This is what confuses me, when I was growing up there was poor kids childcare that I went to that was dirt cheap. Don't they exist anymore? Our (lower income) city offered free summer camp and I went to a variety of after school programs. Sure you can't do that with babies though (I don't think).

The vast majority of my clothes were hand-me-downs or thrift store or sometimes sales rack stuff. My mom and her sisters and brothers passed around garbage bags full of their kids' old clothes for the smaller kids and clothes were passed on to coworkers and friends. Several kids all wore clothes until they fell apart. I was allowed to have one pair of shoes (only from Payless) and I wore them either until they didn't fit or until the next schoolyear came. My parents didn't spend hardly anything at all on clothes.

Medical costs obviously are high (unless you are in the military)

I never even felt deprived or anything either. Not being able to pick out my clothes wasn't even a big issue for me.