Childcare During a Pandemic

Zoe Bouchelle, MD, is a Pediatrics Chief Resident at the Children’s Hospital of Philadelphia. Irit Rasooly, MD, MSCE, is pediatric hospital medicine physician and researcher in the Departments of Pediatrics and Biomedical & Health Informatics at the Children’s Hospital of Philadelphia and a fellow of Society to Improve Diagnosis in Medicine in Diagnostic Excellence. Tara Bamat, MD is an attending physician in the Division of General Pediatrics and Hospice and Palliative Medicine and Associate Program Director of the Pediatric Residency Program. Barbara Chaiyachati, MD,PhD, is a fellow physician in the section of Child Abuse Pediatrics at the Children’s Hospital of Philadelphia.

The COVID-19 pandemic has led to widespread disruption in childcare, including school and daycare closures. While limiting congregation in childcare is an important policy for promotion of social distancing and reduction of viral transmission, it does not come without costs. For young children, in pre-pandemic times, the majority of children under 6 lived in households with all working parents and the shuttering of daycares created an immediate care need for millions of families. For school-aged children, school closures brought concerns about worsening health disparities, educational inequalities, and mental health. For adults, school closures made work challenging (both in-person and remotely) and the new need for in-home childcare could be an added economic burden for millions of families. As pediatricians and mothers working through the pandemic, we worry about the impacts of childcare and school closures on our patients and our children – and ourselves.

Inadequate Childcare

To better understand childcare challenges early in the pandemic, we conducted a survey of parents about childcare access. We recruited a convenience sample of adult (≥18 years) parents of children <18 years via ResearchMatch, social media platforms, and physician listservs (intentionally oversampling among healthcare workers) between April 16 and May 7, 2020, when much of the country was under “stay-at-home” orders. The survey collected demographic, employment, and childcare information. The study was deemed exempt from review by the Children’s Hospital of Philadelphia Institutional Review Board. We used institutional REDCap for survey management and Stata version 15.1 (StataCorp LLC) for statistical analysis.

We found that among the 469 respondents, 301 (64.8%) reported having an essential worker in their household, including 214 (45.6%) healthcare workers. Among essential workers, we found that 79% indicated experiencing a change in childcare with the pandemic, 32% reported less consistent childcare, and almost 8% reported paying at least $500 more per month on childcare. Single parent households and those working in healthcare were less likely to report care for children at home with only immediate household members. These findings underscore the dramatic impact school and daycare closures had on essential workers during the pandemic.

Impact of Inadequate Childcare and Working Parents

There are important consequences of inadequate childcare for working parents that can be drawn from our results including the inherent challenges of going back to work, concerns about the safety and stability of available childcare, and the potential for disproportionate impact on working mothers. We highlight some of these consequences below but it’s important to note that many of these challenges predated the pandemic as part of a broader childcare crisis in the US, and are only underscored by the COVID-19 pandemic. Moreover, these challenges will likely be exacerbated in the aftermath of COVID. 

Parents’ ability to work is critical to ensure already existing socioeconomic disparities do not widen. In pre-pandemic times, almost 20% of children in the U.S. were already living in poverty. During the pandemic, many families suffered lost work, likely placing even more families at risk of poverty. While some families may have been financially buoyed intermittently by stimulus relief and increased federal unemployment, allowing them to care for children safely at home, that benefit has now lapsed and childcare costs must be recognized in return to work calculations.

We also must ensure that families do not need to put children in physical danger in order to return to work. Without support for safe and adequate childcare, working parents may resort to leaving younger children in the care of older siblings or in the care of someone they do not fully trust. Children without appropriate oversight are at risk of injury. For example, we have seen that there has been a 30% increase in accidental shooting deaths by children from March-May 2020 compared to the same period in 2019, a spike in pediatric poisonings and dog bites, and concentration of avoidable harm in emergency departments since the onset of the pandemic.

Additionally, families need access to care that minimizes risk of COVID exposures. Leaving children in the care of a rotating cycle of caregivers increases children’s risk of exposures and continues to put children and communities at risk. Based on our results early in the pandemic, some essential workers who were most critically needed to report to work in person – healthcare workers – were less likely to report care for children at home with only immediate household members. Unfortunately, unabating risk at work and home may lead to a shortages in the healthcare workforce.

Finally, there is increasing concern that childcare shortages and shifting work demands related to the pandemic could disproportionately disadvantage working women and have long-term repercussions on gender equality. Among married couples who work full time, there is evidence that women provide close to 70 percent of childcare during standard working hours. A survey by Boston Consulting Group during the pandemic found that parents now report spending 27 additional hours each week on domestic duties, with women spending 15 hours more each week than men. The shifting demands of work and home life and the looming “Greater Recession” negatively impact all workers, but will likely disproportionately affect working mothers. This could have long-term impacts on the percentage of women in the labor market.

Taking Action Through Policy

 With millions of children out of school and daycare, we are experiencing a national childcare crisis. As we move into the fall and expect that many schools and daycares will not fully reopen, policymakers and employers must advocate for and invest in policies that provide financial, housing, and food assistance to struggling families, keep children safe at home while allowing families to return to work, and provide proactive support for working parents, particularly mothers, who are at risk of being disadvantaged and excluded from reentry into the labor market.

During this unprecedented time, struggling families and children deserve adequate, stable, comprehensive support from their governments and employers.



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