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Cristina Martins Halpern, Mariana Alves, Sandra Pires, Pedro Caldeira da Silve (All the authors contributed equally to the manuscript)

 Pedopsiquiatria, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa.

- Publicação em versão integral: Perspectives in Infant Mental Health, Word Association for Infant Mental Health

Introduction: In many countries, COVID-19 crisis and the nationwide state of emergency forced families to social confinement. Ambulatory care changed, and telemedicine was the preferred way of providing non-urgent consultations. During this period there was a significant decrease in Emergency Room visits, most probably due to the fear of contagion in the health services. Despite that, during the first 3 weeks of this period, two infants were admitted to the Emergency Room of a main pediatric hospital with developmental regression. The aim of this article is to describe this experience and show how we dealt with it.
Case report: A 9-month-old male infant showed drowsiness, decreased motor activity, and loss of skills and a 4-month-old female infant showed for the last 2 weeks, periods of irritability and drowsiness, and sporadic chills. Although physical exam, laboratory and image exams were normal, they were admitted for assessment. After hospital discharge both babies were followed-up in an Infant and Early Childhood Development and Mental Health Centre. We set up a video-call-based developmental and mental health approach. This video-based approach provides a comprehensive management, allowing an early intervention, and taking advantage, even in times of pandemic crisis, of the earliest window of opportunity for brain development and plasticity - the first year of life. In the first case the video-based observation was consistent with Early Atypical Autism Spectrum Disorder (DC:0-5 Axis 1) and in the second case was indicative of global developmental delay.
Conclusion: This video-based approach allowed us to think about our usual clinical practice and posed us several questions. The mandatory confinement may allow parents to closely observe their babies. We deal with challenge of re-thinking the intervention setting and we made a naturalistic home video observation during the first sessions. After that we were able to offer guided interactions. Despite these circumstances, parents engaged in a therapeutic relationship. Finally, we realized that access to technology was not a limitation. We found this video-based approach useful and not widely disseminated for infant and early childhood mental health services.