In Practice

Parental access to hospitalised children during infectious disease pandemics such as COVID-19

A Goga, U Feucht, S Pillay, G Reubenson, P Jeena, S Mahdi, N T Mayet, S Velaphi, N McKerrow, L R Mathivha, N Makubalo, R J Green, G Gray

Abstract


The COVID-19 pandemic has resulted in many hospitals severely limiting or denying parents access to their hospitalised children. This article provides guidance for hospital managers, healthcare staff, district-level managers and provincial managers on parental access to hospitalised children during a pandemic such as COVID-19. It: (i) summarises legal and ethical issues around parental visitation rights; (ii) highlights four guiding principles; (iii) provides 10 practical recommendations to facilitate safe parental access to hospitalised children; (iv) highlights additional considerations if the mother is COVID-19-positive; and (v) provides considerations for fathers. In summary, it is a child’s right to have access to his or her parents during hospitalisation, and parents should have access to their hospitalised children; during an infectious disease pandemic such as COVID-19, there is a responsibility to ensure that parental visitation is implemented in a reasonable and safe manner. Separation should only occur in exceptional circumstances, e.g. if adequate in-hospital facilities do not exist to jointly accommodate the parent/caregiver and the newborn/infant/child. Both parents should be allowed access to hospitalised children, under strict infection prevention and control (IPC) measures and with implementation of non-pharmaceutical interventions (NPIs), including handwashing/sanitisation, face masks and physical distancing. Newborns/infants and their parents/caregivers have a reasonably high likelihood of having similar COVID-19 status, and should be managed as a dyad rather than as individuals. Every hospital should provide lodger/boarder facilities for mothers who are COVID-19-positive, COVID-19-negative or persons under investigation (PUI), separately, with stringent IPC measures and NPIs. If facilities are limited, breastfeeding mothers should be prioritised, in the following order: (i) COVID-19-negative; (ii) COVID-19 PUI; and (iii) COVID-19-positive. Breastfeeding, or breastmilk feeding, should be promoted, supported and protected, and skin-to-skin care of newborns with the mother/caregiver (with IPC measures) should be discussed and practised as far as possible. Surgical masks should be provided to all parents/caregivers and replaced daily throughout the hospital stay. Parents should be referred to social services and local community resources to ensure that multidisciplinary support is provided. Hospitals should develop individual-level policies and share these with staff and parents. Additionally, hospitals should ideally track the effect of parental visitation rights on hospital-based COVID-19 outbreaks, the mental health of hospitalised children, and their rate of recovery.

Authors' affiliations

A Goga, South African Medical Research Council, Cape Town, South Africa; Department of Paediatrics and Child Health, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

U Feucht, Department of Paediatrics and Child Health, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa; Tshwane District Health Services, Gauteng Department of Health, City of Tshwane, South Africa; Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa; Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa

S Pillay, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

G Reubenson, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

P Jeena, Department of Paediatrics and Child Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

S Mahdi, South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

N T Mayet, National Institute of Communicable Diseases, Johannesburg, South Africa

S Velaphi, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

N McKerrow, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Paediatrics and Child Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Department of Paediatrics and Child Health, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa

L R Mathivha, Department of Critical Care Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

N Makubalo, District Clinical Specialist Team, Eastern Cape Department of Health, Nelson Mandela Bay, South Africa

R J Green, Department of Paediatrics and Child Health, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

G Gray, South African Medical Research Council, Cape Town, South Africa

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Keywords

COVID-19; Child health; Parental access to hospitalised children; Hospitalisation; Hospitalised children; Infectious diseases and children

Cite this article

South African Medical Journal 2021;111(2):100-105. DOI:10.7196/SAMJ.2021.v111i2.15388

Article History

Date submitted: 2021-01-20
Date published: 2021-01-20

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