Normalize Dads Bringing Kids to Doctors’ AppointmentsJuly 28, 2022
This viral tweet hit a nerve with providers and patients alike, with groups of enthusiastic fathers and their children singing the praises of medically-savvy dads*, and others lamenting men who can’t even provide their child’s correct date of birth.
Truth be told, most mothers and fathers probably fall somewhere in between these two poles, but it’s still more common for women to bear most of the mental load of childcare. But father’s roles are evolving — and healthcare providers interacting with families can help support greater participation from dads in the care of their children.
Cognitive or mental load is the amount of working memory used to manage multiple cognitive tasks requiring attention at the same time, including those at work, home, and in society. When it comes to childcare, it encompasses being the one in charge of a never ending to-do list of items, including meal planning, school tasks, schedules, childcare, and appointments, and then delegating these tasks and making sure things get done correctly. Not surprisingly, it disproportionately falls on women.
Research suggests that “nearly nine in 10 mothers in committed partnerships say they feel solely responsible for organizing the family’s schedules, for example, and the burden left them feeling overwhelmed, exhausted, and unable to make space for their own self-care.” A 2017 report from Bright Horizons similarly found 72% of working moms feel it’s their job to stay on top of kids’ schedules and 52% are facing burnout from the weight of their household responsibilities.
It’s also not surprising these gender differences spill over into the healthcare field, contributing to increased burnout among physician mothers.
Cognitive load has only worsened during the COVID-19 pandemic. Liz Dean, PhD, Brendan Churchill, PhD, and Leah Ruppanner, PhD, MA, describe the mental load exacerbated by the pandemic, resulting in a range of unpaid additional labor. They suggest employers should adopt policies allowing greater work-life reconciliation, and that “caregiving should be vital infrastructure developed and invested in by governments to reduce competing work and care demands that accelerate the deleterious consequences of the mental load.” These policies and infrastructures would certainly help mothers and fathers alike.
Growth in Paternal Participation
Fortunately, there has been marked growth in paternal participation in caring for children. The increase in women’s educational achievement and the Great Recession of 2008 resulting in loss in paternal employment led to more fathers contributing at 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. The involvement of fathers improves care. For example, studies demonstrate that father involvement during pregnancy is correlated with mothers being 1.5 times more likely to receive first-trimester prenatal care and with reductions in prematurity and infant mortality.
However, equitable parental involvement is even more challenging in children with special healthcare needs. Over half of these children (51%) have private insurance as their sole source of coverage, while others have a combination of public and private insurance (8%), only public insurance (36%), or remain uninsured (3%). Medically complex children may need a parent to care for them more at home and appointments, but there is also an obvious need for the working parent to keep 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).
Treating 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 a COVID-19 exposure at the school and our child needed to be picked up. I was over an hour away, but my husband was working from home, just 7 minutes from the school. They let our child sit in the office for over 4 hours because they didn’t even think to call his father.
The HHS Head Start Early Childhood Learning & Knowledge Center acknowledges there may be a variety of reasons an office or school would default to calling mothers. Since a larger proportion of childhood providers are woman, we may see patterns in their communications where they more easily establish a bond with the mother based on shared interests and care. There may be cultural considerations affecting which parent is more involved in communication and biases regarding the role of men in childrearing. The HHS website offers a variety of suggestions and solutions for schools, offices, and various programs to include fathers in children’s care, including creating more father-friendly environments and strengthening staff skills about relationship-building with fathers.
Medical professionals, particularly pediatricians, can also play a critically important role in encouraging and embracing fathers’ participation in the care of their children. The American Academy of Pediatrics (AAP) published tips to involve fathers in ongoing care. They suggest actively engaging fathers and speaking to them directly to solicit opinions, and reminding parents how children look to their fathers as role models of behavior. Pediatricians should screen new fathers for perinatal depression and have a plan in place if they screen positive. They can encourage fathers to assume early caregiving roles, reminding mothers to let fathers be involved and learn from their own mistakes. This AAP publication particularly encourages pediatric outreach to vulnerable and marginalized fathers, such as those who are socially or economically disadvantaged, adolescent, immigrant, or incarcerated but who wish to remain involved with their children. Lastly, providers should support policies such as the Family and Medical Leave Act and flexible work schedules 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. Many involved, superb fathers stand out as either the primary and/or co-parent, and I enjoy working with them to care for their children. I have also seen fathers’ concerns minimized by healthcare providers and assumptions made about their involvement. We need to do better to make sure all family members feel supported and involved. Many parents want to participate in the care of their children, but economic, societal, race, and/or structural barriers exist. Breaking down these barriers will translate into improved care for infants, children, and adolescents. Enhancing paternal involvement in childcare also decreases the mental load for mothers — improving the wage gap for women would allow more financial freedom for families.
And please, for the love of God, can we normalize schools and doctors’ offices 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 should not imply this is the gold standard. Furthermore, the term “father” refers broadly to fathers and other males, including the biological father, adoptive father, stepfather, foster father, grandfather, guardian, or parent’s significant other who play a significant role in raising a child.
Jennifer P. Rubin, MD, (she/her), is an attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, and an associate professor of pediatrics at the Northwestern University Feinberg School of Medicine.