Being Afraid of and for One’s Parents: The Lived Experience of Children Exposed to Parental Burnout

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

I enjoyed reading this paper which is both original, well presented and timely.

The paper is well structured and the key arguments are clear. This is an important area of research which not only advances understanding in the area of parental burnout but centres the children's views at the centre of the research.  Photolanguage is introduced yet not fully explained in terms of how this approach was used with children. More detail on this would add greater clarity to the research methodology sections. 

I do have a few queries concerning the ethics of this paper which are not 100% clear.  The ethics are not well defined or discussed within the paper. Consent is explained whilst children's right to withdraw, safeguarding and ongoing assent are not discussed in detail. 

Exploring children's perceptions of/lived experiences related to parental burnout is a sensitive area and one that requires safeguarding practices within research approaches. How, for example were the children - when alone with the researcher - supported should they wish to withdraw and/or if they became upset or distressed during the research? Also, how were signs of ongoing assent considered? More detail pertaining to each of these ethical issues is required.

Regards Reviewer

Author Response

Reviewer comments :I enjoyed reading this paper which is both original, well presented and timely.

The paper is well structured and the key arguments are clear. This is an important area of research which not only advances understanding in the area of parental burnout but centres the children's views at the centre of the research.  Photolanguage is introduced yet not fully explained in terms of how this approach was used with children. More detail on this would add greater clarity to the research methodology sections. 

I do have a few queries concerning the ethics of this paper which are not 100% clear.  The ethics are not well defined or discussed within the paper. Consent is explained whilst children's right to withdraw, safeguarding and ongoing assent are not discussed in detail. 

Exploring children's perceptions of/lived experiences related to parental burnout is a sensitive area and one that requires safeguarding practices within research approaches. How, for example were the children - when alone with the researcher - supported should they wish to withdraw and/or if they became upset or distressed during the research? Also, how were signs of ongoing assent considered? More detail pertaining to each of these ethical issues is required.

Reponses : 

Comment 1: Photolanguage

• Thank you for your comment. Following an existing paragraph where photolanguage is explained

“After explaining Secondly, we used a photolanguage to question the children about their representations and perceptions of parental burnout. According to Pyle (2013), photolanguage enables children to communicate using both visual and verbal skills, and the use of images facilitates the emergence of unexpected themes (Pyle, 2013). »

We have now added  : “The children in our sample were invited to pick one or several pictures that would be representative of parental burnout, and to show and explain to the rest of the group why they chose these pictures.”. Please see lines 177-181, page 5

As illustrate din the results section, some images were frequently used by children to describe their parent's exhaustion, particularly through physical signs of fatigue (a person lying down, crying, pulling a heavy suitcase, playing sports, etc.), through the concept of time (photos of clocks), and through risks for the parent himself (car accidents, collapsing buildings, etc.). The presentation of the photos chosen by the children allowed the researcher to question them about their choice to establish a link between the image and the concept of exhaustion as perceived by the child.

Comment 2 : Ethical clarifications

• The ethical and methodological issues involved in this research were addressed in a scoping review of the literature. The results of the literature review informed the drafting of the protocol, and numerous precautions were taken to protect the children while allowing them to exercise their agency, without undermining family balance. We referred to the literature review several times in the description of our methodology.

See for instance : “Congruently with the results of our scoping review (Author1, Author3 & Author4, 2021), children were recruited through their parents, who had themselves been contacted through a health professional or social worker known by the family. For a child to be included, the parents needed to have previously participated in a semi-structured interview about their own experiences and their thoughts on their children's experiences, and they had to have consented to their child's participation (Author1 et al., 2024). This choice was made to ensure the psychological safety of the different family members, as recommended in the literature (Author1, Author3 & Author4, 2021).”

Nevertheless, we would like to clarify that the researcher who interviewed the children had extensive training and experience in pediatrics, which enabled her to adopt an appropriate approach in her interviews with the children, notably by first establishing a relationship of trust through play and then regularly rephrasing the children's comments to ensure that she understood them correctly.

Please see : “Next, to create some familiarity, we took some time to allow each of the children and the researcher to share some aspects of their personal lives, such as the composition of their families, their hobbies, their school, their favorite meals, their last holidays, or the types of gifts they most liked to receive. We used a dice to allow everybody to speak in turn and to choose the topics”.

In response to the reciewer’s comment, we have now added : “The first author, who had extensive training and experience in pediatrics, conducted all the interviews”. Please see lines 159-160, p. 4

As evidenced in the manuscript, the main researcher also paid close attention to the children’s nonverbal communication throughout the interview. The children were allowed to choose the media they wanted to use, and they were given the opportunity to express their emotions using illustrated cards at several key moments during the interview.

Regarding concent, at the beginning of the interview, the researcher clearly asked for the child's consent: “First, we created an environment of trust to allow the children to express themselves, while clearly explaining the purpose of the research, and making sure that the children understood so that they could engage freely”.

We have now added the following clarification:

“After meeting with the parents who had given their permission for their children's participation in the study, we provided the potential participants with comprehensive information about the study. The children and adolescents who then agreed to participate were invited to read and sign an age-appropriate consent form. The process of eliciting consent was repeated verbally each time there was a change of activity (photo language, role-playing, collage). Please see lines 108-110 p. 3

Reviewer 2 Report

Comments and Suggestions for Authors

The article presents a qualitative and participatory study involving 24 children aged 8 to 20, all exposed to parental burnout. The authors seek to understand: (1) how children perceive parental burnout; (2) how they experience these situations emotionally; and (3) what resources they mobilise to cope with them. Authors use age-appropriate creative tools (photolanguage, role-playing, collages, emotion cards), the children describe a significant emotional burden, marked by insecurity, fear (for and of their parents), a mismatch between their own needs and those of their parents, and various coping strategies ranging from withdrawal to overinvestment. The results highlight psychological risks for children and underscore the importance of addressing parental burnout as a major societal and public health concern.

The study stands out for its methodological innovation, combining participatory tools, symbolic mediation, and subsequent validation through an inter-family seminar. The richness of the qualitative material and the attention paid to participants’ psychological safety reinforce the rigor of the work. Finally, the article helps to fill what I believe is a gap in the literature, which, as far as I know, rarely documents children’s own voices in the context of parental burnout.

The introduction, while rich, does not follow the classic presentation structure I am use to :

• The dependent variable (here, the lived experience of children exposed to parental burnout) is not foregrounded at the outset: the emphasis is instead placed on parental burnout (definitions, BR2 framework, causes). The children’s experience appears only in the second part of the introduction, even though it is the de facto DV. This way of introducing the variables does not allow the reader to follow the logic of the theoretical development.
• Independent variables (or potential explanatory factors: parental, familial, societal characteristics, children’s characteristics) are mentioned but not structured as such.
• Mediators or moderators are not made explicit—which is understandable for a qualitative design, but the literature cited (parent emotion regulation, societal context, child health) would have allowed a clearer conceptual framing.
• Hypotheses: an exploratory design does not require hypothesis, however, the authors could better articulate theoretical expectations or specific gaps the study aims to address.

The methodology is overall relevant and coherent with the exploratory aims. The sample (N=24) is good for qualitative research, but recruitment exclusively through exhausted parents introduces a major selection bias: the children most at risk, or those living in the most chaotic households, are unlikely to be recruited. The exclusion of younger children limits developmental scope (underline this in limitation section?). Finally, although psychological safety is well managed, the successive presence of parents before and after the interview may induce desirability bias or inhibit disclosure of sensitive content (underline this in limitation section?).

The analysis clearly follows the steps of structured inductive thematic analysis, well executed: double coding, team discussions. The three final categories are coherent, well-illustrated with quotations, and neatly aligned with the research question.

The methods are appropriate for an exploratory study: no comparative or inferential ambition, which matches the small sample and human complexity explored. The only critique is the near absence of links between children’s characteristics and their reactions: even without hypotheses, a minimal analysis would have enriched interpretation. Likewise, the potential influence of family structure or dynamics is mentioned but only lightly explored.

The discussion is well aligned with existing literature, and the results are interpreted cautiously. The authors avoid over-generalization which is good.

Limitations are presented transparently: sample size, absence of saturation, variability in expressive capacities, potential parental pressure to participate, limits of the tools. However, some limitations would benefit from deeper examination (see above)

The discussion rightly emphasizes the societal impact of parental burnout and the emotional risks for children. The clinical implications could be expanded. The suggestions for future research are pertinent and well articulated.

Note: Although I declared that I did not use any generative AI or AI-assisted technological methods to prepare this reviewer report, I did use it to translate some parts of my review from my mother-tongue to English. 

Author Response

The article presents a qualitative and participatory study involving 24 children aged 8 to 20, all exposed to parental burnout. The authors seek to understand: (1) how children perceive parental burnout; (2) how they experience these situations emotionally; and (3) what resources they mobilise to cope with them. Authors use age-appropriate creative tools (photolanguage, role-playing, collages, emotion cards), the children describe a significant emotional burden, marked by insecurity, fear (for and of their parents), a mismatch between their own needs and those of their parents, and various coping strategies ranging from withdrawal to overinvestment. The results highlight psychological risks for children and underscore the importance of addressing parental burnout as a major societal and public health concern.

The study stands out for its methodological innovation, combining participatory tools, symbolic mediation, and subsequent validation through an inter-family seminar. The richness of the qualitative material and the attention paid to participants’ psychological safety reinforce the rigor of the work. Finally, the article helps to fill what I believe is a gap in the literature, which, as far as I know, rarely documents children’s own voices in the context of parental burnout.

• We thank you very much for your appreciation of our work

The introduction, while rich, does not follow the classic presentation structure I am use to :

• The dependent variable (here, the lived experience of children exposed to parental burnout) is not foregrounded at the outset: the emphasis is instead placed on parental burnout (definitions, BR2 framework, causes). The children’s experience appears only in the second part of the introduction, even though it is the de facto DV. This way of introducing the variables does not allow the reader to follow the logic of the theoretical development.
• Independent variables (or potential explanatory factors: parental, familial, societal characteristics, children’s characteristics) are mentioned but not structured as such.
• Mediators or moderators are not made explicit—which is understandable for a qualitative design, but the literature cited (parent emotion regulation, societal context, child health) would have allowed a clearer conceptual framing.
• Hypotheses: an exploratory design does not require hypothesis, however, the authors could better articulate theoretical expectations or specific gaps the study aims to address.

• We thank you for these suggestions. We agree that the topic of our work, ie. The children’s experience of parental burnout was introduced only later in our introduction. To make up for this, we have now added a sentence at the very beginning of our introduction. Please see lines 24-27, on page 1 :” While parental burnout is a frequently reported phenomenon (Roskam et al. 2021) characterized by a state of extreme exhaustion related to parenthood, little is known still about the children’s experience of it, and the consequences it may have on them.”
• Regarding the suggestion to introduce more explicitly what are the independent variables, moderators and mediators, this is not congruent with the epistemology of our qualitative design. We therefore prefer not to change our text according to this suggestion.

The methodology is overall relevant and coherent with the exploratory aims. The sample (N=24) is good for qualitative research, but recruitment exclusively through exhausted parents introduces a major selection bias: the children most at risk, or those living in the most chaotic households, are unlikely to be recruited. The exclusion of younger children limits developmental scope (underline this in limitation section?). Finally, although psychological safety is well managed, the successive presence of parents before and after the interview may induce desirability bias or inhibit disclosure of sensitive content (underline this in limitation section?).

• We thank you for this comment. We have now added a sentence in our limits section to acknowledge that some children might have been excluded from the study. Please read

Lines 520-523, page 12: We acknowledge, however, that the methods and instruments employed did not permit the inclusion of younger children, thereby constraining the developmental scope of the study

• Regarding the presence of the parents for some of the children, we fully agree that this might have occasionally created a desirability biais. However, partnering with the parents was a necessary condition to limit conflicts of loyalty for the children, as well as a response to our ethical concern that our research should not be detrimental to already fragile family dynamics. This is now emphasized in our limits section.

Please see Lines 535-538 page 12 & 13 : Although it might have occasionally created a desirability biais, meeting the parents beforehand and making them partners in the research process (Author1 et al., 2021) was a necessary condition to limit conflicts of loyalty for the children, as well as a response to our ethical concern that our research should not be detrimental to already fragile family dynamics.

The analysis clearly follows the steps of structured inductive thematic analysis, well executed: double coding, team discussions. The three final categories are coherent, well-illustrated with quotations, and neatly aligned with the research question.

The methods are appropriate for an exploratory study: no comparative or inferential ambition, which matches the small sample and human complexity explored. The only critique is the near absence of links between children’s characteristics and their reactions: even without hypotheses, a minimal analysis would have enriched interpretation. Likewise, the potential influence of family structure or dynamics is mentioned but only lightly explored.

• Thank you very much for these comments, which meet some of our own questions and frustrations inherent to this first exploratory study, which was conducted with a small sample of families. The small number of families, some of which are characterized by the presence of very specific needs (eg. Children with a rare disease does not allow us to make further inferences. This is congruent with discussions we had in our steering committee as well as ethical recommendations.

The discussion is well aligned with existing literature, and the results are interpreted cautiously. The authors avoid over-generalization which is good.

Limitations are presented transparently: sample size, absence of saturation, variability in expressive capacities, potential parental pressure to participate, limits of the tools. However, some limitations would benefit from deeper examination (see above)

• Thank you. The above recommendations have been integrated in the limits section

The discussion rightly emphasizes the societal impact of parental burnout and the emotional risks for children. The clinical implications could be expanded. The suggestions for future research are pertinent and well articulated.

• Thank you for this comment. We have now slightly emphasized the need for clinical interventions. More may be found in our previous article on how exhausted parents experience their interactions with their children (reference not reported here for the sake of anonymity)

See lines 515-517 p12.    This leads us to advocate for an increased recognition of parental burnout as not only a personal or family problem, but as a possibly important societal and public health concern, with implications for child prevention and health promotion, including the development of early clinical interventions to better serve the needs of the families concerned (Author 1 et al. 2024).