Tragically, the pandemic has taken a close caregiver among tens of thousands of children. How can we, as pediatric health care providers, provide care and comfort?
From April 1, 2020 through June 30, 2021, more than 140,000 children in the United States experienced the death of a primary caregiver, according to findings recently published in Pediatrics. The modeling study calculated COVID-19-associated orphans (death of one or both parents) and deaths of custodial and co-residing grandparents using mortality, fertility and census data. Investigators reported that for every 4 COVID-19 deaths, 1 child lost a parent or caregiver.1 As a pediatrician, I found this statistic, which highlights a crisis for children in the pandemic, profound.
Unsurprisingly, the study also reveals disparities in COVID-19-associated deaths among caregivers. Native American and Alaska Native children were 4.5 times more likely, black children were 2.4 times more likely, and Hispanic children were 1.8 times more likely to lose a caregiver parent or grandparent than their non-Hispanic white counterparts. These data reflect the disparate COVID-19 infection rates and outcomes in communities of color and underscore long-standing inequalities, such as discrimination, barriers to health care, education gaps, and poverty. economic instability.1
The loss of a parent or primary caregiver who provides love, security and stability is a devastating event and has a long-term impact on a child’s health and well-being. Parental loss is identified as a childhood trauma or negative childhood experience that, unbuffered, can lead to toxic stress, affecting brain and body development and increasing the risk of various physical, mental, behavioral and related problems. substance use in childhood and beyond.1
Perhaps the most impactful element of the study is the call for “child care,” a comprehensive response to improving outcomes for children who have been orphaned. The 3-pronged approach aims to:
- prevent deaths of caregivers associated with COVID-19 through effective and equitable policies and practices that improve access and uptake of COVID-19 vaccines;
- prepare families, offering support and services to help the child who loses a parent or primary caregiver;
- protect children through programs that build family resilience, improve parenting skills and improve family relationships.1
Pediatric health care providers are uniquely positioned to support children grieving the loss of caregivers to COVID-19. By incorporating strategies from the study and learning from grief experts, such as the Pediatric Advanced Care Team (PACT) at Children’s Hospital of Philadelphia in Pennsylvania, we can empower families to come to terms with a loss. trauma by guiding them through the grieving process.
PACT highlights 3 key areas along with tips to help families through death and bereavement2:
IMPROVE COMMUNICATION: Use age-appropriate language and avoid euphemisms (eg, say “Mom is dead” instead of “We lost Mom”). Allow the child to ask questions, provide helpful books (www.commonsensemedia.org/lists/books-about-grief), prepare the child for what will happen next (eg funeral) and how it could feel in the coming weeks/months.
RECOGNIZE THAT GRIEF DIFFERS AND VARIES IN DIFFERENT CHILDREN: Be prepared for regression (eg, bedwetting), as well as sleep problems, roller coaster emotions, and behavioral changes (eg, anger, withdrawal).
DEVELOP POSITIVE COPING SKILLS: Encourage honoring (eg, a balloon release) and remembering of the loved one (eg, sharing stories, creating a memory box/scrapbook/video, keeping traditions). Bereavement counseling can help both the child and their current caregiver, who should also take care of themselves and understand the stages of grief.2
Pediatric health care providers will encounter orphaned children during the pandemic. Developing clinical action steps to deal with this pandemic-related trauma and ensuing grief is important and should incorporate the following steps:
- Screen for caregiver loss related to COVID-19: “Has this child lost a parent or other caregiver to COVID-19? »
- Assess grief symptoms and address any maladaptive responses.
- Promote healing and building resilience by encouraging safe, stable, nurturing relationships and environments and positive childhood experiences.
- Provide referrals and resources, such as support from social services, United Way 211, bereavement programs, trauma-informed mentorship programs, parenting classes and quality child care, and literature on mourning.
- Advocate for federal, state, and local support for children who have lost a parent or other caregiver to COVID-19, such as coordinating efforts to identify orphans; create a fund for children bereaved by COVID-19; and expanding access to community-based, bereavement-focused and trauma-informed mental health services.3
- Amplify organizational efforts and trusted voices to reduce health disparities and promote pandemic-related health equity, such as The Conversation Between Us, About Us, a campaign co-developed by the Kaiser Family Foundation and the Black Coalition Against COVID.4
- Continue to promote COVID-19 prevention by encouraging families to practice safety measures, including vaccination, mask-wearing, hand hygiene and testing, as well as advocating for protective layers at the community scale to reduce the spread of the virus and associated deaths.
Since Pediatrics released these study results, the number of children orphaned due to COVID-19 has risen to more than 200,000.5 Health care providers play a critical role in raising awareness, protecting families, and responding when children experience the loss of a parent or other caregiver to COVID-19.
1. Hillis SD, Blenkinsop A, Villaveces A, et al. Orphanage and caregiver deaths associated with COVID-19 in the United States. Pediatrics. Published online October 7, 2021. doi:10.1542/peds.2021-053760
2. How to help children grieve. Children’s Hospital of Philadelphia. December 7, 2021. Accessed December 10, 2021. https://www.chop.edu/news/health-tip/how-help-children-grieve
3. Treglia D, Cutuli JJ, Arasteh K et al. Hidden pain: children who have lost a parent or guardian to COVID-19 and what the nation can do to help them. COVID Collaborative. December 2021. Accessed January 27, 2022. https://www.covidcollaborative.us/assets/uploads/img/HIDDEN-PAIN-FINAL.pdf
4. The conversation: between us, about us. Accessed January 5, 2022. https://www.greaterthancovid.org/theconversation/toolkit/
5. Hill D, Parga-Belinkie J. Pediatrics on call. Pediatric Research Roundup, Orphanage Due to COVID-19 – Episode 96. Posted January 4, 2022. Accessed January 26, 2022. https://www.aap.org/en/pages/podcast/pediatric-research-roundup- orphanhood-due-to-covid-19/