Overwhelm, loneliness and anxiety on one side of the 'line'. On the other, 'ears', support and techniques to help deal with emotions, amid the turmoil heightened by the pandemic.

One report published on Wednesday (1st) by the #Colabora Project, from Rio de Janeiro, narrates the drama of mothers of children with microcephaly in the Northeast region – a story that includes reports from women about the regressions they see in advances achieved by their children, and about the shock to the mental health they feel due to the social isolation imposed by Covid-19, the disease caused by the new coronavirus.

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The Santos Dumont Institute (ISD), a reference in the Unified Health System (SUS) in providing care to children with microcephaly through the  Specialized Center for Hearing, Physical and Intellectual Rehabilitation (CER III) of the Anita Garibaldi Health Education and Research Center, is mentioned in the text among those who try to reduce these impacts by offering teleservices. And the attention goes beyond physical rehabilitation. 

Since March, when the clinic's in-person services were suspended, ISD's multidisciplinary team has developed and implemented strategies to provide emotional support to families and show them ways so that – with guidance – they can maintain children's stimulation in the home environment and avoid setbacks. 

Listening, reception and strategies

“Psychological services try to give mothers (still the main caregivers of children) a space to listen, in which they can externalize feelings that were already very present in their lives, but which intensified with the pandemic. A space for them to integrate this pain, be welcomed in this suffering and also see possibilities of dealing with the moment in a healthier way”, explains the Institute's clinical psychologist, Fernanda Rebouças.

Psychological services are provided weekly or fortnightly, according to need, and identified overload and loneliness among the feelings heightened in women during quarantine.

Breathing techniques for moments of heightened anxiety and encouragement for self-care are among those disseminated to help them.

Microcephaly

Microcephaly is a congenital malformation in which the child's brain does not develop properly.

One of the visible signs is the size of the head, which is below the average for children of the same sex and age.

The ISD Multidisciplinary team served an average of 30 children with this condition in Rio Grande do Norte between 2019 and the beginning of 2020. 

Nineteen of them had weekly monitoring before the quarantine. Currently, the frequency of monitoring is individualized, according to the context of each child. 

Services are provided through channels such as video calls, phone calls and WhatsApp messages.

The children come mainly from the municipalities of Natal, Macaíba, Parnamirim, Extremoz and São Gonçalo do Amarante and are up to 5 years old. Among them, 9 have microcephaly due to Zika and the rest have the disease associated with other congenital infections such as syphilis, toxoplasmosis, rubella and herpes.

In a publication on the website To explain causes, symptoms, treatment and prevention, the Ministry of Health notes that epilepsy, cerebral palsy, delayed cognitive, motor and speech development, as well as vision and hearing problems can accompany people with this condition.

“The idea is not to focus just on the child, but on the family”, says psychologist

From a treatment point of view, “the idea is not just to focus on the child, but on the health of this family and mother”, emphasizes ISD psychologist Fernanda Rebouças. Samantha Maranhão, a neuropsychologist at the Institute, adds that the team encourages women to seek and expand support networks, even virtually, with neighbors, close family and friends, so that they don't feel so alone. “We also reflect on the need to share responsibilities and tasks, whenever this is possible.”

The challenges that families face from an emotional point of view make it difficult, but have not prevented children's rehabilitation actions from being carried out in most cases. 

There is support from a psychological point of view and from the rehabilitation team, with support for families via teleservice and telemonitoring, says Camila Simão, physiotherapist and coordinator of Physical Rehabilitation at CER Anita Garibaldi, which includes the ISD Microcephaly clinic. 

In some cases, she notes, the Institute's therapists send guidance via videos or present them on video calls, so that families can carry out rehabilitation exercises at home.

“We follow this process and with their feedback, any adjustments are made. Some mothers, however, are unable to implement these guidelines and what has been done is to put them in contact with the reference therapist for emotional support”, explains Camila. 

“The majority of our children with microcephaly”, adds the physiotherapist, “the predominant characteristic is neuromotor impairment which we classify as GMFCS V, that is, according to the gross motor function classification (GMFCS) they depend on other people to remain standing. or sitting and to carry out transfers, that is, to change position or move around”.