What Might it be Like for a Child, When a Parent Dies?
I said goodbye to the most important person in my life. I didn’t understand why everyone was sad and crying. I did know that we were going to church. I didn’t know why my mom couldn’t come home and make my favorite dress with the tiny blue flowers on it look nice. My mom always made my dress look nice before I went to church. However, today it was all wrinkled, and it made me sad to wear a wrinkled dress to church.
My Dad said we were going to church to say goodbye to my mom because, “she had got so sick and the doctors couldn’t fix her.” She died and wouldn’t be able to come home ever again. At 5 ½ years old, I didn’t know what it meant to die, but I did know I missed her terribly. I wished with all of my heart for her to come home one more time and make my world pretty again.
She was always the one who made things better. I knew that she would always find a way to, “fix it and make it all better, no matter what happened.” Now she was gone, and my heart broke as I realized nobody could fix how much I missed her and mend the pieces of my broken heart.
What do Young Children Need After the Death of a Parent?
Young children who have lost a parent or caregiver need what I call the 4 C’s:
- Coherent Story
EMS brought a two ½-year-old child into my emergency department a while back along with his nanny, who was driving the vehicle they were traveling in. Another driver had plowed into their car, seriously injuring the nanny. The child was buckled in his car seat in the backseat and was uninjured. He was in the ED while the police attempted to locate the parents. The child was inconsolable until his mom showed up, took him in her arms, and he immediately calmed down and, in a language that only his mom would understand, began to say over and over. Mimi Woo Woo, Mimi WooWoo. He was telling his mom the story of what had happened. His mom supplied that he was telling her his beloved Mimi was taken away by the WooWoo, his name for an ambulance or firetruck.
Several days later, he revisited us with his mom to thank us. When I asked how Mimi was, he became animated and threw out his arm, then brought them together and said Bang Bang. At which point his mom added, “that’s right, you were riding in the car with Mimi when another car hit your car with a big Bang Bang.” Then he said, “MiMi go WooWoo,” and Mom again translated “yes, Mimi had to go in the Ambulance to the hospital so the Doctor here could help her.” At which point, he got a big grin on his face and finished the story with satisfaction.
“Mimi good.” “Yes,” mom added, “Mimi is getting better, and Mimi is coming home very soon.” Mom then said that he had told the story over and over and over again with her help. Grinning and blowing kisses, he left with his mom.
Clearly, in the days after the accident, he told the story repeatedly with assistance from his mom until he had a coherent story. After an emotionally traumatic event telling and retelling the story helps a young child deal with it emotionally. When an adult listens and adds context to the repeated telling of the story, this lets the child process his fears and go on with his daily routine in a balanced and healthy way.
For young children, connection or attachment to their caregivers is hard-wired in their brains as a survival mechanism. Their connection with their parent or caregiver provides the basis for their sense of well-being. It lets them explore and learn. It is essential for emotional safety, stress regulation, adaptability, and resilience. When a parent or caregiver dies, it is vital that they still feel connected with the parent who dies and their caregiver.
How can the surviving caregiver help maintain the connection with the parent that died and with them?
- Let the child know that it is ok to have their feelings of grief or sadness. Their emotions will overwhelm them. When this happens, sit with them, comfort them and connect with them via a “me to moment.” Respect their way of coping.
- Talk about their fears and anxieties: young children will often worry that they did something to cause their parents’ death. They worry about who will take care of them,
- Give them adequate information about the death. Help them build a coherent story. Listen when they want to tell the story of what happened. Young children need to tell the story repeatedly with a loving adult.
- Provide a sense of safety and security in their world
- Involve them in rituals and anniversaries or opportunities to remember the person who died.
Anyone who has lost a family member needs lots of caring people to support and encourage them. A young child needs lots of hugs, cuddles, closeness, and love. Caregivers’ grief can be overwhelming at times, and it is essential that your child feels looked after and cared for. Following the death, it may be helpful to ask other family members and friends to help you care for your child/children. Take care of yourself, processing your feelings of grief and loss will help you be available emotionally to your child.
Maintaining continuity at home, school, and in the community is essential. Keeping the same routine as before the death is comforting and predictable to a child. When children can predict what will happen next, they feel safe. Let the teachers or caregivers know what happens if your child attends school or daycare. They may be able to provide some extra support for your child.
What are some Additional ways I can Provide the 4 C's?
- Make a Memory Box where your child can store favorite pictures and mementos of your child and the person that died.
- Put together a Memory Board with pictures from fun family times with the parent or caregiver that died. Involve your child/children in selecting the photos and change them every few months.
- Encourage your child to draw pictures or write about (if they are old enough) the person that died.
- Use the name of the person who has died and talk about them. Talk about your feelings, and it is ok to cry with and in front of your kids. It’s important to normalize sadness for our children. Crying is also good for you. It reduces stress by releasing oxytocin and endorphins. Both are “feel-good” chemicals. That’s part of why a good cry helps you feel better.
- Give your child objects and special things. Help your child pick some special objects and things of the person that died. They may be an item of jewelry, clothes, or other things.
- Create some Remembrance Rituals that are special and unique. A few ideas might include playing their favorite song monthly or weekly. Lighting a candle on anniversaries. Engaging in their favorite activity.
How Many Children Have Lost a Parent or Primary Care-Giver to COVID?
These past two years, the U.S. has dealt with many sad statistics. A tough one is a study recently published in the Journal of Pediatrics that estimates one in every four COVID deaths was a parent or caregiver for a child under the age of 18. The majority of these children come from racial and ethnic minority groups.
“This means the child left behind was without a mother, father or a grandparent who provided for that child’s home needs and nurture — needs such as love, security, and daily care,” says Susan Hillis, an epidemiologist at the Centers for Disease Control and Prevention and lead author of the new study.” (link)
According to the CDC, there were 858,909 deaths from the COVID pandemic. From Jan of 2020 through Jan of 2022. Based on the above estimates, that means over 200,000 kids have lost a parent or primary caregiver to COVID.
Why Many Children Didn't Get to Say goodbye.
The hospital where I work as an ER physician was at the epicenter of the start of the COVID pandemic. The hospital was in lockdown, and only the staff and the sick and dying were allowed in.
We were the caregivers and support system for our patients. We were also their only connection to their loved ones. When all too often, it was time for the final goodbye, with heavy hearts and tears in our eyes, we held up a cell phone or iPad to connect their family with them via face-time for a last goodbye. Then once they died, it was often many months before their loved ones could have a funeral.
Mental health care providers who work with kids tell me that these losses are particularly traumatic because many kids didn’t even get to see their parents or grandparents in the hospital or say goodbye to them. A unique feature of the pandemic is that it deprived our children and us of our loved ones and took away our ability to come together as a family and community to grieve. To support one another, to get through one of the most challenging times of life, and to heal.
When should I seek Professional Help/Therapy for my child?
Children often try to protect their parents after the death of their other parent or caregiver. They may fear talking about and expressing their grief will further distress their parent. Children who have difficulty processing and expressing their grief may need professional help. Many of the following signs are expressed normally by children who are grieving. When they continue for a long time, and it doesn’t appear they will get any better, it may be time to seek additional help. Some of the signs are:
- Difficulty talking about the parent who died.
- Aggression, both physical and verbal.
- Withdrawal from friends and social activities.
- Physical symptoms tummy aches and headaches.
- Eating and Sleeping changes. Unable to sleep or doesn’t want to get up even after a long sleep period of sleet.
- Overeating or becoming a very picky eater with minimal appetite.
- Self-Destructive behavior.
- Acting much younger than age for a prolonged period of time.
- Excessively imitating the dead person.
If you are concerned that your child or a child you are the caregiver for needs professional help, talk to the child’s pediatrician about your concerns. They can guide you and help you find the right therapist for your child.
If you are looking for additional resources, Dr. Elena Lister recently shared her book, Giving Hope, conversations with children about illness, death, and loss with me. It is a resource I use in my practice as an ER physician and the founder of ESP Emotional Social Parenting. The advice in her book is readable and applicable to anyone dealing with this challenging topic.