Solid Support the Best Counter to Uncertainty

Robert Sege, MD, PhD, FAAP

February 13, 2023


February 2020 started out like any other winter in Boston – cold and dreary. However, almost overnight, the world was changed by the pandemic and the dramatic public health response. As a child abuse pediatrician, I shared the great fear that child abuse and intimate partner violence would increase during the shutdown. To find out what was really happening at home, we joined with the American Academy of Pediatrics and Prevent Child Abuse America to conduct a national survey of 3,000 U.S. parents at three different times during the pandemic. The goal of this CDC-funded project was to measure risk factors of violence in the home. The survey asked parents about the impact of the pandemic and how their families adapted to the disruption of the pandemic. In the end, the complex results of the survey confirmed the resilience and strength of American families, even during this time of stress. They also identified opportunities to support families.

After many years in primary care, I wasn’t surprised the survey included good news. Overall, many parents said their families grew closer during the pandemic. For most families, the biggest change occurred when schools and preschools shut down, moving children's education from the classroom to the home. Most children experienced significant educational disruption: less than one-third of school-aged children continued full-time in-person education as of March 2021. About half of all parents reported this was very stressful. However, most of these stressed-out parents (60%) also reported the experience allowed the caregiver and child to grow closer.

These survey results helped me realize the heartwarming stories I heard from my own friends and family members were common across the country. Many families across the country, living in different circumstances, found hidden rewards in the face of disaster. Parents' comments also revealed the range of experiences children had with online learning. One parent reported: “The lack of motivation and exercise made it (remote learning) difficult for my child . . . she kept falling asleep over her laptop.” Another reported that “my son has been able to complete his schoolwork much earlier than during a typical day . . . so he has much more time for other activities.” The clinical lesson for pediatricians is clear: We should approach families with an attitude of curiosity.

Would stress disrupt positive parenting practices? Maybe not so much – even during the peak of the pandemic disruptions, only one in six parents disclosed their children were spanked in the past week. Although survey methods vary, a steady stream of surveys over the years suggests a decline in the use of spanking among American caregivers. The data in this survey suggest this declining trend probably continued during the pandemic.

“Many families across the country, living in different circumstances, found hidden rewards in the face of disaster.”

We learned a lot more about corporal punishment from the survey. Parents who spanked their children also tried several other techniques, both harsh and supportive. Of great concern to pediatricians, we found that 3 of 5 respondents who reported their children were spanked also reported intimate partner violence.

When I started out in practice, spanking was quite common. This has changed. Now that only a minority of families hit their children, spanking may be a marker of broader violence within the home. Much to think about when trying to help parents cope with the normal problematic behaviors of childhood.

Families of children and youth with special health care needs were particularly affected by the pandemic. Services were disrupted, economic educational and health challenges increased, and many worried their children were falling behind. We can assume families severely affected by the disruption in services for children and youth with special health care needs may require increased support for years to come.

The picture of family life during the pandemic was complex. Family life was disrupted, but increased supports may have eased the stress for families. Economic stress, a known risk for child abuse, was buffered by public benefits including unemployment insurance, increased SNAP food benefits, a moratorium on evictions, the child tax credit, and many other local and community responses. And research shows economic supports can decrease violence in the home.

Although the period of pandemic shutdowns is over, the disruptions to the lives of children and their families continues for many. As pediatricians, we know parents want the best for their children and do amazing things to protect them. As a society, we provided the basic supports that were needed to avoid family catastrophe, and, as a profession, we need to continue to advocate for the expanded family supports that families still need in the shadow of the pandemic.


*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author

Robert Sege, MD, PhD, FAAP

Robert Sege, MD, PhD, FAAP is a pediatrician and director of the Center for Community-Engaged Medicine at Tufts Medical Center, and a Professor of Medicine and Pediatrics at Tufts University School of Medicine. Dr. Sege is nationally known for his research on effective health systems approaches that directly address the social determinants of health. He has served on the AAP Committee on Child Abuse and Neglect and on the AAP Council on Injury, Violence, and Poison Prevention