COVID-19 Caregiver Restrictions in Pediatrics

Erica C. Kaye

doi:10.1542/hpeds.2020-004291

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Key Principles and Action Items for Rethinking COVID-19 Caregiver Restrictions

Key Principles	Action Items
Parents (and other primary caregivers) play an essential role in the care of an ill child.	Instead of framing policies around “if” or “when” caregivers should be allowed to visit, refocus conversations around “how” caregivers can safely visit.
Prognostic uncertainty leads to challenges in predicting if or when a patient may clinically deteriorate or die.	Create standardized operating procedures that liberalize visitation for the family of patients with critical illness, worsening clinical trajectories, or those approaching end of life. Develop systems that empower frontline clinicians to make real-time modifications to restrictions during extenuating circumstances.
Frontline health care professionals experience moral distress when tasked with implementing policies that they did not develop.	Provide frequent and transparent communication to clinical staff about visitation policies. Proactively involve frontline health care workers in policy decision-making and implementation processes. Create forums and avenues that empower clinicians and staff to share their expertise and challenge existing policies as the pandemic evolves.
Caregiver restriction policies, when universally applied, may not be equitable for socioeconomically disadvantaged families, disproportionately affecting underrepresented minority families.	Build pathways for leadership to engage in bidirectional dialogue with underrepresented minority families; empower families to share their perspectives and recommendations with policy decision-makers. Systematically examine unintended impacts of caregiver restriction policies on socioeconomically disadvantaged families, with transparent disclosure of findings and discussion of proposed solutions.