Theme 1: Parents’ experiences during the COVID-19 pandemic were isolating and overwhelming.

Subtheme: Isolation and disconnection “I was not allowed to visit my kid when he was admitted. I nearly burst out due to the unforeseen prognosis and didn’t have the emotional support.” (Parent A). “I couldn’t have imagined how bad it was. Many families’ members were diagnosed with COVID-19, and we and our families, our relatives, could only keep in touch by phone. Everywhere was shut down.” (Parent B). “Both my husband and I were not allowed to visit our child; we could only wait for caring teams to phone us to talk about the child’s condition and progress.” (Parent C). “We, as parents, could not visit our daughter and we were really upset and could not share the caring at this critical moment. We definitely understood the precaution, but it was so taxing on both me and my husband.” (Parent D).

Subtheme: Distress and trauma “My husband and I were frightened by the phone call from the nurse that our son’s condition had suddenly changed, and he needed to be put on the ventilator. Justin is our only child, and we were afraid that we would lose him. At that moment, it was like a knife stabbing my heart. Fortunately, he recovered speedily.” (Parent B). “It was extremely challenging. Our daughter was born prematurely and was only discharged from the hospital for six months. During her stay in intensive care, it was already a traumatic experience. Unfortunately, she was diagnosed with COVID, and this was a painful experience for us and a tough time for her to fight the virus.” (Parent E), Subtheme: Intense emotional expressions “It was scary to stay home and wait.” (Parent D). “We were terrified to receive the call. When the nurse called us, we both prayed it was good news and not bad. Once I heard that my child’s condition showed no improvement, it really hurt me. I burst into tears.” (Parent F). “We could only speak to the doctors or nurses very briefly. Whenever there were opportunities to ask, I would often forget what I wanted to ask, or the information became too overwhelming. When my parents or husband came home and I repeated all of this to them, it was heartbreaking all over again.” (Parent H).

Theme 2: Disruption to the family and family-centered care

Subtheme: Parents’ essential caregiver role “The hospital as an institution made many policies in that critical moment that prevented caregivers (the parents) from visiting and caring for their children.” (Parent G). “Parents should have been allowed to visit their children at that essential moment. That separation was like breaking up the family and made me feel so alone. I wanted to share and take care of my child during this pandemic.” (Parent H). “During the hospitalization, my child was unstable for the first few days. I felt my child’s loneliness. As a family, it was better to let someone stay to take care of my child.” (Parent B). “Due to the policy, my child had to be left alone and cared for by the doctors, nurses, and multidisciplinary personnel. It was quite scary for the children to come face-to-face with unfamiliar people during nursing care.” (Parent E). “We were being forced to be apart from our children, while they were left alone to face numerous doctors, nurses, and different healthcare professionals. This policy resulted in a lot of trauma for the children and parents.” (Parent D).

Subtheme: Egregious loss Category: Bonding loss “Both of us were not allowed to visit our child until discharge, and the siblings were not able to meet each other. It became harder for the siblings to understand what was happening.” (Parent B). “I felt suddenly that my bond with my son had changed. He was just three months old when he was admitted to the ward. It was our first child, and my husband and I really missed him. And I often cried.” (Parent C). Category: Experience loss “I wanted to exclusively breastfeed my three-month-old baby, and in the hospital, he needed to change to bottle feeding as I could not breastfeed him. I was worried that he would not adapt to bottle feeding and not eat well.” (Parent C). “We could only wait for the nursing staff to arrange face-time through WhatsApp. I disliked this interaction, and my child did not recognize me.” (Parent F). “I felt disconnected from my daughter. I was not able to visit her because I was diagnosed with COVID-19 too.” (Parent H). Category: Loss of time “We live together, eat together – in fact, when my husband was not diagnosed with COVID-19, we needed to separate from each other to reduce the risk of being infected. But when my child recovered and was discharged from the hospital, we still needed to live separately until we had a negative result.” (Parent H). “We and my family were diagnosed with COVID-19 at different times. I needed my mother to take care of him after his discharge. It took a long time to wait for the whole family to get a negative result in the COVID-19 test.” (Parent C).

Theme 3: Interactions with pediatric isolation ward providers intensified or alleviated emotional distress.

Subtheme: Support and validation “We understood the precautionary steps that the isolation ward was taking, but maybe it was too difficult for the parents to follow and we needed their support for both of us caring for our child.” (Parent A). “The doctors and nurses could have been more sympathetic and supportive. Whenever they called us to discuss the child’s condition, they seemed to be in a hurry and we could not ask them for clarity about the child’s condition.” (Parent E). “I felt that no one understood the real pain and trauma I was dealing with. He needed to be put on a ventilator for a few days due to respiratory difficulties. I was struggling emotionally and mentally and did not understand what was happening when I received a call from the nurse that my child’s condition had gotten worse. I also felt that the policies were so strict – they caused psychological or mental harm to parents.” (Parent B).

Subtheme: Professionalism and consistency “During the hospitalization, I was afraid that my child would be infected by other diseases. I was worried that the nurses were not sanitizing and washing their hands properly before touching my baby.” (Parent E). “The policies and protocols kept changing in both the communities and the hospital. I felt that there was no consistency for the care providers and that this would affect the care given to my child too.” (Parent G).

Subtheme: Alienation and inclusion “I was confused with the staff’s explanations. Every day, different nurses contacted me telephonically and their explanations were not always clear.” (Parent H). “I was bothered by the rotation of the staff who worked in the ward. I was afraid that during the rotation they would neglect the treatment and care for my child.” (Parent D).