The COVID-19 pandemic continues to cause a great deal of loss and grief, not least among children. Many are enduring sudden separation from beloved playmates, abrupt disruptions in routines, cancellations of special events, and for some, the deaths of parents, grandparents, and others close to them.
Children express and process grief in different ways. Many factors influence their grief response, including personality, experiences, observations of others, and, especially, childhood developmental stage.
Developmental Stage and Grief
Most toddlers don't fully grasp the permanence of death, though they can deeply miss the people they love. My two older daughters were only 3 and 5 when they first experienced death. When they asked questions or expressed sadness, we picked a star in the sky to represent our lost loved one. They enjoyed staring, pointing, and talking to their special star. This ritual seemed to soothe them and provide comfort during a truly difficult time.
It is common for very young children to report uncanny conversations with a beloved family member who has died, and it's important not to dismiss their experiences. Some young children might cry one moment and switch to happy and playful the next. Some may show no signs of grief at all.
As children get older they tend to have a better understanding of the permanence of death. At this stage, they are more likely to experience grief the way we experience it as adults. It is normal for them to experience feelings including denial, sadness, anger and even rage.
If they've ever lost a pet, remind them how it felt, how they were sad for a while, how they mourned and honored the pet, and how they felt better over time. Referring to their favorite movies where characters died but were still honored and celebrated (Lion King, Moana, or Frozen, for instance) may also help.
You can also encourage them to continue to do the things they did with the person they lost. Allow them to brush their teeth or comb their hair "the way Grandma showed me." Encourage them to continue the rituals, routines, and special events they shared with their loved one to honor and remember them.
Beware that some children feel responsible for the death of a loved one. They may believe their mistakes or behavior caused their beloved to die. It is important to provide reassurance as well as comfort, letting them know they aren't to blame.
One of the most important things a parent can do for children is to tell them immediately when a loved one has died. Keeping it simple is key, especially with young children who should not be bombarded with complicated details. Avoid telling them how they must be feeling with statements like, "You must be angry or sad." Instead, just listen. Let their questions, as well as their behavior, be your guide.
If a loved one becomes very sick with COVID-19, it is important to share your hopes and wishes for a positive outcome, but also take the time to discuss the possibility that things may not turn out the way you hope. This may help lessen the shock if your family member succumbs to the virus.
Many parents attempt to conceal their own grief for fear of upsetting their child. However, seeing a parent react appropriately to tragedy may encourage children to open up and express their own emotions. On the other hand, extreme displays of grief (such as wailing or falling over) can be traumatic for children to witness. If your grief is too overwhelming initially, do wait to talk to your children until you are able to speak to them calmly and clearly, even through your tears.
When to Seek Professional Help
Grief changes us all, and children of all ages might, for a time, lose interest in things they normally enjoy. However, if this loss of interest persists, if weeks go by and your child still seems inconsolable, consult your health care provider.
In very young children, you might notice that your once avid SpongeBob fan now refuses to watch his favorite show or participate in fun activities. Sleep and appetite changes are also common. Your child may become irritable, clingy, and needy. Potential signs that may lead you to seek professional help include throwing tantrums, an inability to communicate their needs, regression in previously learned behaviors (potty training, for instance), or aggression toward others.
Older children and teens can be even more transparent. You should seek help if, months after the loss of a loved one, your child is still uninterested in schoolwork, maintaining social connections, and engaging in previously pleasurable activities. More important, if your child tells you he/she wants help, it's important that you consider accommodating this request. It is common for parents to rationalize and dismiss changes in behavior after losing a loved one. "Oh, it's normal for you to feel that way. You don't need help. It will get better in time." Ignoring the call for help may lead to catastrophic outcomes.
Memorializing Your Loved One
Parents are always asking if it's okay for their children to attend funerals. There is no ideal response as many factors play a role, but the younger the child, the more preparation is needed. During this pandemic, traditional funeral gatherings have become rare. Therefore, you and your child might collaborate on ideas to honor your loved one, whether it be writing a letter, composing a song, drawing a picture, or looking at photos and sharing treasured memories.
Children should also know anniversaries will be difficult. There is always a first birthday without Grandma, a first Christmas without Dad, as well as the anniversary of the death itself. Prepare children for these difficult times by checking in on their emotions and allowing them to freely express themselves. They will learn that grief may be experienced in waves and have effects when it is least expected. Randomly hearing a song or watching a show can trigger a grief reaction.
They should also know that, as time passes, their grief will lessen, but the sacred memories of mom or grandpa will be in their hearts forever.
You can read more about children and grief in this factsheet from the American Academy of Child & Adolescent Psychiatry, and more about helping your child cope with being homebound during COVID-19 in this article from the Center for the Study of Traumatic Stress, which also offers advice on how to talk to your child when a family member is hospitalized or dies from COVID-19.
Mid-Atlantic Permanente Medical Group, P.C. (Permanente) is our network of over 1,500 physicians who practice in our medical centers located in Maryland, the District of Columbia, and Virginia.