Maternal and Child Health Amid COVID-19: The Child Care Matters Study

Photo (from left to right): Calpanaa Jegatheeswaran, Sumayya Saleem, Samantha Burns, Michal Perlman, Petr Varmuza, and Ryan Luo

Dr. Michal Perlman and her team in the Department of Applied Psychology and Human Development at the University of Toronto, and members of the Edwin S.H. Leong Centre for Healthy Children, provide an update on the results of a COVID-19 wave of data collection in the Child Care Matters (CCM) study.

The CCM is a longitudinal study conducted in partnership with the City of Toronto. We collected data from close to 900 low-income families recruited from the City of Toronto childcare subsidy waitlist between 2014-2016. Multiple waves of data were collected for each family, starting when the children were 12 months old and into early elementary school. The original CCM families had substantially lower incomes relative to the average-income family in Toronto. Almost 40% were headed by single mothers, and 44% of mothers reported that English is not their first language. Our CCM sample consists of families that are generally under-represented in health research.

We gathered one wave of data within approximately six months of the onset of the COVID-19 pandemic and then a second wave of data, with the support of the Leong Centre, one year later. This funding also facilitated the coding of open-ended questions, analysis, and write-up of our findings. We gathered essential information related to child and maternal well-being with a focus on children’s early childhood education and care experiences in this study. Below we describe two ongoing projects based on subsamples of the original CCM sample that include assessments from our two most recent waves of data collection.

Maternal and Child Mental Health During COVID-19

We found heterogenous patterns of change in both maternal, and child mental health, with a non-trivial proportion of children and mothers showing improvements in mental health early in the pandemic (see Saleem et al., 2022). Further, we identified the specific ways that both maternal and child mental health changed soon after the onset of the pandemic (Burns et al., Under Review; Jegatheeswaran et al., In Prep). We also found that challenges with children’s education at home were related to higher levels of maternal and child mental health concerns early in the pandemic (see Burns et al., 2023).

We are currently examining how maternal and child mental health prior to, early on and later in the pandemic uniquely impacted one another. Testing the bi-directional relationship between maternal and child mental health, we found that this relationship changed from early on to later on during the pandemic. Notably, children had worse mental health outcomes early on after the onset of the pandemic if their parent had a prior history of mental health challenges. Over a year into the pandemic, mothers had worse mental health outcomes if their children experienced mental health challenges at the onset of COVID-19. Overall, interventions that support maternal and child mental health must consider the family as a unit as well as time since the onset of a stressful event such as the COVID-19 pandemic.

Earlier Parenting and Vaccine Hesitancy During COVID-19

Another important concern that emerged during COVID-19 was maternal vaccine hesitancy for their children, with fewer than half of eligible Canadian children being fully vaccinated. To maximize vaccination uptake in the future, it is important to identify potential barriers to vaccination. Using CCM data, we examined the effects of parenting beliefs and attitudes as a potential marker for vaccine hesitancy.

This involved analyzing qualitative and quantitative data from 209 mothers in our second COVID-19 wave. We found that 40% of mothers did not intend to vaccinate their children because: (1) mothers thought that their children did not require the vaccine (too young, low-risk, or already infected); and (2) they had concerns about the vaccine (needed information, doubted the science). We also found that mothers who were more overprotective and confident in their parenting role before the pandemic were more likely to be hesitant to vaccinate their children against COVID-19.

Understanding the nuances behind mothers' vaccine hesitancy can facilitate future efforts to promote vaccination among children. 

In the following projects, we will be investigating the long-term effects of the pandemic on children’s mental health and whether family characteristics (e.g., household income and maternal education) and early childhood education environments (e.g., children’s child care experience) are associated with these changes. Analyses of the impact of exposure to early childhood education and care (ECEC) during the pandemic will provide information about a possible buffering role that ECEC can play when children and families face major environmental stressors.