During the early phase of the pandemic the number of people attending accident and emergency departments reduced dramatically.i This effect was almost universal, affecting people from all parts of society and for all health conditions. But in our recent paper, a collaboration with colleagues from Frimley Health NHS Foundation Trust, West Hertfordshire Hospitals NHS Trust and the universities of Glasgow and Bristol, we highlight one notable exception to this rule. Presentations at Emergency Departments for infant-feeding problems increased by 9% in England in the period from April 2020 to March 2021, compared with the previous year.ii Why, when most other patients were staying away from ED, did infant-feeding presentations increase? We examine this effect in detail and identify some possible causes.
Initiating and maintaining breastfeeding is not always straightforward. During the pandemic, parents were separated from many of the formal and informal sources of support. A large number of health visitors were redeployed during the first wave of the pandemic to respond to the healthcare emergency and many aspects of health visiting were suspended or delivered virtually. GP services, a source of holistic care for new families and their babies, changed markedly, with telephone calls replacing face-to-face consultations. And lockdown measures disrupted many forms of informal and familial support that would normally be available to women who had recently given birth. We note that infant feeding presentations at ED increased more dramatically for women giving birth for the first time.
Remote support services, initiated by voluntary-sector organizations, helped to plug this gap by providing support with breastfeeding following hospital discharge. But access was contingent on awareness of these support services and availability of information technology and is therefore unlikely to have been uniform and comprehensive.
Early discharge from hospital after birth was encouraged in efforts to reduce the risk of a COVID-19 infection. We found that ED presentations for infant feeding were particularly marked amongst women who had been discharged on the day of birth or the following day. This ties in with earlier studies that showed that shorter hospital stays following childbirth were associated with an increased risk of readmission for feeding problems and jaundice.
Even before the pandemic, infant feeding presentations at ED were not uncommon. Emergency departments are accessible, but they rarely represent the best solution for an infant with feeding problems. And EDs are under enormous pressure. So what might be done to address this problem?
The decision to suspend health visiting services during the pandemic was taken at a time of great uncertainty. But should another pandemic or emergency occur, then we would ask policy makers to think carefully about maintaining the service. It is common practice to prioritise infant-feeding services in countries experiencing the effects of natural and man-made disasters.
And perhaps the pandemic can prompt us to finally tackle the long-standing, underlying issue of breastfeeding support arrangements in England. Breastfeeding rates are consistently lower in England than in many other countries. And we know that many women stop breastfeeding earlier than they would like, citing problems with lack of support. Services must be accessible, proactive and be able to respond rapidly to parent’s emerging concerns. If not, then we should not be surprised when parents bring their babies to ED.
In this webcast colleagues who collaborated on this paper discuss what happened during the pandemic and what we can learn from it to better meet the needs of parents and families with infant feeding problems.
This is a great example of the powerful insights that can be drawn from clinical, analytical and academic fields collaborating to understand and address health problems. A special recognition to the collaborators of this work, who came forward with their experience and expertise:
- Dr. Patrick Aldridge - Paediatric Clinical Lead and Consultant at Frimley NHS Foundation Trust’s Emergency department
- Dr. Sankara Narayanan - Consultant Neonatologist at Watford General Hospital
- Dr. Luisa Zuccolo - Senior Lecturer in Epidemiology, University of Bristol
- Dr. Samantha Ross - GP in Glasgow with a special interest in infant feeding