India has experienced a devastating second wave of the Covid-19 pandemic. Unfortunate and almost sudden deaths have occurred daily, not just in the elderly but in young and middle-aged people, leaving many children losing at least one parent. Anecdotally, several people have lost someone they know of or love such that grief is a palpable emotion in our everyday existence today.
Needless to say, all loss creates a vacuum, but the death of a parent(s) is a particularly hard-hitting and irrevocable loss. Parental death affects people emotionally at any age but the effect that it has on children and adolescents is inestimable.
It is a traumatic life event that can have far-reaching consequences. Children and adolescents who lose their parent(s) are at an increased risk for short and long-term emotional and behavioural problems. The isolation, loneliness and grief are all too real and constant. There is a perceptible and ungainly “growing up” that occurs in the reverberation of such a life-altering event.
Being the surviving parent/caregiver is undoubtedly challenging, and this is a gross understatement. One has to deal with one’s own grief and loss, practical matters of everyday life, as well the grief of another. These challenges are further heightened when the others grieving include children. Children and even adolescents may or may not understand that life must go on, or the contrary, may expect or want life to go on per usual.
Parents are a child’s anchor, their mooring. The untimely loss of a parent has a profound bearing on identity and socio-emotional development. Not only is the primary loss of the parent devastating, but there are also obvious secondary losses as well – economic and social security among others.
Loss of a parent(s) is also associated with a lifetime of ongoing grief which may occur in waves, especially at significant life events – positive or negative. A young person may miss and grieve their parent’s loss during a performance at school/college, their graduation, their wedding, when they get their first job/salary or become parents themselves or at the loss of another family member. Each time they experience a life event they might think of their deceased parent who may have rejoiced, approved or stood by them at that moment and experience that loss again, acutely.
Austrian neurologist Sigmund Freud put it across best when he said “Although we know that after such a loss the acute state of mourning will subside, we also know we shall remain inconsolable and will never find a substitute.”
“No matter what may fill the gap, even if it be filled, it nevertheless remains something else,” Freud said. “And actually, this is how it should be. It is the only way of perpetuating that love which we do not want to relinquish.”
How children grieve
Grief and certainly grieving depends on several individual and contextual factors. These include the child’s age, temperament, intellectual ability, closeness to the parent who is now no more, traumatic nature of the loss, the child’s view of the preventable nature of the death, the family’s response to the death, social support available, cultural concepts of the afterlife among others.
While Swiss-American psychiatrist Elisabeth Kübler-Ross and British psychologist John Bowlby have spoken about the stages of grief, children and indeed adults do not experience them as progressive and inalterable stages. Rather, they are experienced as predominant mood states at different points in their life.
Children and even for that matter adolescents have issues with communication of their thoughts, feelings and emotions. This is even more pertinent in children and adolescents with special needs. Expression of the grief often requires an adult to make sense of the situation for the child/adolescent in mourning.
Children and adolescents may experience physical symptoms such as stomach aches, headaches, or may show regressed behaviour ie behaving in a manner consistent with a younger child. They may display clinginess, anxiety, become withdrawn, show anger or aggression towards people and objects. There may also be marked anxiety towards the surviving parent/family member.
Understanding of death
Toddlers (below two years of age) may not comprehend the notion of “death” but will definitely be able to sense a change in their immediate environment. Pre-schoolers may have an idea of death but may not fully understand the permanence of death, or its universality.
Death may be associated with “magical thinking” or “egocentricity”. For instance, a four-year-old may think he has caused his father’s death because he was naughty the previous day. As children grow older and have had an experience with death, their understanding improves. But, along with that understanding come feelings of anxiety regarding anticipatory loss, a sense of their personal safety being threatened and a loss of permanent security.
Seeking professional help
It can typically take any time up to a year for a child to work through their grief. There could be memories and emotions that resurface around the death anniversary of the parent and during other significant moments when the child would have liked the parent to be around.
While everyone grieves in their own way, causes of concern include children/adolescents expressing death wishes, thoughts of self-harm or suicide. Persistent changes in behaviour lasting months including academic decline, enduring changes in mood/personality, being withdrawn, loss of sleep, appetite, weight loss, re-experiencing traumatic events and nightmares.
Unusual behaviour such as auditory or visual hallucinations, frequently being out of touch with reality are also points of concern. Children and adolescents with special needs may express their grief more behaviourally. An assessment by a mental health professional and help at this point may assist the child/adolescent and family deal with their individual and collective grief.
What caregiver can do
While caring for the young person their charge is important for caregivers, caring for themselves is equally necessary. A caregiver’s well-being is a necessity for them to offer care and be available to the young person.
They should pay attention to their meals and physical rest and find a space to express their emotions – talking to a trusted friend or family member, writing in a journal, sitting in silence focusing on nature as it is accessible and creating a memoir for the loved one can all be helpful.
One should give themselves permission to seek or accept help from others. A caregiver should express their sadness or worry to some extent in their child’s presence. It will help them feel comfortable in doing the same.
While maintaining a familiar and predictable routine is often helpful when working through their grief for children of all ages, other strategies to support children may be matched to the stage of development they are in. The strategies would also need to be chosen based on the nature of the child and their existing cognitive, emotional and social capacities.
Helping young children
Though infants or children with special needs who cannot yet speak may not fully understand what has happened, they often recognise the changed circumstances and experience emotional reactions in their body. It would be useful to hold them and cuddle them more often.
Speaking and singing to them in soft, soothing tones could help them feel safe and calm. Facilitating adequate rest and sleep is important for them to stay comfortable. Please follow their signals for when they are full or tired or ready for play.
This would help them bond better with their new caregiver if the parent they lost was the one who was closely involved in the daily care of the child. Placing a photograph of the deceased parent in a visible place in the house would also serve as a bridge for the young child to gradually come to terms with the parent’s absence.
My friend’s five-year-old child has been at times argumentative and irritable, and at times playing happily, after my friend’s husband passed away suddenly. The child does not talk about his father.
Children in the preschool period (three to six years old) often express their emotions through their behaviour. Helping them identify that they are screaming because they are angry and pushing someone away because they are scared while supporting them to calm down can help them feel safer and be better able to say what they are feeling in words.
Using photo albums, possessions of the parents and stories can help the child come to terms with parental death over a period of time. Talking about what mummy or daddy would do with time at different points of the day could also be a way to keep the parent alive in the child’s day.
Telling them that the parent has died and will not come back would be helpful for the child’s coping in the long-term, even if adults may be apprehensive about the emotional upheaval that the child may experience at the moment. Giving them space to ask any questions that come to their mind and answering them as honestly as possible would also be helpful. Playing by themselves or with another person without particular instructions on what to play and how to play, can be particularly helpful for children at this stage.
Supporting older children
Children who are around 10 years of age often understand the finality of death. Providing the child with an opportunity to be part of rituals organised by the family can help the child acknowledge the finality of the parent’s death and gives them a chance to say goodbye.
Encouraging the child to create something in memory of their parent can also facilitate some closure. They may also find storybooks addressing themes of loss through death quite useful.
When the child and the dead parent have shared a difficult relationship grieving may be harder and may take longer. Accepting the child’s emotions as they come and go in waves (anger, sadness, worry, fear, disappointment, boredom, calmness and happiness) and supporting them to accept those emotions, can go a long way in facilitating the emotional well-being of the child. Ways to revisit memories of the deceased parent can be planned in discussion with the child.
Supporting teenagers cope
Younger teenagers may not be comfortable expressing their emotions in the presence of others and may seem to be focused on their needs more than others in the family. This is just how a young teenager’s mind works and does not imply that they are selfish or uncaring.
The attempt to hold off expressing their emotions may sometimes trigger explosive outbursts. Giving them time and space to access the emotions evoked by parental death while letting them know that you are available to listen when they wish to talk can be most helpful. Older adolescents may be able to express their emotions and be available for others in the family. It would be helpful for them to stay connected with a trusted adult while working through their bereavement.
Long term support
This is a difficult time. The best outcome would have been the presence of the parent in their children’s lives. For children/adolescents and the surviving family to accept the reality of the loss, go through the process of grief, readjust to life without their parent/loved one, while keeping their parent in their hearts and minds is as complicated and painful as it sounds, but must be attempted.
Children and adolescents who have lost a parent(s) need long term support and care from their extended family and community, including at and by the school. While caring adults may want to shield the young from pain by avoiding conversations about death and grief, creating a space where their grief may be expressed, in an adaptive manner would facilitate healing.
Recognising that the surviving parent/caregiver or indeed the child/adolescent may also require professional help is key. In these trying times, never has the adage “it takes a village to raise a child” been more relevant or indeed necessary. The task at hand is to build that village for our children – one that fosters resilience and builds empathy in the aftermath of life-changing circumstances.
Preeti Jacob is an Associate Professor at the Department of Child and Adolescent Psychiatry at the National Institute of Mental Health and Neuro Sciences, Bangalore.
Nithya Poornima Murugappan is an Associate Professor at the Department of Clinical Psychology at the same institution.