As Research Assistants for Children’s HealthWatch, our job is to conduct interviews in the Pediatric Emergency Department (ED) at Boston Medical Center with parents, predominantly mothers, of very young children. The interview is voluntary and most parents choose to participate. You might think that mothers would be hesitant to tell us about their living situation, child’s health, and participation in assistance programs, but they are generally grateful to have someone listen to their stories even though they are in the stressful situation of bringing their child to the ED.

We have been Research Assistants for about a year and in an average week we conduct ten to fifteen interviews each. After spending time in the ED with families, we’ve noticed the far reaching impacts of material hardships on child health and family well-being. Parents want to raise healthy children and when they put their day on hold in order to cope with a child’s health emergency, this priority is clear. Nevertheless, raising a healthy child is not as simple as taking a day off, usually unpaid, when he or she is sick. Parents work hard to provide food for their family, to afford safe and accessible childcare, and to have a warm place they can come home to. While being a parent is a lot of hard work, we don’t hear complaints about it. All of these parents find joy and pride in raising happy, healthy children.

Although the parents we speak to have the best intentions to care for their children, sometimes things just don’t go according to plan and obstacles, such as losing a job or getting sick, can get in the way of meeting basic needs. These situations are not exclusive to single-parent families or the unemployed. We come across many families in the ED that have one or two working parents, but still have to choose between bills to pay. Their full-time income, often at or near minimum wage, may be too much to qualify for public assistance. Government guidelines may consider a working income to be sufficient, but in many cases it is not enough to raise a family. We hear parents say that they feel punished for working hard or getting a raise.

Many families we interview do not have enough money for food and parents are honest about the sacrifices they make to feed themselves and their families. Sometimes in order to stretch their budgets, they are forced to feed their children a poor, unbalanced diet due to frequently relying on low-cost foods with little nutritional value. Other times, we hear that children eat adequate meals, however, since budgets are tight, other expenses must be sacrificed, or, very often, mothers sacrifice their own needs. Mothers instinctively want to nourish their children, even if it means there will not be any food for them, or money left for rent.

Utility bills are another stressor. Mothers often tell us they are worried about their children’s health because they are unable to pay high utility bills during cold, brutal winters like the one we just experienced. Unable to pay the heating bills in the winter, and in some cases ineligible for state utility shut-off protection programs, some families resort to using the cooking stove for heat. Consequently the entire family is put at risk of burns and gas explosions, but it is a dangerous risk that parents reluctantly make to meet the pressing, immediate need to keep their children warm.

Mothers express sadness at their inability to provide basic needs, such as food and shelter for their children. Sometimes the sadness stems from feelings of hopelessness because they are already doing everything they can on their own, and sometimes the sadness stems from feelings of guilt because, as mothers, they are aware of the physical and psychological toll that food and housing insecurity has on their young children.

These struggles are not unique, yet the parents we talk with often feel alone. The stories we hear are often domino-like tales of how one event sets off a cascading tide of events that leave families with all their resources depleted and feeling they have nowhere to turn. For example, a common situation is mothers who were fired or are unable to find work due to inadequate childcare. Massachusetts is the most expensive state in the nation for childcare. If she is working, a mother may be eligible for a childcare voucher. However, without the voucher or if the copay is too high, mothers find it difficult or even impossible to commit to training programs, go on job interviews or start a job due to an infant or toddler’s constant need for care and attention. Mothers talk about how frustrating this experience is – they want to work or obtain training to build their skills, but cannot afford to leave their children in safe care. There is no lack of desire to participate in the workforce and become financially independent; instead there is a lack of assistance and support at the critical moments when they are making forward strides.

It can be difficult to listen to these stories in the ED when you know the mother is trying her hardest and you just want to help her. It is helpful to remind ourselves that the interview is just the beginning as far as the work goes. We aren’t just asking questions. We are documenting the need for change and we are able to do that because families allow us to see firsthand the toll that the hardships they endure take on young children’s health. The one universal priority when sitting in ED patient rooms with parents is healthy children.  If we can nourish children so that mothers can spend less time in hospital rooms with their kids, and help parents afford safe, quality childcare so that they can go to work, we will be one giant leap closer to getting families back on their feet and children growing up with strong bodies and minds.