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Q&A: COVID infant study

Local pediatrician answers questions about the effects of infection during pregnancy
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Dr. Kellie Waters from Summit Paediatric Clinic says a study that showed no significant delays between infants whose mothers had COVID-19 during pregnancy between those whose mothers did not is reassuring. SUPPLIED/Photo

On Jan. 4 the Journal of the American Medical Association released a study held at Columbia University Irving Medical Center in New York City that looked at the impacts a COVID-19 infection during pregnancy may have on a child.

The study found infants born during the pandemic scored significantly lower on the gross motor, fine motor, and personal-social of the Ages and Stages Questionnaires — a screening tool used for children — at six months compared with a historical cohort of infants born at the same institution, regardless of whether their moms had COVID during pregnancy.

The findings suggest maternal stress, not COVID-19, impacts infant neurodevelopment.

Dr. Kellie Waters, a pediatrician with Summit Pediatric Clinic in St. Albert, answered The Gazette's questions about the study.

What are your overall thoughts of this study?

"I think it is important that people are starting to ask what potential impact this pandemic will have on our children, including on those who are born during this strange and stressful time.

"I also think it is reassuring that these researchers found that, in those infants whose moms had experienced mild or asymptomatic COVID during pregnancy, there were no significant deficits reported in their development at six months compared to a similar group of infants whose moms had not experienced COVID."

What would you tell parents who see this study and have concerns?

"This is a small study and should be interpreted cautiously, requiring repetition with a much larger population and expert assessment of development rather than parent report as the primary outcome.

"I would reassure them that the domains of communication and problem solving were found to be equal in pre-pandemic and pandemic groups being studied and that only the gross motor domain had more infants (in the pandemic group) meeting an actual cut-off point for possible delay.  

"The meaning of the differences between historical and pandemic group scores are otherwise not really meaningful.

"I would also reassure them that monitoring development is part of normal check-ups done by any family doctor or pediatrician and early intervention is helpful regardless of cause."

The study speaks about the possible link between stress and infant development, can you talk about stress impacts parents should be aware of? 

"There is a growing body of evidence that maternal stress during pregnancy can be detrimental to the health of the child. Things like asthma and growth restriction seem to be more prevalent and there is some evidence that children are more likely to develop ADHD or other neurodevelopmental challenges when exposed to toxic stress in utero. 

"Of course, it is really hard to sort out how much of these issues are due to genetic and postnatal environmental influences, but there are indicators that pregnancy stress is not good for the growing fetus.

"What can parents do about this in the midst of a pandemic? Make sure they are taking care of themselves as much as possible. The adage of airline attendants about "putting on your own oxygen mask first" is really true. Infants do best when their parents are mentally healthy, so asking for help is really vital for pregnant moms or new parents who are struggling."   

Are you noticing anything in your own practice with concerns about “pandemic babies” and slowed development?

"I would not say that I am seeing more developmental delays in infants secondary to the pandemic.

"What I am seeing is that assessments and supports for those children who have delays are severely lacking in the community because of pandemic restrictions, growing wait lists, and redeployment of staff. This is going to unfortunately have long-term impacts on these children's development as we know early intervention is key.

"I get lots of questions from new parents about whether masking or limited social interactions because of the pandemic are going to be harmful to their infant's development. These are good questions, and I think there is research ongoing to answer them. My intuition and own experience say that for the vast majority of kids, this won't be an issue."

What should parents of pandemic babies be aware of?  

"They should be reassured that infants' brains are incredibly plastic, and children are amazingly resilient.  

"They should monitor their own mental health, because we know infants of depressed or anxious mothers have worse neurodevelopment outcomes if their mothers are not being supported and cared for sufficiently. Also, I think parents really need to cut themselves some slack — there is no book called Perfect Parenting During A Pandemic for a reason — there's no such thing!"

What does normal development for a six-month-old look like?  

"There is a wide spectrum of normal, but I generally ask whether a child is starting to sit, even briefly, while resting forward on their hands (called tripod sitting) and rolling front to back and back to front. (Gross motor)

"Fine motor skills I ask about include whether the child is transferring toys between hands and starting to hold their bottle by themselves, if bottle-fed. For speech, parents should be starting to hear consonants in the child's vocalizations: "bababa" or "mamama.”

"With respect to social development, the child should be recognizing their caregivers preferentially and maybe even starting some stranger anxiety. If an infant isn't doing all of these things right at six months, that can still be quite normal, but they should be following up with their primary care provider."

What should parents watch out for when it comes to their baby’s development?  

"There is a wide variety of normal.  

"The biggest thing is to expect ongoing progression even though it may be slow at times. If a young child regresses — loses a skill or developmental milestone they had previously demonstrated — the parents should bring this to the attention of their primary care provider as soon as possible.

"If parents have concerns about their child's vision or hearing, this needs to be investigated. My experience has been that parents are pretty tuned in to their child and if their intuition is telling them there is something to be concerned about, they shouldn't ignore this."

What can parents do to help their baby with the development of fine/gross motor and personal-social skills?  

"The best ways to help with motor skills are:

1. Start tummy time early and continue frequently when the infant is awake and in a safe environment.

2. Try to minimize screen time for infants (zero is ideal, but I would say there is a difference between putting the child in front of a TV or iPad and having it on in the background while the child is playing in the room and facing away.)

3. Read and sing to infants.

4. Encourage older infants to self-feed with finger foods when safe from a choking point of view."

Is there anything that I’ve missed or that you think is important to talk about?

"I would encourage pregnant women to be fully vaccinated against COVID-19 (including a booster) as soon as possible.  

"We know that the newer variants of COVID-19 are making pregnant women quite a bit sicker. There have been maternal deaths from COVID-19 in Alberta, which is especially tragic for the newborn left behind.  

"Expectant parents also need to know that because of the increased risk of severe illness in pregnant women, if not fully vaccinated, they are eligible for a monoclonal antibody treatment (AHS will actually come to their homes to deliver it!) called Sotrovimab if diagnosed in the first five days of symptoms. If someone thinks this may apply to them, they should call 811."

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