Sometimes they blame themselves. How to help grieving children who have lost their parents to COVID

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Lucia, a 9-year-old girl, suffered the deaths of her father and grandmother over a three-month period from COVID-19. Because these losses occurred in the midst of the pandemic, Lucia was unable to say goodbye to her father or grandmother, who was her primary caregiver, and the family was unable to organize a real funerals. After the deaths, Lucia was inconsolable, yearning and yearning for both her father and grandmother, and experienced high levels of self-blame, fearing that she passed the virus on to her family members. Because the family was at this stage so cautious and maintained a social distance at all costs, Lucia was increasingly isolated. After learning about teletherapy services offered by a mental health center that I run, Lucia began working with a therapist who helped her identify and overcome her active suicidal thoughts, which led her to fantasize. about reuniting with his father and grandmother in paradise. The therapist helped Lucia find healthier ways to feel connected with her father and grandmother and to make sense of their death in a culturally sensitive and age-appropriate way.

Due to the staggering number of COVID-related deaths in this country, we are now facing a silent epidemic of mourning among children, or what I call here “the long psychological COVID.” At the request of her family, I used “Lucia” in place of the child’s name and changed other credentials to protect her privacy while giving a clear picture of how the psychological toll of the pandemic on the children of our country will be significant and long-lasting. Across the country, more than 167,000 children have died of at least one parent or guardian from COVID, including 25,630 young people in Texas alone. In fact, Texas is one of the top four states for caregiver loss rates. The majority of these losses were among black and Hispanic families, many of whom faced racial health disparities and higher death rates even before the pandemic, making them even more vulnerable to mental health issues. and behavioral. In fact, a new advisory from the U.S. Surgeon General describes the unprecedented impacts of the pandemic on youth mental health across America, as well as the mental health challenges our youth faced even before the pandemic. .

In the wake of the death of a loved one, most children are resilient and will naturally experience “good grief” – finding healthy ways to connect with the deceased and make sense of their death over time. However, many children who have died from COVID, especially those with a history of trauma or loss, are more likely to develop long-term psychological COVID, involving a host of psychological or behavioral issues related to grief. The sudden death of a loved one is the best predictor of poor academic performance, beyond any other form of trauma, including physical violence or sexual violence. These young people are also more likely to experience post-traumatic stress, depression, anxiety and risky behaviors. Although we do not yet have enough data to know how long psychological COVID can last, studies show that traumatic losses in childhood can lead to a wide range of problems in adulthood, including relationship difficulties, drug addiction, prolonged bereavement, depression and suicide risk. This speaks to the need to identify bereaved youth “at risk” as quickly as possible and to provide early intervention.

Susan Hillis, author of a National Institutes of Health report, told the Houston Chronicle, “With the love, affection and support of the remaining parent… there is a lot of hope, provided these kids get it right. the help they need when they need it. The problem is, many adults have difficulty knowing when and how to help a grieving child.

Children typically face three main challenges after the death of a loved one. First, they may really miss the person and aspire to get it back. Second, they may feel lost without the person or not know how they will go through life without the person. Third, they can be very concerned about how the person died.

Fortunately, there are a number of things adults can do to overcome these challenges. They can help children find ways to feel connected to the deceased or engage in activities that the person enjoyed. They can talk openly about the person with the children, for example by saying their name or sharing happy memories. They can help identify positive traits or characteristics that children have in common with the person and discuss how to continue the legacy of the person by focusing on those traits and behaviors. Children’s concerns about the circumstances of death often arise from unanswered questions. did they suffer? Were they afraid? Adults can help by allowing children to ask any questions they may have and by providing simple, straightforward answers.

We have seen firsthand how these types of interventions can help in our center. A 12-year-old girl who lived through her father’s death to COVID was consumed with grief and despair over her future, believing she could never get through life without her father and her support. Over time, and with her mother’s encouragement, she began to think that he would want her to live fully and began to do things that she knew would make him proud, declaring, “He wouldn’t. not that I’m sad at all. the weather. He would like me to enjoy my life and accomplish the things he never did, like getting a college degree.

14-year-old boy who lived through his mother’s death from COVID was very concerned that his mother died on her own in hospital, and he never got a chance to say goodbye to her . With the support of his therapist, he was able to write a letter to his mother, telling her everything he had wanted to say, as well as a heartwarming letter that he imagined his mother would write in response. He also began to find ways to feel more connected to his mother, including cooking his favorite meal, keeping one of his jewelry in his pocket, and, with his father’s help, identifying all the positive traits he had in him. ‘he has in common with his mother. .

While most bereaved children will only benefit from adult support, certain “red flags” may indicate the need for further assessment and possible therapy. These include significant behavioral changes that lead to impaired daily functioning – in young children this can take the form of eating or sleeping disorders or separation anxiety, such as refusal to leave the side. of the person who takes care of them. For older children or adolescents, this can involve constant crying, extreme social withdrawal, or excessive risky behaviors such as drug use and reckless driving. Other warning signs to look for include signs of post-traumatic stress disorder such as nightmares, not wanting to talk about the person, hypervigilance, or a numb appearance. Finally, any expression of a wish to die would require the immediate attention of a qualified clinician.

Lucia, who successfully completed her treatment, is now a strong advocate in her school of masking and vaccinations. She works to protect her peers from the COVID-related losses she has suffered, in order to turn the circumstances of the tragic deaths of her family members into something that can prevent others from suffering in the same way.

While discussions of the long COVID have focused almost exclusively on the impact of the virus on physical health, it is time for us to pay attention to the equally damaging psychological COVID that bereaved children are likely to experience. Collectively, we have the capacity and social responsibility to identify and support the grieving children of our country and, in doing so, ensure the long-term well-being of our most vulnerable young people.

Kaplow, PhD, ABPP, is Executive Director of Trauma and Bereavement Centers at the Hackett Center for Mental Health, Houston (www.tagcenter.org) and Children’s Hospital of New Orleans; professor of psychiatry in the Faculty of Medicine, Tulane University; and CEO of the Lucine Center for Trauma and Grief in Houston (lucinecenter.com).

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