The Invisible Patient in the Pediatric Care Crisis

Ask a working mom what it’s like to be on call 24/7 for her family’s health and the words flow quickly, often with gratitude for being asked. I’m anxious. Overwhelmed. Burned out. I feel like I’m failing. Clinically, this reflects sustained hypervigilance and chronic stress, leaving millions of women physically and emotionally depleted. Societally, it reveals a dangerously neglected truth about modern motherhood: America’s pediatric care system increasingly relies on mothers to absorb its failures.

The data on who manages the family’s health are clear. Women make an estimated 80% of medical decisions and handle most of the logistics, arranging more than two-thirds of healthcare appointments. Acting as the family’s de facto health manager is itself a job, and for most mothers, it is layered on top of paid work: according to the Bureau of Labor Statistics, 74% of U.S. mothers with children under 18 are in the labor force, including 69% of those with children under age 6.

As a mother of three and a pediatrician, I hear the voice of maternal anxiety every day. I understand the impossible calculations mothers make when children’s needs exceed access to care. Our calls peak after work hours: a mom deciding whether a baby’s fever warrants waking siblings for a trip to the emergency department; a mother distraught after giving a toddler the wrong medication; a parent trying to determine if a child is still contagious and whether she can justify missing work. Severe earaches at 3 a.m. Fiery rashes on a Sunday. It’s all in a mother’s week. And that’s among moms fortunate to have relatively healthy children.

Nearly one-third of children today have a chronic physical, developmental, or behavioral condition, including asthma, obesity, or neurodevelopmental disorders. These children require significantly more resources; research indicates that youth with chronic illness who are high users of the healthcare system have a median of nine clinic visits and six prescribed medications per year. For mothers, that means more schedule juggling, more time off work, and heightened financial strain.

Demand for pediatric care is rising even as the pediatric workforce shrinks. Routine appointments now often require waiting weeks, and specialist visits can take months. Research in JAMA Network Open highlights that children with complex chronic conditions are increasingly reliant on hospital resources as community access thins. Geography further compounds the problem.

By 2020, nearly 60% of rural counties in the U.S. lacked a general pediatrician, and this proportion worsened over the preceding decade. Recent workforce projections suggest that national pediatrician adequacy will continue to decrease from 92% in 2025 to just 81% by 2037. The harsh consequences of these systemic access failures fall squarely on mothers and, in too many cases, are quietly turning working moms into patients themselves.

Mental health conditions are now the most common complication of pregnancy and childbirth. Approximately one in five mothers develops a maternal mental health condition. In the year following birth, the rate of depression among Medicaid-enrolled women is nearly double that of women with private insurance.

Rising chronic illness among children, worsening pediatrician shortages, and shrinking geographic coverage are converging to expose deep weaknesses in our pediatric care system. Four policy changes can help redress the structural failures that have placed an unsustainable burden on mothers.

First, strengthen the pediatric workforce pipeline. Pediatrics is among the lower-compensated physician specialties, even as medical school debt frequently exceeds $200,000. Expanding student loan forgiveness programs and incentives for practicing in underserved communities would strengthen the workforce and reduce access gaps in high-shortage areas.

Second, expand pediatric capacity through technology and artificial intelligence. Validated digital tools can reshape care delivery by handling documentation, administrative work, and structured triage, increasing efficiency without sacrificing quality. This allows pediatricians to focus where they add the most value: complex clinical judgment and relationship-based care.

Third, reform Medicaid payment and make telehealth permanent. More than half of U.S. children are insured through Medicaid or the Children’s Health Insurance Program (CHIP), yet reimbursement has not kept pace with rising practice costs. Aligning reimbursement with the true cost of care and securing permanent telehealth coverage would reduce avoidable emergency visits and overall system costs.

Fourth, increase investment in pediatric innovation. Children make up more than one-fifth of the U.S. population, yet pediatric research receives only about 10%-to–13% of NIH funding. Greater investment could help identify consequential health conditions earlier and improve treatments, easing the daily healthcare burden mothers carry for their families.

The insecurities that come with raising a child may be as old as time, but access gaps, payment inequities, and workforce shortages are policy choices. When mothers are stretched thin managing illnesses and emergencies, the strain erodes their work, income, and well-being. It is time to build a system that supports the caregiver as intentionally as it treats the child. Until we do, the invisible patient in America’s pediatric crisis will remain the working mother.

Lyndsey Garbi, MD, is double board-certified in pediatrics and neonatology. She is a co-founder and Chief Medical Officer of Blueberry Pediatrics (a virtual pediatric care company), an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and an active member of the American Academy of Pediatrics.

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