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Caring about caregivers: the role of paediatricians in supporting the mental health of parents of children with high caregiving needs
  1. Benyamin Rotberg1,
  2. Jean Wittenberg1,
  3. Julia Orkin2,3,
  4. Natasha Ruth Saunders2,3,4,
  5. Eyal Cohen2,3,4,5
  1. 1 Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
  3. 3 Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  5. 5 Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Eyal Cohen, Division of Pediatric Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; eyal.cohen{at}

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Improved survival of children with life-threatening conditions has resulted in more children in need of caregiving support. For example, a child assisted by medical technology may need constant monitoring of a tracheostomy at home, often a role taken on by parents. Increased caregiving is also required for children with certain developmental or psychiatric conditions that have self-injurious or high-risk behaviours.

Risks for the caregivers

Caregiving for a child with high needs can be a fulfilling experience, but can also pose substantial risks of burnout as well as poor mental and physical health. Caregivers face increased stress, financial burden and sometimes stigma and social isolation. Those stressors may increase the likelihood of depression and anxiety, as well as of premature maternal cardiovascular disease and mortality.1

Implications for child health

Even if caregivers do not meet criteria for a mental illness but are struggling with high emotional distress, their parenting skills and ability to promote secure attachment may be affected. Children of parents with mental illness have elevated risk for poor growth, feeding difficulties, depression, behavioural challenges and poor learning.2 A child with a disability and high needs may be even more susceptible to these detrimental effects. Some adverse outcomes may be reversible with support for the caregiver. For example, therapy for depressed mothers has been reported to improve the child’s mental health, social and academic functioning and the mother–child interaction.3 4 Likewise, children exposed to adverse experiences—most commonly parental mental illness—have been shown to have improved language and behaviour, decreased injuries and more uptake of immunisation …

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