Article Text

Original research
Nurturing care during COVID-19: a rapid review of early evidence
  1. Kerrie Proulx1,2,
  2. Rachel Lenzi-Weisbecker1,
  3. Rachel Hatch1,
  4. Kristy Hackett1,3,
  5. Carina Omoeva1,
  6. Vanessa Cavallera4,
  7. Bernadette Daelmans5,
  8. Tarun Dua4
  1. 1Research and Evaluation, FHI 360, Durham, North Carolina, USA
  2. 2Alliance for Human Development, Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
  3. 3Epidemiology Division, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
  4. 4Department of Mental Health and Substance Abuse Use, WHO, Geneva, Switzerland
  5. 5Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
  1. Correspondence to Dr Kerrie Proulx; kerrie.proulx{at}


Objectives The COVID-19 pandemic has brought significant changes to family life, society and essential health and other services. A rapid review of evidence was conducted to examine emerging evidence on the effects of the pandemic on three components of nurturing care, including responsive caregiving, early learning, and safety and security.

Design Two academic databases, organisational websites and reference lists were searched for original studies published between 1 January and 25 October 2020. A single reviewer completed the study selection and data extraction with verification by a second reviewer.

Interventions We included studies with a complete methodology and reporting on quantitative or qualitative evidence related to nurturing care during the pandemic.

Primary and secondary outcome measures Studies reporting on outcomes related to responsive caregiving, early learning, and safety and security were included.

Results The search yielded 4410 citations in total, and 112 studies from over 30 countries met our eligibility criteria. The early evidence base is weighted towards studies in high-income countries, studies related to caregiver mental health and those using quantitative survey designs. Studies reveal issues of concern related to increases in parent and caregiver stress and mental health difficulties during the pandemic, which was linked to harsher and less warm or responsive parenting in some studies. A relatively large number of studies examined child safety and security and indicate a reduction in maltreatment referrals. Lastly, studies suggest that fathers’ engagement in caregiving increased during the early phase of the pandemic, children’s outdoor play and physical activity decreased (while screen time increased), and emergency room visits for child injuries decreased.

Conclusion The results highlight key evidence gaps (ie, breastfeeding support and opportunities for early learning) and suggest the need for increased support and evidence-based interventions to ensure young children and other caregivers are supported and protected during the pandemic.

  • COVID-19
  • Child protection
  • Community child health
  • Depression & mood disorders

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Collaborators The authors are grateful to the support and collaboration provided by Vanessa Cavallera, Bernadette Daelmans and Tarun Dua from the World Health Organization, Geneva, Switzerland.

  • Contributors KP is responsible for the overall content as the guarantor and coordinated the review, screened citations and full-text articles, abstracted data, interpreted the results and wrote the manuscript. RL-W and RH screened citations and full-text articles, abstracted data and edited the manuscript. KH helped conceptualise the research, interpreted the results and edited the manuscript. CO coordinated the review, obtained the funding and edited the manuscript. All authors approved the final version to be published.

  • Funding Lego Foundation funded this work (grant number 1226.001).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.