NHS England have confirmed that the 6-week check can safely be conducted in person at 8 weeks to coincide with the first primary childhood immunisations; minimising attendance at the practice (14 April 2020).
Due to COVID-19 many providers have reduced the frequency of face to face/in person contacts with families during their postnatal period. Patients will only be seen in person by the health visiting service if they are highly vulnerable, otherwise these contacts are being done remotely by telephone or video.
This means the only NHS face to face/in person contact with new mothers and babies is the GP 8 week check
This postnatal check is a key and vital opportunity to identify:
RED FLAG PRESENTATIONS - should prompt urgent senior psychiatric assessment:
Amber risk factors for Perinatal Mental Health- (indicators of increased future risk):
How to refer to the Perinatal Mental Health Team
Information on Southern Health NHS website
OUT OF HOURS: Contact the Mother and Baby unit directly- 01962 897711- they will email referral paperwork for you to complete
For evidence-based information from experienced specialist pharmacists regarding any medication and potential interactions with breast feeding (anti-depressants etc.), email The Breastfeeding Network- Drugs in Breastfeeding - firstname.lastname@example.org
During COVID-19, most contacts with Health Visitors and patients will be via telephone or video appointment. The only face to face contact will be when there is an ‘assessed and compelling case for doing so’. This decision will be made with advice from senior practitioners and safeguarding colleagues, and include information from partners such health and local authority children’s services.
IF YOU HAVE QUERIES, QUESTIONS OR CONCERNS ABOUT A CHILD (e.g. weight monitoring OR HV FOLLOW UP CARE), PLEASE CONTACT YOUR LOCAL HEALTH VISITING TEAM (link below) IN THE USUAL WAY
To find your practices local health visiting team, please click on the link below: Find your local HV or email your HV Team via their generic email
Audiology screening: This service is continuing via maternity post-delivery in the usual way, however, any babies that require further assessment in the community, are being referred but WILL NOT be seen until community services resume post covid-19 (parents will be contact in due course).
Hip/Ophthalmic Referrals: NHSE has advised that GPs should continue to refer patients to secondary care using the usual pathways and to base judgments around urgency of need on usual clinical thresholds (taking into consideration need for non-face to face consultations, likely delays in recommencement of routine elective activity, and communicating likely delays to patients at point of referral).' Secondary care will hold clinical responsibility for GP referrals and will follow these up in due course.
REMEMBER Bruising in babies is very rare and must be considered abuse until proven otherwise. If any professional thinks a skin mark on a baby could be a bruise they must refer to Children’s Services via a phone call under the bruising protocol in the usual way.
Children’s Services will then arrange an examination in person with a consultant paediatrician. Bruising Protocol
Making a referral to Children’s Services in Hampshire: This referral needs to be completed via the inter-agency referral form (IARF) which can be found here
CONTACT NUMBERS FOR LOCAL AUTHORITY CHILDREN’S SERVICES:
Office Hours: 01329 225379
Out of Hours: 0300 555 1373
Office Hours: 02380 832 300
Office Hours: 02392 839 111
Isle of White
Office Hours: 0300 300 0901
Out of Hours: 0300 3000117
Digital Imagery of Birthmarks/? Bruising during COVID-19
If ANY (e.g. social worker), professional is sent a digital image directly from a parent we recommend that the baby is seen in person for a full physical examination by an appropriate health professional (for example; midwife, health visitor or GP).
If a HEALTH professional is sent a digital image directly from a parent we recommend the baby is seen in person for a full physical examination by an appropriate health professional.
If a health professional is asked for a second opinion on a probable BIRTHMARK, by another health colleague, we recommend that the child is seen in person for a full physical examination.
In some situations digital images may enable a health professional to make a correct diagnosis, and avoid the need for the child to be examined in person. An example might be a large cavernous haemangioma (strawberry birthmark). However, if there is any uncertainty the child should be seen in person for a full physical examination. The use of digital images should only be considered a temporary approach during coronavirus.
Otherwise it is business as usual
Abusive Head Trauma of babies is most common during 6-12 weeks of life. This is correlated with the peak in infant crying. The 8 week check is a key opportunity to reinforce the below info:
Abusive head trauma (AHT) key points:
Challenges of COVID-19:
Resources for professionals and patients
See the ICON Toolkit from the HSCP webpage / See the ICON patient leaflet
Key Messages to Reinforce:
Do not place pillows, cot bumpers and soft toys in the cot
Children’s Partnership – Every Sleep Counts Toolkit - Website
Every Sleep Counts is a programme of prevention aimed at parents and carers
The Lullaby Trust - Website
The Lullaby Trust raises awareness of sudden infant death syndrome (SIDS), provides expert advice on safer sleep for babies and offers emotional support for bereaved families
If you have a concern that there is potential Domestic Violence and Abuse (DVA), consider referral to Hampshire Stop DA Services for victims and Hampton Trust for perpetrators. See section 9 of this document for resources of support for victims and perpetrators. The IRIS Guidance has been developed specifically for GP’s during COVID-19 and recommends the following when discussing DVA with patients remotely:
If it isn’t then ask for a suggested safe time to call back. Be aware that situations change quickly and that risk is dynamic.
Wessex LMC has produced a statement for parents that we strongly support; please reiterate this message to your patients:
“COVID19 is unlikely to cause a serious illness in children, but please remember children can still become seriously unwell from other causes that are always around. Please do not let concerns over COVID19 stop you from contacting medical services. If you are not sure if your child needs to be seen please go to https://www.what0-18.nhs.uk/national for advice or contact 111 or your GP. For information about crying babies go to https://what0- 18.nhs.uk/parentscarers/worried-your-baby-unwell-under-3-months/my-baby-crying- excessively. If your child is severely unwell call 999 or go to ED.”
Patients attendance for their 8 week check
We recommend that surgeries send new parents/carers a text message of encouragement to attend their 8 week postnatal check.
The suggested wording would be:
NHS England has stressed the importance to maintain good vaccine uptake and coverage of immunisations. Where practices experience high demand on services, it is important to prioritise time sensitive vaccines for babies, children and pregnant women:
All routine childhood immunisations offered to babies and infants including vaccines due at one year of age including the first MMR dose
All doses of targeted hepatitis B vaccines for at-risk infants should also be offered in a timely manner
Mental health screening questions
link to RCGP perinatal mental health toolkit
Domestic Abuse screening questions
Postnatal health education
Click here for formal evaluation
Please click here.