Quality of life and healthcare utilization during the COVID-19 pandemic are more restricted in chronically ill than in healthy children: a tertiary care children’s hospital experience
Authors: Hilberath Johannes , Mast Anna-Sophia , Holweg Maximilian , Kränkel Lara , Remppis Jonathan , Renk Hanna , Lang Peter , Schulte Johannes , Fuchs Jörg , Slavetinsky Christoph 
Published: January 2024

The global COVID-19 pandemic forced changes in everyday life of children and adolescents due to government containment measures, an altered healthcare accessibility and utilization, and public concern about SARS-CoV-2 transmission. Data on the challenges and impact on children and their families with chronic diseases are limited. The primary objectives of this study were to assess (i) concerns for SARS-CoV-2 infection, (ii) perceived effects on health-related and overall quality of life (HRQoL and QoL), and (iii) accessibility and utilization of healthcare, comparing families with chronically ill children to families with healthy children during the second SARS-CoV-2 infection wave in Germany. A caregiver questionnaire was designed and participation offered in the emergency department and outpatient clinic of a German tertiary care children’s hospital. 45.9% of the 205 participants were majorly concerned about their children contracting a SARS-CoV-2 infection. Caregivers of chronically ill children (128/205, 62.4%) stated significantly more often a negative impact on their child’s QoL (w = 0.17; p = 0.014), while caregivers of chronically ill adolescents over the age of 13 expressed significantly more frequent a negative impact on their child’s HRQoL (w = 0.21; p = 0.016). Outpatient appointments for chronically ill children were significantly more often canceled (w = 0.17; p = 0.025). Caregivers of chronically ill children were significantly more likely to report that they would actively delay hospital visits for emerging health issues due to the pandemic (w = 0.12; p = 0.049).

     Conclusion: Our findings underscore the importance of identifying families with chronically ill children as a vulnerable patient group with higher burdens during the COVID-19 pandemic and potential future pandemics. Healthcare providers may mitigate such burdens by ensuring reliable appointment allocation, offering contactless healthcare options, and providing tailored advice regarding vulnerabilities and preventive measures specific to their chronically ill children.

What is Known:• The SARS-CoV-2 pandemic has led to significant restrictions in everyday life and both accessibility and utilization of healthcare for children and adolescents.• Chronically ill children faced exceptional challenges as they depend on regular and functioning medical care, but data comparing the pandemic’s impact between chronically ill and healthy children are lacking.

What is New:• The perceived impact of the SARS-CoV-2 pandemic on quality of life is more negative for chronically ill children and their health-related quality of life is more often affected compared to healthy children.• Caregivers of chronically ill children would more often delay a visit to their child’s doctor during the SARS-CoV-2 pandemic and their medical appointments are more often postponed which both could increase health burdens for such vulnerable patients.