PolicyLab

The COVID-19 pandemic has taken an extraordinary toll on families. As a primary care pediatrician, I hear from parents and other caregivers trying their best to navigate complex decisions and situations—balancing COVID-19 risk with social isolation when thinking about activities for their unvaccinated children, or alternating day and night shifts to be available for their child’s hybrid school schedule. Many still face economic hardship with inflation and growing costs, feelings of anxiety and loneliness, and fear of a virus that could surge with future new variants. 

When the pandemic first hit, our study team wanted to understand how children were being impacted by their caregivers’ stress. In collaboration with the ChildHelp National Child Abuse Hotline, we examined how children and adolescents experienced and described caregiver stress through text and chat conversations with hotline counselors between March and June of 2020. In our recently published findings, we identified several themes showing how children experienced and amplified caregiver stress. Below, we explore a few of those key themes through youths’ words, and discuss the policy implications as we face the lingering impacts of the pandemic.

In Their Own Words: How Caregiver Stress Impacted Children During the Pandemic

A common driver of caregiver stress was financial insecurity, which increased family conflict. Youth said: 

“They say I’m a disappointment…I’m the problem they don’t have enough money every week”

“Money is tight however and I don’t know if that [counseling] service is expensive…[my mom] doesn’t have a job right now so we’re stuck at home”

Parental discord was another common source of stress, and a few youth made references to intimate partner violence: 

“My parents always argue with each other and when I try to speak to them it’s always the wrong time and sometimes they even lash out on me”

“My mom and dad are fighting a lot and it’s starting to scare me. My dad [threw] a pot at her yesterday and it almost hit me”

Unmet expectations related to school and household chores were another key driver of caregiver stress: 

“Sometimes my sister and I will talk to [my mom] about how we feel she expects too much of us and how it stresses us out…Usually, she’ll respond with something about how she works all day (she’s a doctor) and shouldn’t have to come home and do more work”

“She’s getting mad that I’m not going outside enough during quarantine for one, that I don’t do enough around the house for my age either”

Both physical and mental health concerns emerged: 

“My mom doesn’t wanna talk to me. My dad’s sick. It’s like everything is going down on me”

“She’s threatened me with physical abuse and blames her actions on her mental illness”

Well beyond the second anniversary of the pandemic, these themes continue to ring true, and are echoed by thousands of caregivers in surveys conducted by the American Academy of Pediatrics (AAP). As communities move toward opening up and scale back protective measures, such as mask and vaccine mandates, COVID-19 still imposes significant economic, health and social costs on families. 

The Need for Policies That Support Families

One of the striking findings of our study was that children and adolescents either internalized their caregivers’ stress, or were targets of stress and conflict. With the well-being of children and their caregivers so intricately linked, it is critical that we ensure policies and interventions to support children address the family as a unit.

Our findings demonstrate the importance of providing resources for economic hardship. With food prices increasing and federal programs set to expire (including school lunch programs and extra Supplemental Nutrition Assistance Program (SNAP) benefits), more families will face food insecurity and child hunger. Interventions such as an expanded child tax credit and easier access to vital public benefits are essential.

A comprehensive policy agenda to support caregivers, which would include these financial supports as well as interventions such as paid family and medical leave, would help reduce caregiver stress in the long term. In addition, pediatric settings can be leveraged to provide family-based services that improve caregivers’ physical and mental health.

Finally, our study highlights how text and chat platforms can expand children’s direct access to support and counseling services, and may represent one strategy to address acute needs as policymakers explore long-term investments to expand access to behavioral health services and support parity between mental and physical health services.

The COVID-19 pandemic has exposed gaps in our safety net, while shining a light on how all families benefit from increased supports. Policies and programs that effectively and equitably address family stress and conflict can help fill these gaps, ensuring that children and their caregivers all do better.

Yuan He, MD, MPH, is a former affiliate trainee at PolicyLab.