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Coping with grief in childhood and adolescence in the context of the SARS-CoV-2 pandemic

Given the current health emergency situation, many families will face the sudden loss of people who are close to them. How could you help your kids to deal with it?

4 May 2020
Father with his sad children.
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Given the current health emergency situation, many families, children and adolescents are facing the unexpected and sudden loss of people who are close and relevant to them. 

This article aims to provide information regarding grief in childhood and adolescence, highlighting the relevant or differential aspects of loss in the current situation and offering general guidelines to communicate to children the death of a loved one.

Relevant aspects of the current situation

Due to the SARS-CoV-2 pandemic situation, it will be frequent to find ourselves in situations of sudden death (without the possibility of saying goodbye or being prepared to handle the loss). This, alongside confinement and the impossibility of carrying out the usual dismissal rituals (wake, burial, funeral), places us in a hard position.

Confinement causes an alteration of routines and the loss of habitual relationships with significant people in the environment. This can generate fear and anguish, which will be added to the difficulties of mourning for a sudden death when there has been no opportunity to say goodbye before the person died or to perform the habitual departure rituals.

Not being able to anticipate death or maintain our normal routines is a sudden, rapid and unexpected change. The social isolation that confinement entails makes it difficult to emotionally accompany the sick family member and, if one of the parents becomes ill, the child will have to remain confined at home, without its main bonding figures.

When an unexpected death occurs during this COVID-19 pandemic, try to help the child accept the news without any preparation. Verbalizing our own experience of shock and disbelief will help, as well as giving them time and space to assimilate the facts.

Both adults and children may find it more complicated to elaborate a healthy grief these days, as they will not be able to express and concentrate on the emotional needs that naturally trigger the loss process. If we want to be capable of saying goodbye to a loved one, it is necessary to guarantee a healthy grief.

Children and adolescents, but also the rest of family members, will most likely feel they need to perform rituals or symbolic acts of dismissal of the loved one once the process of confinement comes to its end.

How children and adolescents cope with the death of a relative

Death always involves suffering and pain and therefore it is generally difficult to talk about it. Sometimes it even becomes a taboo subject among families, and it is harder when you have to explain the loss of a loved one to a child.

Adults tend to avoid talking about death with their children in order to protect them from suffering. But death is nothing but another life experience and talking about it helps children to understand it, explore and express their suffering, sadness and pain, which eventually will allow them to experience grief.

On the other hand, we must bear in mind that children often have death very present: they sometimes simulate that their toys or pets die while playing and they may even express that they would like to die when they are angry or in emotionally intense situations.

However, we must remember that their concept of death is still immature or under construction (for example, they may not yet understand the concept of irreversibility); therefore, offering children a space to speak about death in a natural way may prevent them from assuming wrong ideas and concepts about it.

Consequently, it is important that parents accompany children in this process of emotional experience and grief, offering them a space to speak safely, and allowing children and teenagers to express their emotions and understand the phases of the life cycle and the loss process.

General guidelines for discussing death with children and adolescents

Below you will find some ideas and guidelines to facilitate communication and discussion about the death of a loved one in the current context:

  • It is recommended that the parents/bonding figure communicate the death of the loved one. If this is not possible, the most emotionally close adult should be in charge.
  • News should be delivered as soon as possible.
  • Find a quiet, familiar, cozy and safe place for the child. This is usually his/her room. Sit next to him/her so that you are at the same level. Depending on the stage of development and the child's personal characteristics, there can be physical contact or hugging.
  • The language employed must be adapted to the child’s age; it is important to use simple phrases, a calm tone of voice and a close attitude.
  • In a short but understandable message, try to explain that something very sad has happened, that the loved one has died and that it will not be possible to see this person again.
  • It is important to accompany the child’s individual emotional process, helping to express his/her emotions and clarifying any doubts hi/her may have.
  • It is necessary to respond with real information but without giving more information than the child has the cognitive and emotional capacity to process. For example, if the child shows guilt feelings, it is important to make him/her understand that he/she is no responsible for what has happened.
  • Creating a space to talk and address the child’s concerns about loss, respecting and validating his/her emotions, will favour the development of a healthy grief.
  • It is necessary that the we take care of the child at all times, and that he/she is aware that he/she will not be left alone and that any emotional response is adequate in this situation.
  • During childhood we learn from our adults of reference what the emotional expression related to pain should be like. If the adult denies or hides his/her feelings, the child will tend to do the same. The loss process is a painful process and, therefore, emotions of sadness, pain and crying are expected. It should be noted, however, that all emotions and all forms of expression are individual and valid.

Remember theses key points

  • Who: the closest person (parents, when/if possible).
  • When: as soon as possible, but always in person.
  • Where: an intimate and safe space, where children can freely express what they feel.
  • How: in a clear and concise way, giving children time and space to ask questions.

Understanding the concept of death throughout development

Children do not fully understand the concepts of death and loss but this changes throughout development. Below we present the differential characteristics of this comprehension according to the child’s age:

From 0 to 2 years-old

At this age, cognitive development in children does not yet allow them to understand the concept of death, but they perceive the person's absence. There is, however, a lot of separation distress, especially if the person who died was a reference figure. The child will perceive the changes taking place as a result of the death of the relative in the routines and in the environment and, especially, he/she will perceive the state of mind of the caregivers. In this sense, the child may seem more irritable. Sometimes sleep and eating may be altered.

Recommendations:
  • Keep the same routines if/when possible.
  • Guarantee the child’s safety and care. Explain that he/she will not be left alone.
  • Use adapted language.
  • Make sure there are known reference figures in case the parents cannot be there.
  • Use stories, games, etc., to make it easier to understand what happened.

From 3 to 6 years-old

At this developmental stage (pre-operational phase), children show a limited understanding of death (especially the youngest). Although death may be present in their vocabulary, in their drawings and even in their games, they still do not understand that it is an irreversible phenomenon (they may think that who dies can return) and universal (they may think that it cannot happen to them or to their acquaintances).

On the other hand, they also do not understand the concept of causality, and may use magical thinking to explain the death of the loved one. In this case we must be alert, because children may tend to think that they have been responsible in some way for the death of the relative.

Recommendations:
  • Use a concrete and clear language when speaking about death with the child.
  • Do not overly repress feelings while explaining, it is normal to cry or be weak at this time.
  • Be by the child’s side, and do not require him/her to continue listening if he/she does not feel like doing it. Show the child that there will always be someone by his/her side. Our role is to accompany them, whatever their response is.
  • If necessary, it is advisable to use additional materials, such as stories or movies, so that the child can better understand the situation, but always adjusted to reality.
  • Perform the corresponding ritual once confinement is over. Five-year-old children can participate if they want, but it is important to anticipate the situation and explain what it will be like.
  • Since the face-to-face farewell has not been possible, children can perform symbolic acts: bring drawings, toys or whatever is relevant to them, on the day of the farewell. This can help them understand that there is no return (death is irreversible)
  • Reassure them and make them feel safe.

From 6 to 12 years-old

This is the stage of concrete thinking, so children already have more capacity to understand the concept of death and all that it entails: universality, irreversibility and causality.

At this age is they can show more fear, so we must to try to clarify as much as possible the real aspects of loss in order to prevent these fears and fantasies from growing. At this stage, they are also more curious so they may ask all kinds of questions, some of which may be uncomfortable, but we should always try to answer them, whenever we can.

Recommendations:
  • Clarify the real aspects of loss so fears are not potentiated.
  • Offer a space for emotional expression and for asking questions, and try to answer them clearly and sincerely.
  • Do not talk about the deceased person as if it was a taboo subject. Make it natural.
  • Involve the child in dismissal rituals adapted to the current situation (for example, writing a farewell letter, drawing a picture...), so they can express their emotions.
  • They often ask "where is the body is and what will happen to it." In these circumstances, more than ever, it is necessary to answer these questions with information adjusted to reality and that the child can understand.
  • The goal of mourning the loss of someone you love is not "to turn the page quickly so that my child does not suffer". Thus, it will be positive to talk about the deceased person, look at pictures, remember anecdotes, mutual moments of coexistence, etc. in order to be able to mourn in a healthy way.

Adolescence

In adolescence abstract thinking has already been developed, allowing children to understand death in a similar way adults do. However, teenagers may present a different emotional expression, for example, they may manifest very little suffering or tend to be more irritable. At their age, teenagers begin to worry about the impact that death will have on their lives.

Recommendations:
  • Explain the reality of the loss.
  • Actively involve teens in departure rituals, as long as they agree.
  • Legitimize their emotions and allow them to express them. Remember that all emotions are valid.
  • Listen to their opinions.
  • Offer an example of how we have developed a previous grief or how they themselves did it at another time (with a loved one, a pet...).
  • Always be available while respecting their private space.

To sum up… remember that

  • The current pandemic will generate sudden death situations in many families and informing children and adolescents about this will become a challenge.
  • All children and adolescents have the right to receive information that is adjusted to the real situation, taking into account the time of development they are living in.
  • There is no single and universal way of expressing discomfort. We all have our own ways and they are all valid.
  • Not talking about a painful event does not mean that it does not exist. By avoiding talking about something painful, not only do we not help children and adolescents understand what has happened, but we also limit their emotional expression and prevent them from activating personal resources that will be useful throughout their lives.
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Coping with grief in childhood and adolescence in the context of the SARS-CoV-2 pandemic