# Building Resilient Pediatric Care: Lessons from Service Disruptions for Children with Special Healthcare Needs During the COVID-19 Pandemic in Germany

## TL;DR

During the early stages of the pandemic in Germany, most children with special healthcare needs faced reduced access to care, especially those with more complex conditions.

## Contribution

The study identifies structural weaknesses in pediatric care systems and proposes crisis-resilient frameworks to protect vulnerable children during public health emergencies.

## Key findings

- Up to 88% of children with special healthcare needs experienced reduced access to services during the pandemic.
- Higher disease complexity was closely linked to greater disruptions in care.
- No significant associations were found between service disruptions and socioeconomic status or caregiver mental health.

## Abstract

What are the main findings?
During the first round of the survey, up to 88% of children with special healthcare needs (CSHCN) experienced reduced access to pediatric healthcare and therapeutic services.Disruptions in care were closely linked to higher disease complexity, while no significant associations were identified with socioeconomic status or caregiver mental health.

During the first round of the survey, up to 88% of children with special healthcare needs (CSHCN) experienced reduced access to pediatric healthcare and therapeutic services.

Disruptions in care were closely linked to higher disease complexity, while no significant associations were identified with socioeconomic status or caregiver mental health.

What are the implications of the main findings?
The study reveals critical structural weaknesses in pediatric healthcare systems, highlighting the urgent need to strengthen continuity of care for children with complex medical needs.Developing crisis-resilient, integrated, and family-centered pediatric healthcare frameworks is essential to protect CSHCN and ensure equitable access during future public health crises.

The study reveals critical structural weaknesses in pediatric healthcare systems, highlighting the urgent need to strengthen continuity of care for children with complex medical needs.

Developing crisis-resilient, integrated, and family-centered pediatric healthcare frameworks is essential to protect CSHCN and ensure equitable access during future public health crises.

Introduction: This study aimed (1) to describe services involved in healthcare provision for children with special healthcare needs (CSHCN) and explore changes in the frequency of service provision reported by parents during the first wave of the COVID-19 pandemic; (2) to analyze associations between healthcare service provision and disease complexity; (3) to explore potential associations of changes in frequency of service provision with disease complexity, socioeconomic status (SES), and psychosocial factors; and (4) to generate actionable insights for building crisis-resilient care systems. Methods: A sequential series of cross-sectional online surveys at three points in time was conducted among caregivers of children with and without special healthcare needs in Germany. We analyzed data from the first survey (08/2020–10/2020). Results: Among CSHCN, reductions in treatment reached up to 88.4%. Positive associations between the reduction in treatment during the pandemic and disease complexity could be shown. There was no evidence for associations between reductions in healthcare provision, SES, and/or mental health. Structural vulnerabilities within existing care pathways for children with and without special healthcare needs could be identified. Conclusions: The findings highlight major gaps in healthcare continuity and underscore the urgent need for crisis-resilient care structures. CSHCN with more complex needs require prioritized, consistent, and structurally protected access to multidisciplinary services. The study calls for long-term investment in integrated, cross-sectoral, and family-centered healthcare frameworks to safeguard CSHCN in future public health emergencies.