Finding New Ground—Fostering Post-Traumatic Growth in Children and Adolescents After Parental Death From COVID-19

With 4.7 million deaths worldwide and counting, the SARS-CoV-2 pandemic has secured its place as one of the deadliest public health crises in a century. To date, public health efforts have focused largely on reducing morbidity and mortality [1], but a new pandemic—a pandemic of grief—has emerged.

Most COVID-19 deaths have occurred in adults, and what limited resources we have allocated toward grief have mostly been directed to them [1]. This strategy overlooks the seismic impact that losing a close caregiver—in some cases one or both parents—to COVID-19 can have on children [1,2].

In April 2021, researchers estimated that nearly 40,000 children under the age of 18 years in the U.S. had lost a parent to COVID-19—a statistic made even more sobering by the fact that data show that this tragedy disproportionately impacts black children [2]. International data show similar trends toward ‘pandemic orphanhood’, with as many as 1.5 million children worldwide having lost a parent, grandparent, or adult caregiver due to COVID-19 [1].

The sheer size of these statistics and certainty that the number of bereaved children and adolescents will continue to grow as the pandemic rages on underscore the urgent need for clinicians, teachers, policy makers, and researchers to develop strategies to help pandemic orphans not only cope with the loss but also grow and find meaning from trauma.

The importance of meeting this goal cannot be overstated. With a few exceptions, losing a parent is one of the most life-altering experiences for children and adolescents [3], especially when the death is unexpected. Studies show that parental death can have profound short- and long-term consequences for children and adolescents [4], including traumatic grief, depression, poor educational outcomes, and unintentional death or suicide compared with their nonbereaved peers [5]. Even more troubling, without adequate counseling and support, these sequelae can persist into adulthood [6], putting children and adolescents at increased risk for future mental health crises, maladaptive coping, abuse, chronic diseases, and poverty [1].

New research on trauma points to possibilities for helping pandemic orphans, recognizing that the impact of trauma is not universally negative. In particular, research into a phenomenon known as post-traumatic growth, originally conceived by Tedeschi and Calhoun (1996) [7], suggests that while profoundly sad, the psychological struggle during and after a stressful life event such as losing a parent can act as a catalyst for positive changes such as increased appreciation for life, fuller understanding of one's own personal strength, enhanced spiritual development, and a deepening of intimate relationships [7].

With this mind, what can we do to encourage post-traumatic growth in children and adolescents who have lost a parent or caregiver to the pandemic?

Recommendations

Acknowledge pandemic orphanhood as a serious problem

First, as a society and a health care community, we must acknowledge that a growing number of children and adolescents will share the experience of pandemic orphanhood—which is likely to become a central part of their identities. Health care providers, teachers, and other pediatric service personnel will need training on how to assess for and respond to grief related to the pandemic, and research will be needed to identify the most effective strategies to help children and adolescents work through trauma, loss, and grief from the pandemic.

Normalize death and grief

Well-intentioned adults want to protect children and adolescents by avoiding conversations about death and grief [8]; however, research shows that in most cases, children and adolescents want information about death as they maneuver through the grieving process [9]. As health care professionals, we can lead the way by normalizing discussions around death and teaching children and adolescents to express their grief. Simple, honest conversations about the death and dying process provide assurance that the COVID-related death is not their fault and allow them permission to express feelings of sadness, anxiety, and grief.

Gain new coping skills for future adversity

Without question, the death of a parent or caregiver to COVID-19 will alter the lives of children and adolescents in profound ways. As health care professionals, it is essential we help them navigate the pain and grief associated with loss and adapt to many changes that will follow. How children and adolescents learn to manage trauma now will set precedence for how they will approach adversity in the future. Wherever possible, clinicians should use trauma-informed care strategies based on current evidence to help children grieving the death of a parent or close caregiver from COVID-19 [10]. Health systems should invest in tools and resources to help pandemic orphans. Long-term support is needed for both children and adolescents as well as their surviving parent and family members to help them develop skills to adapt to new challenges they will experience.

Find meaning, normalcy, and belonging during grief

Children are susceptible to identity changes and can struggle with how to make sense of loss. Fostering meaning, normalcy, and belonging during the grief process is crucial. The key strategies include resuming normal activities (e.g., after-school activities, sports, friendships), providing a constant presence by the surviving family members, and addressing separation anxiety by offering reassurance that they will be cared for. A sense of normalcy and belonging not only shapes children's ongoing beliefs and expectations after a loss but also contributes to rebuilding their sense of meaning and purpose in childhood and into adulthood.

Call to Action

Children possess a remarkable ability to translate parental death into personal growth and skills for adapting to trauma, but most will need the help of informed and caring adults to do so. Knowing that they are not alone in their hardships and given strategies to adapt to the unexpected loss, children and adolescents can grow and become resilient despite enduring one of life's most tragic experiences.

As the COVID-19 pandemic continues to ravage communities, now is the time to support children and adolescents who are navigating the loss of parents or close caregivers as they seek to find new ground.