Addressing the Childcare Gap of Siblings of Hospitalized Children

Families with critically ill children require comprehensive support to withstand the hospitalization experience. Parents struggle to balance caregiving among their children, often choosing between being near a sick child and caring for their healthy siblings. Families with medically complex children have increased financial difficulties, particularly those with longer travel times to the hospital.1,2 Because childcare outside the family is most effective when prearranged, addressing sibling childcare may mitigate family stressors.3The objective of this pilot study was to understand childcare needs for families of medically complex children by performing a needs assessment with the Ronald McDonald House (RMH) Stanford, a 123-room center near the hospital that can provide sibling support.Families of hospitalized children currently staying at RMH Stanford, or those who used their services in the past 2 years, were surveyed. During the eligibility period (January 2020–March 2022), 1390 families were served. In 2018, 41% of all persons staying at the facility were under age 18 years (61% 0–9 years). A mixed methods survey including multiple choice and open-ended questions was sent electronically and in printed form. Survey domains included demographics, resource utilization, and perceived childcare needs (see Supplemental Fig 1). Caregivers were asked about all forms of childcare for siblings during hospitalization of a sick child. No validation technique was used; however, the research team and RMH partners revised survey questions to limit bias or misunderstanding. SPSS software was used to perform analysis, specifically t tests and Pearson correlation coefficients. Open-ended questions prompted participants to describe how childcare availability for siblings would impact care for their sick child and caregiver responsibilities. One reviewer examined the responses and identified core patterns, coded with assistance from the team.4 The study was approved by the Institutional Review Board.Caregivers (n = 133) completed the survey in English (n = 112) and Spanish (n = 21), yielding a 10% response rate. Caregivers reported limited use of formal childcare (Table 1). Seven percent used daycare outside RMH. One parent noted that “[childcare] would have afforded me the ability to have my children close with me while I visited the baby and prevented more time off work for my family.” See Supplemental Table 2 for identified patterns and representative quotes.Employment changes caused by a child’s illness often occurred; 75% of caregivers indicated that a family member needed to quit and/or reduce work. Caregivers with income >$100 000 were more likely to use extended family (P = .005) and friends (P = .04) compared with those with income level <$30 000. The lower income bracket did not use a specific type of childcare significantly more than higher income brackets. Of participants, 17% relied on older siblings.Half of families (53%) were somewhat to extremely worried about childcare, and even more (72%) indicated they would use free childcare if offered through RMH. Those more frequently hospitalized exhibited increased worry about childcare (Pearson r = −0.19, P = .05). Weekdays 8 am to 5 pm were the most identified times for childcare needs.Sibling childcare is a critical gap for families with hospitalized children, particularly those who live far away (an RMH eligibility requirement) and those with financial difficulties. Increasing childcare access may impact health outcomes; weekday business hours were the most identified time of need, which is often when caregivers need to be present in the hospital for rounds, procedures, and medical updates.The socioeconomic discrepancy in using extended family and friends indicates the role of support networks impacting a parent’s ability to be at bedside. The economic impact of the childcare gap is reflected in 75% of caregivers having a family member quit and/or reduce work to care for their hospitalized child. This may compound parental stress and lead to additional inequalities, contributing to increased healthcare disparities.Limitations of this pilot study include a small sample size and limited yield rate (10%) of RMH families at a single site. The survey timing occurred during the coronavirus disease 2019 pandemic, when lack of childcare may have been higher.It is critical that physicians identify caregivers’ childcare needs and connect families to programs that support childcare for siblings of hospitalized children. Our results illuminate the need for accessible sibling childcare options, particularly for families facing financial hardship. Providing childcare services for siblings at the hospital, or at institutions such as RMH, may fill an important psychosocial and financial need.