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29 SET – Dear director,
For some time I have been operating in a Covid drive-through where I do nasal and oropharyngeal swabs. In recent days, I have been puzzled by the large number of swabs that pediatricians prescribe for children of all ages and the fact that no parent has received information about the operational risks inherent in rhinoceros and oropharynx swab procedures in children in this area. stage of development in which they oppose and do not cooperate with any invasive procedure.
These risks, well known, current and not merely theoretical, are the following:
1- Risk of tampon breakage and consequent inhalation. Standard swabs are provided with a break point to break the rod after collection and insert it into a tube. Many colleagues have already reported cases of tampon breakage in children’s mouths. A case of a child who died following the procedures necessary to remove a piece of inhaled tampon was recently reported in the United Arab Emirates.
2 – Risk of injury to the nasal, oral and pharyngeal mucosa. The national press has reported many cases of preschool-age children who have attracted the attention of specialists for injuries to the mucous membranes caused by the execution of the swab. To understand how specific this risk is, such a risk is enough to note, for example, that the diameter of a baby’s nostril is smaller than that of the tip of the standard swab and that therefore to insert it into the nasal cavity it is necessary to you must force the nostril. Obviously, the lesions represent loci minoris resistentiae for other respiratory tract infections. In recent days the international press reported on the case of a newborn who died as a result of inapparent bleeding caused by the execution of the hyssop.
3 – The psychological trauma of the child and the social alarm it caused in the families (which in almost all cases is then unfounded) There is an extensive literature on the long-term psychological trauma caused by invasive procedures in preschool children. Furthermore, the throat swab is one of the few invasive procedures for which there are no effective local cognitive-behavioral or pharmacological techniques to reduce fear and pain in the child.
When, as it is my professional and ethical duty, I explain these risks to parents, they invariably tell me that they have not been informed by the pediatrician and that they have not had the opportunity, as is their right, to discuss them with the caregiver to reach a an agreement. conscious and participatory decision.
Many parents have told me that the prescription of such an invasive and risky procedure has occurred in many cases without the pediatrician having visited the child, but simply because of mild and clinically nonspecific symptoms reported by the mothers; that in most cases they would not even have referred the child to the pediatrician if they had not been forced by the need to return the child to school, after being rejected by the child in the opinion of personnel lacking the skills to assess signs and symptoms as a child.
In other words, mothers report a surreal chain of decisions with alarming frequency:
– the janitor or other personnel without medical experience believe that the child has symptoms attributable to Covid-19;
– the mother, despite the fact that she believes that these symptoms are completely irrelevant according to her own experience (scientific literature has shown how sensitive and specific the mother’s perception of the child’s health is) is forced to report them to the pediatrician;
– in an astonishing number of cases the pediatrician, without visiting the child and therefore without checking whether the symptoms detected by the caretaker are true and clinically relevant, prescribes the tampon. Parents are often told that they are “obliged” to prescribe the tampon, but it is not clarified on the basis of which standard.
The paradoxical result is that too often, in the absence of a clinical filter performed by the pediatrician, the swab is ultimately done following the clinical judgment of a … concierge not shared by the mother and supported without comment from the pediatrician.
Speaking with the families, a generalized climate of bewilderment and disbelief arises due to a decision-making process that must have the clinical judgment of the pediatrician and the informed participation of the family at the center, but which they perceive as distorted and pathological.
In addition to what I have just reported, I have also been able to observe, to my great confusion, numerous cases of prescriptions for which it was really impossible for me to understand the clinical justification.
The most striking example was that of a 40-day-old breastfed infant with no clinical signs, negative for neonatal screening, healthy and with regular growth, whose father had returned without any symptoms from a business trip and whose pediatrician prescribed the tampon to the whole family, including the little one.
The parents did not present symptoms or suffer from chronic or degenerative pathologies; the family consisted of only three and there were no elderly or chronically ill people in the house; the boy had close contact only with his mother, what was the point of undergoing such an invasive and risky procedure? If the mother was also positive, what was the point of cleaning the baby? Being breastfed and in constant close contact with his mother, it is almost certain that he too would have tested positive. And if the little one had tested positive, what would have been the use of knowing, given that there is no preventive treatment and the only measure to take is careful observation?
The abnormal number of tampons that are prescribed, the lack of information about the risks and the stories of the parents are clearly a sign that something in this process is not working and needs to be corrected urgently.
Prof. Dr. Filippo Festini
Associate Professor of Nursing Sciences
MED / 45 general, clinical and pediatric
Department of Health Sciences
University of Florence
Meyer Children’s Hospital
September 29, 2020
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