The COVID-19 pandemic led to huge changes to children’s daily lives including school closures, loss of contact with family and friends, and financial difficulties which impacted on the wellbeing of all children. The Social Determinants of Health model gives us a framework to consider the impact of lockdown directly on children, and indirectly through the impact on parents, families, community and government policy as children cannot be considered in isolation to families or society. Children have suffered directly with lack of access to healthcare, and a decline in their mental health. Infant bonding may have been affected due to maternal stress, anxiety or depression, compounded by limited Health Visitor support. Poverty, food insecurity and lack of exercise contributed to increased obesity. Many children will have been exposed to domestic violence, parental mental illness and child abuse without being able to tell teachers or other adults outside of the home, these Adverse Childhood Experiences (ACE) increase the risk for subsequent health and behaviour problems. Children have spent many hours online for school learning and socialising with friends but faced risks of criminal exploitation and grooming. The long-term financial implications of COVID-19 will continue to impact on society for many years to come and further increase social inequalities.

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Aims Within Paediatrics, the complexity of communication over a range of developmental stages in childhood and caregivers means clear communication is key to safe clinical care and reducing adverse events. A Danish study 1 of root-cause analysis (RCA) of adverse healthcare events identified communication errors in >50% of cases.Simulation is an evidence-based tool to optimise communication and confidence in multi-disciplinary team (MDT) leadership. However, assessment of communication in the workplace and simulations are largely focused on verbal communication.60-70% of communication is non-verbal though visual cues from lip-reading and facial-expressions for both hearing and Deaf people. 2 The advent of facemasks across the NHS has highlighted the impact of losing half the communication modality. A 'Silent Sims' programme was developed for Paediatric A&E MDT focused on non-verbal communication aiming to establish: 1. 'Innate skills' to facilitate non-verbal communication 2. Identifying strategies to facilitate challenging communication 3. An inclusive Paediatric ED (PED) department. Methods A monthly Simulation programme was well-established within PED. A new programme alternating between verbal and non-verbal 15 minutes Sims was developed to encompass clinical staff rotations to ensure ongoing learning over 6-months.Following Sim pre-briefing, participants were informed just before commencement, 'this is a silent sim' to enable them to devise real-time communication strategies. Scenarios included Pneumothorax, Sepsis, DKA with Deaf carer (verbal Sim) and Ventilation issues.There were 15 minutes team-debriefs and feedback. Immediately after each session, a survey was circulated to rate learning and experience using 10-point Likeart-Scales alongside free-texts. Results There were 18 participants with an average 6 participants per Simulation. Likert-scores were consistently high regardless of the scenarios involved. (table 1)Qualitative feedback was overwhelmingly positive with 100% of participants requesting regular 'silent sims'. Common themes were identified (figure 1) and disseminated to all staff via infographic newsletter. Conclusion 'Silent sims' were initially expected be challenging and potentially not work in practice. However, the clinical teams rose to the challenge, following expected clinical algorithms with safe outcomes. Participants reported intrigue at natural use of innate non-verbal and manual communication through pointing, miming, waving to get attention etc.

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