Judith Crowell, MD, a child and adolescent psychiatrist at Stony Brook Medicine provides important insights and tips on what you can do to help at a time when bereavement and grief are affecting families in unprecedented ways due to social distancing during COVID-19.
In this time of the COVID-19 pandemic, many families are experiencing losses of loved ones. The processes of grief and mourning are disrupted by social distancing, making it difficult to truly mark a passing and share the pain.
With a more predictable death, there are opportunities to say goodbye and some planning can be done. The deaths due to the COVID-19 pandemic are traumatic: They were not expected. An ambulance may have come for a loved one struggling to breathe. If there were opportunities to say goodbye, they may have been limited or even done remotely with the help of a healthcare worker who, however caring, is struggling themselves to cope with uncommon stress and the magnitude of what their job now entails.
It is easy to see how children could be overlooked in such situations. Even in ordinary times, children are often left out of discussions and events surrounding death, as the adults around them are preoccupied with their own grief and overwhelmed by preparations and planning.
When children experience the loss of someone close to them, especially a parent, they lose a major organizing, loving, and supportive person in their lives. The person who would typically help a child to cope with fear, pain, and loss is no longer there to reach out to. This role may be left to other caregivers who do not know the child as well.
Children of different ages handle death and grieving differently
It is important to know that children of different ages understand death very differently and may need different supports. They also don’t express grief in the same way that adolescents and adults do; their grief may be much less obvious, because their ability to discuss their feelings is often limited. And they’re easily distracted by play, so it may look as if they’re indifferent. This can lead adults to downplay a child’s experience of the loss.
- Toddlers and preschoolers do not understand that death is permanent and that everyone eventually dies. They may ask about the return of a lost person. Young children especially want physical comfort when they’re upset. As much as possible, hugging and holding a child will help. Keep in mind, however, that some children don’t want a substitute for the person who is lost and will struggle to get away. On the other hand, they may be clingy and fussy. It’s easy to see how adults could find this range of reactions from a grieving child challenging to deal with to the point that the well-meaning adult may eventually back off from trying to help.
- Older preschoolers and young school age children do know death is permanent, but they typically think that only old people die. When they experience a loss, they may believe they have caused the death. They need reassurance from others that this isn’t true. At a time when we often don’t know how COVID-19 was contracted or if someone was indeed careless, this may be true for older children and adults as well. It’s very easy to blame others and ourselves.
- Older school age children begin to understand death more like adults do. They know that it’s not just the elderly who die. And they know that they can die. They may worry that the deceased person is lonely or cold. These concerns may lead a child to be more anxious and fearful for themselves or others, including the person they have lost.
- Teens are the most likely to say things like, “it’s just not fair” or that their loved one “didn’t deserve to die.” They may be angry and hide their sadness. They’re also typically more aware than younger children are, of the distress that other family members are feeling. As a result, they often try to “be strong” and not show their pain.
Will things get better?
For most children and teens, the most intense parts of grieving will fade in about 4 to 6 months, but there will be waves of grief for a year or more, especially at holidays, birthdays, or other events or experiences when the loved one’s presence is especially noted and missed, such as graduations. The good news is that most children will recover well even from a traumatic loss.
How to help a child (and everyone) recover
- Include the child in rituals and activities that help remember the loved one, including planning and participating in memorial services or activities
- Talk about feelings and the person who died with stories and memories
- Help support acceptance of death by explaining that:
- The person did not want to die
- The person did not want to leave the child
- The person who died won’t return. Don’t create false hope by saying things like, they’re “far away” or “asleep”
- Religious beliefs can be very helpful
- Provide ongoing warmth and affection from the surviving parent or grandparent and other caregivers
- Tell the child they will be safe, taken care of, and loved
- Tell the child they are important and valued
- Keep structure and a routine- — It is important to remember that life is not usually so unpredictable and unmanageable