This viral tweet strike a chord with both providers and patients, with groups of enthusiastic fathers and their children singing the praises of medically savvy dads*, and others bemoaning men who can’t even provide the date of exact birth of their child.
Truth be told, most moms and dads probably fall somewhere in between these two poles, but it’s even more common for women to shoulder most of the mental burden of child care. But father roles are changing — and healthcare providers who interact with families can help support fathers’ greater involvement in their children’s care.
Cognitive or mental load is the amount of working memory used to handle multiple cognitive tasks requiring attention at the same time, including those at work, home, and in society. In childcare, that means being responsible for an endless to-do list, including meal planning, school chores, schedules, childcare and appointments, and then to delegate these tasks and make sure things are done properly. . Unsurprisingly, it falls disproportionately on women.
Research suggests that “nearly nine in ten mothers in committed partnerships say they feel solely responsible for organizing family schedules, for example, and the burden has left them feeling overwhelmed, drained and unable to cope. make room for their own care.” A 2017 report from Bright Horizons also found that 72% of working mothers believe it is their job to keep children’s schedules and 52% face burnout from the weight of their household responsibilities.
Nor is it surprising that these gender differences spill over into the healthcare field, contributing to the rise in burnout among physician mothers.
Cognitive load has only gotten worse during the COVID-19 pandemic. Liz Dean, PhD, Brendan Churchill, PhD, and Leah Ruppanner, PhD, MA describe the mental burden exacerbated by the pandemic, resulting in a range of extra unpaid work. They suggest that employers should adopt policies that allow for greater work-life balance, and that “caregiving should be a vital infrastructure developed and invested in by governments to reduce the competing demands of work and care that accelerate deleterious consequences of mental workload”. These policies and infrastructures would certainly help mothers and fathers.
Growth of paternal involvement
Fortunately, there has been a marked growth in paternal involvement in child care. Rising female education and the Great Recession of 2008 leading to the loss of paternal employment led to more fathers contributing to the home or becoming the stay-at-home parent. There has also been an increase in research and publications focusing on fathers and their roles in families. Involving fathers improves care. For example, studies show that father involvement during pregnancy is correlated with mothers being 1.5 times more likely to receive prenatal care in the first trimester and with a reduction in prematurity and infant mortality.
However, equitable parental involvement is even more difficult in children with special health needs. More than half of these children (51%) have private insurance as their only source of coverage, while others have a combination of public and private insurance (8%), only public insurance (36%) or no are not insured (3%). Medically complex children may need a parent to care for them more at home and at appointments, but it is also obvious that the working parent retains their private insurance coverage. One can easily imagine how one parent becomes the primary caregiver (perhaps the mother) and the other the primary breadwinner (perhaps the father).
Treat fathers equally
Last year, in the middle of a busy clinic, I missed a call from our youngest child’s school. When they finally reached me 4 hours later, it turned out there was exposure to COVID-19 at school and our child needed to be picked up. I was over an hour away, but my husband was working from home, only 7 minutes from school. They let our kid sit at the desk for over 4 hours because they didn’t even think to call his dad.
The HHS Head Start Early Childhood Learning & Knowledge Center recognizes that there may be various reasons why an office or school would not call mothers by default. As a greater proportion of child care providers are women, we can observe trends in their communications where they more easily establish a connection with the mother based on shared interests and care. There may be cultural considerations affecting the parent who is most involved in communication and prejudices regarding the role of men in raising children. The HHS website offers a variety of suggestions and solutions for schools, offices, and various programs aimed at including fathers in childcare, including creating more father-friendly environments and building child care skills. staff in building relationships with fathers.
Health professionals, especially paediatricians, can also play a crucial role in encouraging and supporting the involvement of fathers in the care of their children. The American Academy of Pediatrics (AAP) has published tips for involving fathers in continuing care. They suggest actively engaging fathers and talking to them directly to solicit opinions, and reminding parents of how children see their fathers as role models. Pediatricians should screen new fathers for perinatal depression and have a plan in place if they test positive. They can encourage fathers to take on early caregiving roles, reminding mothers to let fathers be involved and learn from their own mistakes. This AAP publication specifically encourages pediatric outreach to vulnerable and marginalized fathers, such as those who are socially or economically disadvantaged, adolescents, immigrants, or incarcerated but wish to remain involved with their children. Finally, providers should support policies such as the Family and Medical Leave Act and flexible working hours as ways to balance family responsibilities and employment.
As a child neurologist caring for patients with complex medical needs, I have been honored throughout my career to work with amazing parents. There are many superb and involved fathers who excel as primary parents and/or co-parents, and I enjoy working with them to care for their children. I have also seen fathers’ concerns downplayed by health care providers and assumptions made about their involvement. We need to do better to ensure that all family members feel supported and involved. Many parents want to participate in the care of their children, but economic, societal, racial and/or structural barriers exist. Removing these barriers will result in improved care for infants, children and adolescents. Improving paternal involvement in childcare also decreases the mental burden on mothers – improving the pay gap for women would allow more financial freedom for families.
And please, for God’s sake, can we normalize schools and doctor’s offices by calling dad first?
*Families come in many shapes and sizes, and all are valid; this particular tweet resonated with heteronormative two-parent homes with more “traditional” gender roles, but shouldn’t imply that this is the gold standard. In addition, the term “father” refers broadly to fathers and other men, including biological father, adoptive father, stepfather, adoptive father, grandfather, guardian or significant other. of a parent who plays an important role in the upbringing of a child.
Jennifer P. Rubin, MD, (her), is an attending physician at Ann & Robert H. Lurie Children’s Hospital in Chicago and an associate professor of pediatrics at Northwestern University Feinberg School of Medicine.