How do I convey to my three-year-old grandson that his mother is not coming back? This was the first unread message, which I read after waking up in the morning about a week ago. The message was from a former patient of mine, with whom I had little contact for the past few years, apart from the customary messages around festivals and new year. The mother, 34, died due to Covid. The child’s father had mild symptoms and was at home, extremely distraught. He believes that he had Covid and passed on the infection to his wife, ultimately resulting in her death. He was wrecked with guilt.
Conveying news of death to anyone is, perhaps, one of the most emotionally demanding tasks. When conveying it to children, it is even more complex. In the current situation, where so many members of the family are sick or have died, it is harrowing.
In some medical training programmes “breaking bad news” is part of one’s training. However, for most doctors in India, we learn through our experience at the coalface. I do not think any training whatsoever exists, at least in our country, regarding how to “break bad news” to children.
As with most things in life, context matters the most in such situations. What matters is the age of the child, the family situation in which he or she lives, current social support — or the lack of it — for the child, language skills of the child and whether the child has any disability. The nature of the relationship is another key dimension. Each child is different, his or her relationship with the person who has died is different too. It is crucial to understand the nuances of differences in each child’s environment before we can begin to convey the news of death to a child.
My dear friend and my go-to person in many tricky clinical situations, Dr Soumitra Dutta, consultant psychiatrist at Tata Medical Centre, Rajarhat, Calcutta, is an expert in this domain. He works in a cancer hospital, where preparing the staff and relatives for the eventuality of death and loss is an integral part of his routine work. Soumitra makes an important point. Bad news is bad news. Therefore, we often try to use euphemisms to make the news more palatable. However, it is not advisable to do so. Younger children can be concrete in their thinking. To reduce confusion, avoiding expressions such as “passed on” or “went to sleep” is important. The news has to be conveyed honestly and most importantly, sensitively, without rushing through the process. For most of us, telling a child that your parent or a loved one has died is an extremely difficult task. Because of the inherently difficult nature of the task, we may inadvertently rush through the process, as it is a natural human reaction. Therefore, adults conveying the news have to be emotionally ready themselves before they communicate with the child.
For clinicians, often our task is to prepare carers to convey the news to children. Families seek guidance from us regarding the process of conveying the news of death. It is always ideal that the news is given to the child by someone who is close to the child. In some rare situations, the news may be given to the children by doctors BUT it has to be in presence of family members.
There is finality in death. We cease to exist in our physical form and our spiritual and religious beliefs guide us (adults) how we view death and afterlife.
For children, however, the concept of death may not be clear. The understanding that death is final and there is no coming back of the person, develops usually between the ages of five and seven. This is an important point to remember if we ever have to talk to a child about death. Therefore, for the young child whose grandmother contacted me, explanation that his mother has died and he will never be able to see her in the physical form he was used to, has to be conveyed in age-appropriate language.
Children look to adults regarding how to respond in most situations. Hence, our response around the child is important. We need not mask our feelings, but it is important not to further traumatise the child through extreme expressions of grief. Many children become clingier, have disrupted sleep, ask the same questions repeatedly or display difficult behaviour. This can happen because a significant person in the child’s life has suddenly gone away and the emotional reactions of children to the person’s continued absence indicates emotional distress rather than bad behaviour. Some children may not express any reaction in the immediate aftermath of bereavement. That too is normal.
Let them talk about their fears
For children who are older, the basic principles of conveying the news remain the same. Gentle, sensitive, age-appropriate language has to be used. It is important to convey that the person has gone away permanently. They may ask questions about why that has happened and honest answers, without too many grim details, is perhaps best. Not overloading them with information is important, with a clear message that they can come back with questions at any stage in the future. Enabling them to talk about grief is one of the most powerful lessons we can impart to children.
Death can make children fearful about the future. Give them a chance to talk about their fears and validate their feelings. Reassurances that all members of the family are together in the grieving process allows them to express their thoughts.
Older children may want to avoid participating in family rituals, often to the extent the adults in the family may expect them to. They may want to spend more time with friends or on social media. Giving them agency regarding how much involvement they want and allowing them options is preferable. Participation in rituals helps to express grief. I have seen some families allowing older children in planning the ritual, which in times of the pandemic is necessarily restricted. Many families have used the skills of older children in families to create collages, videos and narratives celebrating the life of the departed person. This is an extremely helpful and creative way of dealing with death.
Expression of grief is not uniform for all of us and it is not a linear process across time. Expressions of grief may remain dormant or suppressed and may come to the surface later. Many older children may suppress expressing grief because they feel it might overwhelm other members of the family, who, too, are struggling. It is often important to convey to them that they too can express their distress without any fear.
What children need is a safety ring around them. Their grief needs to be absorbed and ‘contained’ by the adults around them. It is a hard task and acknowledging to the child that adults too will break down, cry and may temporarily be emotionally unavailable, helps them grasp the situation better.
Experiencing death early in life can change the way a person feels and thinks about life. It can have great impact on the overall personality development of the child. Unfortunately, nature has forced upon us a challenge in which we are having to grasp this grim reality which breaks us from inside. There can be no easy way to do it and words are never enough. We need not fill our sadness with words. Tears and hugs can act as balms for losses which can only heal over time.
Dr Jai Ranjan Ram is a senior consultant psychiatrist and co-founder of Mental Health Foundation (www.mhfkolkata.com). Find him on Facebook @Jai R Ram
