Developmental delays faced by children also known commonly as a ‘delay’ has seen significant visibility increasingly. With the urban sectors showing higher numbers for conditions such as Autism and genetic related developmental disorders the dire need to address childhood delays medically and holistically remains a high priority both in the developed and developing world. The objective identification of a ‘delay’ in a child is made by observing and measuring the relevant developmental domain of a child which often includes gross motor, fine motor, speech, reading, skills required for independence and social skills.
A longitudinal study done in the US that examined children aged 3- 17 that has received a diagnosis of a delay revealed that over 17% of children were given at some point given a diagnosis of a delay/ disability. ADHD, Learning Disability and Speech and senses related delays were the most common. Although no official data is available in Sri Lanka currently on children facing developmental delays several preliminary studies show that with increased pre-natal, peri natal and postnatal complications elevates the risk for children having delays. One study done as a developmental surveillance at the Colombo North Teaching hospital revealed that a direct impact of postnatal complications impacted cerebral palsey and other developmental disorders. Maternal stress level, socio economic variants and now even a pandemic situation is likely to make children vulnerable for delays.
Currently in Sri Lanka Island wide services are available initiated both by the government and the private sector to identify and treat early children with or at risk for a delay or a disability. However, the Covid – 19 pandemic situation posed a new challenge to all health care and educational professionals addressing delays presented in childhood. This called forth for innovation and evidence based systems that would effectively address health, rehabilitative and educational needs of children with delays. Thus tele health systems in the form of tele therapy and tele consultations that provides online support directly to children and their caregivers towards their development currently is in operation.
Importance of Early Identification and ROI in child development in a pandemic.
Many developed economies have singularly recognized the need for investments made in early intervention and thus are reaping the benefits of a more productive labor force that contribute to the economy overcoming and despite disabilities. The Return On Investment (ROI) of the Federally/Nationally funded Head Start program in the US ranges from USD 7-9 for every dollar invested.
In a pandemic, children with a delay or at risk for a delay remain highly vulnerable. If unaddressed these children have a high risk of having a disability that could limit their contribution as adults making them dependents. This poses a serious risk to any economy calling forth for proactive measures. Hence investments made both at an institutional and at an individual level for children facing delays particularly at the time of the pandemic should remain a priority.
Evidence of Tele health and Tele Therapy for children.
Telehealth has been used by pediatric clinicians for over a century, in cases of emergency and monitoring use of telephone facilities were an important part of the over all pediatric practice. More advanced technologies such as video consultations are prevalent with its high usage happening since 2020 with the Covid 19 pandemic.
According to a study done recently Telehealth presents the opportunity to bridge many divides including geographical and logistical challenges. It states that ‘many acute pediatric conditions can be managed safely and effectively through telehealth especially when remote physical exam equipment is used. Telehealth can also be especially useful in medical care of children with medical complexity. Traveling with medical equipment to multiple subspecialists can be incredibly challenging and often a similar quality visit can be conducted through telehealth in the comfort of a child’s home environment.’
Evidence suggests that the integration of telehealth into the pediatric patient centered medical home can enable families to gain convenience while maintaining the essential relationship with the health professional.
Speech delay and tele therapy
A preliminary study conducted by Ceylon Speechie recently revealed that tele therapy in Speech and Language Therapy given through an online platform delivered in the form of parental training remained successful with children below the age of five. These results were even comparatively better than face to face consultations. Tele therapy improved the overall communication, speech and language skills of the all the children that were part of the study. The improvements were mainly identified to be due to the reduced stress levels of parents during tele health consultations, clinician being able to analyze child’s natural environment in reference to the treatment plan, easy accessibility of the service and high parental involvement.
In a study published dating back to as 2017 a systematic review revealed both telehealth and in-person participants made significant and similar improvements when treatment effects were measured through outcomes in speech and language therapy given for school aged children.
Findings previously before the Covid -19 pandemic showed there is limited but promising evidence to support telehealth for delivering speech-language pathology intervention services to school-age children. In 2021 these evidence is further backed by many researches with parents expressing high levels of satisfaction with tele health programs given for delays that children faced.
Way forward
Sri Lanka is well known for its health care structure indicative of outcomes that are seen as exemplary to the developing world. With 99% of all maternal deaths occurring in the developing world, the South Asian region accounts to the predominance of these. Sri Lanka’s closest neighbour India both on geographical as well as on influential grounds, has an estimated 300 maternal deaths per 100,000 births whilst in Sri Lanka it is less than 30 per 100,000 live births. A similar trend is also seen in infant mortality rate. These indicators illuminate the long established healthcare structure of the country, that has prioritized training health professionals towards serving the poorest and the most under resourced communities in the country. It also stand as a testament to the long establish medical education of the country ensued solely by state investments.
Nevertheless when skilled doctors in the country save lives at the birth of infants who have odd chances to live, there remains a dire lack in trained professionals monitoring and facilitating optimal child development. In Sri Lanka too there has been a rise in the presence of developmental disabilities in children with a recent study showing 1 in 93 children in Sri Lanka are affected by the disorder.
Some of the disabilities are presented full blown later on in a child’s life due to medical professionals and parents missing out on early presenting signs. Many children in the country have been diagnosed with childhood developmental disabilities the effects of which could have been minimized or even reversed if early detection and treatment were provided.
Within the new scenario of the pandemic use of tele health platforms both for tele therapy and other pediatric needs should be acknowledged and made use of optimally within this context.