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

Introduction: This study aims (1) to describe services involved in healthcare provision for children with special healthcare needs (CSHCN) and explore changes in frequency of service provision described by parents during the first wave of the COVID-19 pandemic, (2) to analyze associations between 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, to then be able (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 SHCN in Germany. We analyzed data from the first survey (08/2020-10/2020). Results: Among CSHCN, reduction of treatment reached up to 88.4%. Positive associations between reduction of treatment during the pandemic and disease complexity could be shown. There was no evidence for associations between reduction of healthcare provision, SES and/or mental health. Structural vulnerabilities within existing care pathways for children with and without special healthcare needs (CSHCN) could be identified. Conclusions: Findings highlight major gaps in healthcare continuity and underscore the urgent need for crisis-resilient care structures. CSHCN with 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.