746 - Making It Work: Childcare Needs and Choices of NICU Families with Other Children at Home

Publication Number: 1722.746

Leslie M.. Harris, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Sam Wein, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Katie J. McMorrow, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Tricia J.. Johnson, Rush University, Chicago, IL, United States; Aloka L. Patel, Rush Medical College of Rush University Medical Center, Chicago, IL, United States

Background: Families of infants in the NICU (NICU families) face multiple barriers to being present in the NICU, including access to childcare for their other children. Childcare is necessary due to visitation policies with age-based restrictions and may be challenging during "off-hours" (nights and weekends), when parents may want or need to be present. Family presence is associated with better infant health and development, yet there are virtually no rigorous data on the childcare needs of NICU families.

Objective: To characterize NICU families' childcare arrangements and decision-making factors that impact their presence in the NICU.

Design/Methods: We conducted a pilot prospective cohort study of NICU families with at least one other child at an urban level III NICU (June-October 2025). At enrollment, parents reported demographic and socioeconomic characteristics and childcare arrangements, followed by questionnaires on childcare, stress, and NICU-related activities every 2 weeks for 3 months or until NICU discharge. Parental NICU presence and infant data were obtained from NICU visitor logs and electronic medical records.

Results: The 22 mothers of 27 NICU infants had a median of two other children at home (Table 1). Over half (55%) identified as non-Hispanic Black and 82% had public insurance. Most mothers reported having a partner (86%) and lived with at least one other adult (86%). Families used a combination of family, informal, and formal childcare providers (Figure 1), of which less than a third were paid. Only 30-40% of mothers reported they spent as much time in the NICU as they wanted, with half reporting not having enough childcare to be in the NICU when desired (Table 2). Available childcare, transportation, and participating in infant's regular care were the most common reasons mothers came to the NICU at specific times. Childcare needs and personal health were the two most common barriers to spending time in the NICU.

Conclusion(s): Parents of NICU infants who have other children identify childcare as a major factor impacting the time they spend in the NICU. Preliminary analysis of this cohort of primarily low-income parents shows complex childcare arrangements with heavy reliance on extended family to provide childcare over the course of the infant's NICU hospitalization. Further work will examine how childcare arrangements change over the NICU course and how met vs unmet childcare needs may be associated with household characteristics and parental involvement in infant care (maternal breastmilk feeding and skin-to-skin care).

Table 1. Parent and Infant Characteristics


Figure 1. Summary of Non-Maternal Childcare Providers for All Children
School* - Lighter green indicates that parents reported a child attends school during school year but did not select as childcare provider during study period.

Table 2. Childcare and Maternal NICU presence
*Per NICU visitor logs.
**Subjects rated childcare factors as very important, somewhat important, and not important.