

That day, I took Isabelle to the community midwife clinic for her 3-week check. I was taken aback to find the midwife fully gowned and masked, and standing at the far end of the room. She remained there for the duration of the appointment. Having been accustomed to handing the baby over at such appointments and having her handled and treated as a precious bundle to be celebrated, it was unnerving to be asked to undress and weigh Isabelle myself, shout out the weight showing on the scales and then re-dress Isabelle, whilst the midwife kept as far away from us as possible. She didn’t even look at Isabelle properly. Despite not having regained her birth weight, Isabelle was nevertheless signed off. She and I returned home, not to see another person outside of our household until her 6-week baby check, which took place at the end of May 2020, when she was 13 weeks old.

At this 13-week appointment, the GP weighed Isabelle and told me that she had barely gained any weight since she was last weighed 10 weeks earlier. I was astounded and devastated to learn that Isabelle was seriously underweight. When I look back at photographs, it is clear to see that she was underweight but at the time, in isolation at home, I hadn’t noticed; something I will always berate myself for.

The GP referred Isabelle to the community paediatric team. In the meantime, there was nowhere else that the GP could send her for monitoring. All the weigh-in clinics were closed, and health visitors had largely been redeployed to help the Covid effort. There was no feeding support available. In the end, the GP herself continued to weigh Isabelle at the surgery on a regular basis. Isabelle made slow but sufficient progress to avoid hospitalisation, but it was not until she weaned that she began properly to gain weight and thrive.

During her early months, I had also noticed a different issue with Isabelle, some unusual markings on one of her legs. However, it was not until she gained weight when weaning that the issue became properly noticeable; the affected leg did not plump up in the same way as the other. Initially the GP said to wait until the appointment with the community paediatric team (for the weight issue) came through and to deal with her leg at the same appointment. But as the discrepancy in Isabelle’s legs became more apparent, and with no word from the community team, I pushed for a hospital referral. This was made but it still took a few months for the appointment to come through. As soon as she was seen, she was diagnosed with a rare congenital condition and within weeks had been seen by a multi-disciplinary team of doctors. It seemed to me at that stage that the hospital care was there for those who needed it, but the access to that care had been almost entirely blocked by the Covid restrictions and processes. Fortunately for Isabelle, no harm arose for her as a result of the delay in diagnosing this condition.

In the meantime, Isabelle’s appointment with the community paediatrician, that she had been urgently referred for at 13 weeks, finally came through. She was now 13 months old and by this time there was no longer an issue with her weight and the hospital-based team had taken over her care for her other condition. To this day I do not know what the cause of Isabelle’s failure to thrive was and I feel that it is thanks only to good fortune that she came through those first few months unharmed. On reflection, I believe that Isabelle was discharged by the midwife at the 20-day appointment prematurely because of the Covid lockdowns, and that she should not have been discharged until she had regained her birth weight. I also believe that but for the lockdowns, a midwife or health visitor laying professional eyes on Isabelle would have noticed how underweight she was and would have taken action much sooner than 13 weeks of age.

I am certain that if Isabelle’s recovery for either of her conditions had been dependent upon medical intervention, she would not have received it in a timely manner and would have suffered injury as a result.

Research

Having experienced first-hand as a mother the impact (and the potentially serious consequences) of removal of baby services during lockdown, I started to consider the position from my professional point of view as a solicitor and undertook some research. I was interested to learn that within only a few months of the lockdowns, reports were starting to emerge from charities who were concerned about the impact the lockdowns were having on babies. The first major report, “Babies in Lockdown”, was published as early as August 2020. The research found that only 1 in 5 mothers with a baby under two months old had seen a health visitor face to face during the first lockdown.

Health visitors are generally responsible for assessing the growth, development and nutritional needs of infants whether that’s at home or in baby clinics. One of the early days’ checks performed by a health visitor is for jaundice. Jaundice is common in newborns, but if it does not resolve and babies have high levels of bilirubin in their blood, they can go on to develop kernicterus. This is a rare but serious complication of untreated jaundice, which can cause permanent brain damage. Health visitors also look out for signs of low blood sugar, for example, a lack of interest in feeding, lethargy, low body temperature, floppiness or a blue tint to skin and lips. These could indicate hypoglycaemia. If undetected and untreated, hypoglycaemia can cause cerebral palsy, developmental delay, epilepsy and eyesight problems.

Some of these signs are subtle, which is why the importance of in-person professional health checks cannot be understated. One respondent to the “Babies in Lockdown” report rather scathingly observed that these signs cannot be spotted down a telephone line. Furthermore, it should not be left to the parents to detect these signs for themselves and realise the potentially serious implications.

Despite the 6 week check being described by the Royal College of General Practitioners as a high priority service during lockdown, an NSPCC report found that almost a quarter of Lockdown Babies did not undergo the 6 week baby check. At the 6-week check, babies have a thorough physical examination, usually by a GP. This essential assessment aims to detect congenital heart disease, developmental dysplasia of the hip, congenital cataract and undescended testes. Babies also have their weight, length and head circumference measured to ensure they are developing as they should. Normally, if there are any concerns about a baby, referrals can be made, including to the community paediatric team.

Paediatric outpatient referrals and appointments decreased as a result of the pandemic. One research paper noted that neonatologists were particularly concerned about early hospital discharges after birth due to Covid-19 concerns before feeding had been established, and infants then returning to hospital with feeding difficulties and severe dehydration. In older children, diabetic ketoacidosis and sepsis were reported to be the top two conditions where there had been a delay in diagnosis. One medical report was actually called, “Where have all the children gone?” and the answer it found to this question was: “They remain at home, some of them with very important and serious pathology that can (and needs to) be treated.”

In Autumn 2020, a follow up to the “Babies in Lockdown” report was published, called “No one wants to see my baby”. This really struck a chord with me as that is exactly how I had felt for months. It also made me realise that after several long months of feeling isolated and alone, I was anything but alone in the battle to have my baby seen.

Conclusion

Most Lockdown Babies will not have come to any harm as a result of the omission of their routine checks or delayed access to healthcare services. I am thankful that Isabelle is one of these children. It will be rarer still for a Lockdown Baby to have suffered a serious, life-changing injury due to the withdrawal or depletion of services.

But what is the legal position for those who have? Traditionally when patients suffer injury, it is because a person or a system has performed negligently following an assessment/appointment. There has to be an element of contact between a healthcare professional and a patient to give rise to a duty to take care. Lockdown Babies who were not seen, but who had a condition which would have been detected/treated if they had been, and who have suffered harm as a result of the failure to see them, find themselves in an entirely unique position. To date there is no law which clearly states that injury as a result of a complete omission can give rise to a claim.

The charities concerned about the Lockdown Babies coined a phrase: a healthcare “baby blind spot”. The “baby blind spot” left Lockdown Babies isolated at home and invisible to the world. This will no doubt resonate with many in the way that it resonated with me. I am keen to ensure that those babies who have been harmed by the healthcare “baby blind spot” do not remain in a legal “baby blind spot” as well, unable to seek justice for the harm caused.

If, like me, your Lockdown Baby is preparing for school and you are reflecting on their start in life in lockdown, and you think that an injury may have arisen as a result of similar omissions to the ones described in this blog, please consider getting in touch. This could be for some legal advice, or simply to share your experiences with someone who has lived through similar difficulties as you.