Singapore

Paediatricians step up to look after children with Covid-19 who are on home recovery


SINGAPORE – Some 45 paediatricians have teamed up to provide free telemedicine care for children with Covid-19, to ease the load off hospitals and designated telemedicine providers for home recovery.

The doctors have been handling 100 to 200 cases a day since Oct 8, including those on scheduled follow-up during the home recovery programme (HRP).

This initiative comes after the Government announced on Oct 9 that home recovery will be the default for children aged between five and 11, since the Ministry of Health (MOH) found that Covid-19 is not a serious illness among the vast majority of them.

Parents earlier told The Straits Times that they would prefer their children to receive medical attention at a hospital due to the lack of tailored telemedicine options for children.

But now they will be getting calls from one of 45 doctors specialising in the care of children, who are authorised by MOH to provide telemedicine support.

Dr Darryl Lim, a consultant paediatrician at Kinder Clinic in Mount Alvernia Hospital in Thomson, told ST that hundreds of kids had been anxiously waiting at home when HRP began.

Hence, the team wanted to beef up the workforce by reaching out to more children under 12 and reduce the waiting time needed for medical attention.

“We wanted to quickly assess who needed to go to the hospital quickly and who could be on HRP,” he said.

When HRP started, many parents, who had yet to be contacted by telemedicine providers, took their children to KK Women’s and Children’s Hospital (KKH) and National University Hospital after they felt unwell, he noted.

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Therefore, the team came up with an arrangement to provide home recovery care to children between five and 11 for free.

“We wanted to get to them faster and reduce the number of ‘pit stops’ at the children’s emergency departments so that the hospitals can focus on kids below five for assessment, while ensuring that those who need quick medical attention don’t fall through the cracks,” he added.

KKH currently sees all paediatric patients who have been diagnosed with Covid-19 at the hospital, and those aged five and below who have been diagnosed in the community setting.

The dynamism and teamwork among the doctors mean that they are able to reach this group of children within one to two days after their positive test result.

He said: “We aim to reach the end of the daily list within 24 hours, and we only contact parents between 9am and 10pm daily, to avoid disturbing them during their much needed rest.”

The team members will chip in according to their differing schedules and workload for the day, he added.

At the end of each day, the doctors compile a check-list of items to follow up on, such as children who need to be called back or those who need urgent medical attention.

The doctors also alert MOH when they identify patients who do not have oximeters – which monitor blood oxygen levels – at home so that a care pack containing one will be delivered to them.

Through his prior experience in child emergency care, Dr Lim pointed out that there are different markers of clinical deterioration in Covid-19 among children compared to adults, which may require prompt medical attention.

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Some signs that paediatricians look out for include lethargy, persistent vomiting and breathlessness, which could be detected via video conferencing, he said.

These cases can then be quickly taken to the hospital for closer assessment and monitoring.

While the voluntary initiative by these doctors will lighten the workload of healthcare workers in hospitals, telemedicine consultations are not without their own challenges.

Dr Cheng Tai Kin, who runs Kinder Clinic at Parkway East Hospital, noted how not all children are suitable for home recovery.

He said: “Some children with heart disease, very bad asthma, who are very obese, they would be at higher risk of Covid-19 complications.”

Dr Cheng added that children with special needs may also require a face-to-face assessment if they are unable to communicate how they are feeling over a telemedicine consultation.

He has also encountered parents who wondered whether he was a scam caller.

To reassure them, Dr Cheng would send them a medical questionnaire about their child’s symptoms and also present his photo ID during the video call.

As to why he is undeterred by these hurdles, he said: “It’s national service. It’s a crisis. We want to relieve the burden on hospital emergency departments. They’ve been very busy for a very long time.”

Parents whom ST spoke to welcome this initiative.

For Ms Lim Pei Hoon, 37, a sales assistant, getting a doctor to see her two five-year-old boys when they tested positive for Covid-19 on Oct 10 was an urgency.

“Both my kids developed a fever, but I didn’t manage to contact MOH, and the Swab-and-Send-Home Clinic I called told me to monitor them at home, and give them medicine if I have any,” she said, adding that the situation was very stressful for her.

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Thankfully, their symptoms resolved in three to five days, and both have since recovered, she added.

Consultant Eileen Chua, 46, who has a daughter aged 10, said having direct access to a doctor is good as parents may have questions to ask.

She added: “But if my child was having symptoms beyond a cough and runny nose, I would like to see a doctor in person. A child with a stomach ache may not know if it’s indigestion or something more serious.”





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