Unintended consequences of restrictive visitation policies during the COVID-19 pandemic: implications for hospitalized children

Abstract

The COVID-19 pandemic has resulted in devastating consequences worldwide with over 2,000,000 deaths. Although COVID-19 demonstrates less morbidity and mortality among children, it has dramatically altered the health-care experience for children and families. This is particularly true for those cared for in inpatient settings. The competing priorities of safeguarding families and health-care personnel from a serious infection, stewardship of limited resources, ensuring family-centered care (FCC), and carrying out end-of-life care have led to tensions in how to effectively implement and execute necessary restrictive visitation policies. While the Centers for Disease Control and Prevention (CDC) provides broad guidelines to health-care facilities on the management of visitors, hospitals must determine how to implement such guidelines. Many children’s hospitals have instituted one-visitor policies with varying levels of restriction, such as allowing one parent at the bedside at any time or requiring families to choose a single parent to be allowed in the hospital for the entirety of the inpatient stay. Such visitation policies can have significant untoward consequences. In this issue, Van Driest et al. explored the consent rate for an observational study conducted in the early months of the COVID19 pandemic after the implementation of a one-parent/visitor policy at an academic children’s hospital. They calculated the consent rate and enrollment rate for historical periods, the time immediately preceding the one-visitor policy, and during the onevisitor policy. The authors found a statistically significant reduction in the consent rate for the observational study in the early months of the COVID-19 pandemic and during the implementation of the one-visitor policy. In this commentary, we focus on the effects of restrictive visitation policies and strategies to mitigate against adverse impacts on children and families, both in research and the clinical setting.