Hesperian Health Guides

Helping children after a caregiver dies

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HealthWiki > Helping Children Live with HIV > Chapter 6: Helping children through death and grief > Helping children after a caregiver dies


In the first few days and weeks after a caregiver dies, children struggle to understand and make sense of what has happened. If children have been prepared, the death will be less of a shock. It can be a very busy time right after someone dies. Do not shut children out of family activities or send them away. Doing so makes it more difficult for them to deal with the death in the long run.

Community spiritual and religious beliefs and customs related to death and burial can help children when there is a death in the family. Talking about your spiritual beliefs may comfort a child. Rituals bring people together for comfort, and help everyone understand what death and loss mean. Even when certain parts of a funeral or ritual do not make sense to a child, he will usually find comfort in watching how people mourn together and remember the person who died.

While no child should be forced to attend rituals and ceremonies, participating in some way usually helps a child deal better with death. If possible, discuss with the child what his customary role would be, and ask if there is another way he would like to participate, such as putting flowers on the grave, or making a note or picture to bury with the person or put on an altar. This can also help a child understand the death more.

If attending the funeral is not possible for the child, it can be helpful to arrange another way for the child to say goodbye. Have a separate memorial at home with music, drawings, and short speeches, or light a candle together while you talk about the person. Or you might invite people close to the child to join him in looking at things in a memory box and adding things to it.

a man talking to child
Today is Auntie Anabel’s funeral. First we will walk together to the church. Her body is in a box called a coffin. She cannot feel or see or hear anything, or be afraid or sad. People will sing and remember things about her.
Will June or Sarah be there?
To prepare a child to see someone’s body, describe it before you go.

Protect children’s resources

Often when parents die leaving behind very young children, their land and belongings are taken by other relatives or distributed according to tradition or a local leader’s decision. Talking with the family, local authorities, or a court can help protect the children’s rights.

a man talking to child
As you know, their father wanted the land to remain with his children, to help them survive. Let us discuss the possibility of withdrawing your claim, for the good of the children.

Help children with grief

How children understand death and show grief changes with their age, and even children who are the same age show grief in different ways.

a man talking to a crying child
Don’t worry, little one, we will always love and care for you.

A child may act very upset, or may seem to feel nothing. She may ask a lot of questions, freely say how she feels, or she may say little. She may be shy, or play roughly, or have trouble sleeping or behaving well. She may even seem unwell, with headaches, belly aches, or other pains. While it is important to pay attention to these problems, what is more important is that you respond with extra attention and love, as much as you are able.

Grief and the changes that come with loss are very difficult for anyone, but especially children. Anger and misbehaving are common signs of grief. If you start by understanding that children act as they do because of grief, it will be easier to be patient and find ways to help them. With time and support, children will be able to grieve, grow and develop their skills and talents, learn self-confidence, and see that life goes on.

When a child is grieving:

  • Teach him how to bear grief by accepting and showing your own feelings. Seeing you do ordinary things, like cook a meal or go to work while missing someone, also helps children.
a crying woman talking to a child
I miss my friend who died so much, and it makes me sad. But I will be OK soon.
  • Encourage children to play. Help them make new friends if needed. Children mourn, communicate, and heal through play.
a woman talking to a child
Yes, you can play. I am here if you need me.
  • Tell stories from your family or culture about death, so children can learn that death is part of life.
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  • Accept the child’s feelings, and be ready for feelings you might not expect. Help the child let feelings out, through crying, moving, drawing, talking, or other ways. Older children may want to write a note to their parent to express how they feel. See Chapter 4 for more ways children can let out feelings.
a man talking to a child holding a stick
No Simon, I don’t think you’re bad — I think you’re just angry. Let’s go chop some wood.
  • Be patient with the child. Grief will pass, but it will take time. Reassure children about this. Allow children to be sad and do not force them to talk. Help them feel that you will be there when they are ready.
  • Because what children need often depends on how old they are, think of your child’s age when you consider how to provide support. The next several pages describe what children of different ages need when they are grieving.
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A child from birth to 2 years old

A child under 2 years old is deeply attached to his mother. He knows her face, voice, and smell, and is used to being held, fed, and loved by her. He feels safe when she is near. Losing a mother can be very hard on children this age, and they are too young to understand death. But babies can be strong and adaptable if a new, loving person cares for them.

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Signs of distress:

  • Distressed babies may cry more, be more difficult to comfort, or have more tantrums.
  • The babies may become aggressive, hitting or throwing things.
  • The babies may seem fearful, clinging more to caregivers, or withdrawing.
  • You may notice changes in eating and sleeping, and in passing urine and stools.
  • The babies may not make the progress you expect in learning to crawl, sit, talk, and walk.
a woman talking to a child
Lalla lalla lori...
Babies like hearing the sound of voices they know.

How to support the child:

  • Arrange to have one main caregiver, rather than several different ones, to help her feel secure.
  • Cuddle, rock, and walk babies when they are upset. You can also comfort a baby with blankets and soft toys they are used to. Some babies like to be wrapped firmly in a light blanket or cloth. Being held is most helpful.
  • Sing and talk to the baby, and repeat the baby’s sounds to him. Encourage older sisters and brothers to do the same.
  • Try to feed the baby, and put her to sleep, at the same times each day.

A child from 2 to 3 years old

A child this age does not understand that the person who died is gone and cannot come back. He may feel abandoned or rejected when a parent dies. Children this age are often difficult to calm. They feel everything strongly, but cannot understand why they feel the way they do. They often show grief and sadness in physical ways.

Children this age are best cared for by someone they were comfortable with and knew before the loss of their parents. Being with siblings and in a familiar place also helps.

Signs of distress:

  • Outbursts of anger, weeping, or tantrums. Difficulty being comforted, even pushing away people who try.
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  • Acting like a younger child, such as wetting clothing or the bed.
 a man thinking
Wet again!
a woman and child talking
Where is Mama? I want Mama!
I’m sorry Kiki. Your mama has died. I know you miss her!
  • Asking for the person or talking about the death again and again.
  • Becoming very quiet and less social, sleeping more, or not wanting to play.
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How to support the child:

  • Hug and hold the child a lot. Reassure children when they are afraid. Sometimes just knowing you will be there when they come home helps children who are grieving.
 a man talking to a child
Don’t worry, Joy, he is a friendly dog.
  • Be interested in what the child says and does. Talk and play with her.
 a woman talking to a child
What is the dolly drinking, Kisha?
  • Allow the child to express feelings. Be patient with his outbursts and when he needs more help with tasks. Help children learn to talk about their feelings by using words for different feelings yourself.
 a woman talking to a child
I see how angry you are that Papa’s gone. When you calm down I will help you eat.
  • Encourage children to help with simple tasks, and praise them when they do well.
 a woman talking to a child
Did you pat the soil down? Good!

Routines still help children this age. Try to wash or feed your child or have him nap at the same times each day.

A child from 3 to 6 years old

a man talking with a child
Is the lizard sleeping?
No, it is dead. It cannot move or breathe or eat anymore.
Use nature to help a child learn about life and death.

Children this age are able to communicate more, and want to talk with you about their thoughts and feelings. They also want to know more about what is happening in the family. Listen to them carefully to understand what they want to know, and answer simply and honestly, in ways they can understand. A little information may be all they want. They also still work out many feelings through actions and play.

Most children this age can understand how birth, life, and death are a pattern all around us and that all living things follow this pattern — plants, animals, and people.

Children this age have strong imaginations. They play games of sickness, doctor, and death, which can help them come to terms with difficulties.

They also believe in things that are not real, such as ghosts and monsters. These beliefs can make their fears very strong. Children this age also believe their thoughts and actions can make bad things happen.

Signs of distress:

a child pounding on a door
Mama! Where are you!!
  • Sadness and crying. Longing for the parent and asking where she is, or about the death. A child who asks over and over again about a parent’s death may be worried you will die too.
  • Running away from a new home to try to go back to the one they know.
  • Fears — of the dark, of sounds, or of being alone.
  • Acting younger than their age, for example, clinging to a caregiver or being less able to talk or understand simple directions.
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  • Bursts of anger at caregivers and playmates.


How to support the child:

  • It helps children this age to have a familiar person caring for them or at least present in their life. Ask children who they want to stay with.


  • Give the child lots of affection and encouragement, and comfort him when he is upset. Show interest in him and try to understand what he is feeling. Speak in words he can understand.
a woman speaking to a child
You miss your Mama’s cooking, don’t you? Let’s cook something together.
Stew?
  • Encourage him to play with other children and explore his world.
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  • Share positive stories and memories about the person who died. Look at pictures of the person together.
two children talking
Listen! Remember how Mama loved this song?
  • Be patient with his fears and questions, and be patient when he needs extra help. Reassure him the death was not his fault if he thinks it was. You may need to do this many times before he stops worrying.


  • Seek help from a community organization or support group if you are struggling to meet the basic needs of your family. Poverty and worries make it more difficult to support young children who are grieving.
a man and a child speaking
I was so mad at Papa I wished he was dead! Then he died.
Oh no, Peter! Your Papa died because he was very ill. You did not make that happen!
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A child from 6 to 8 years old

Children this age can talk and think about complicated subjects. They may want to know more about why people become ill or die, and what happens after death. They may also wonder about their own health, and what it means if they take medicines or are HIV-positive.

They feel grief deeply and will continue to need lots of affection and help. Like younger children, they may worry they caused the parent’s death and need reassurance they did not.

Feelings may change quickly — sadness may become mockery at themselves or at others. Children this age are more able to talk about their feelings. Even so, it often helps when they can use toys, drawings, or play to let out and deal with their feelings.

Signs of distress:

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  • A distressed child may be sad, and long for the person who died.
  • The child may be angry at caregivers or friends, play roughly with toys, show poor behavior at school, or be less willing to take medicine.
  • The child may be afraid that he or his new caregivers will also die, and be reluctant to start new relationships.
  • The child may not want to be alone, especially at night.

How to support the child:

a man talking with a child
These shoes make me think of Mommy
Why?
I remember when she bought them for Pedro. Now they fit me.
She would be happy to see you getting so big.
  • Explain family and community rituals, and support children’s participation as much as possible.
  • Remember the person who died. Talk with the child about the person and look at photos or at things in a memory box. Children this age may be able to imagine the person with them in spirit.
a woman talking with 2 children
I know you miss your mother, and you were upset. It’s okay to be upset, but it’s not okay to hit someone because you feel bad. Please apologize to Faith.
Tonight, we can talk about what you can do instead of hitting when you feel that way.
I am sorry, Faith.
  • Encourage children to play and be active when they are sad. Introduce them to new friends.
  • Decide with the children what to do with the parent’s belongings.
  • Be understanding if the child is clingy. Tell him where you will be when you part, and when you will be together again.
  • Be honest with the child. Never make empty promises, especially if they ask you for something.
  • If children are destructive or mean because of anger or frustration, try to support them in a loving way. Ask them to take responsibility for any harm they cause.

How school can help

a woman talking to children greeting a child at her door.
Come sit with us. Are you OK?
Look, Zena is back!

School can be a place of stability and routine for children who have lost a parent, and a way to forget sadness at home. When teachers and students acknowledge a grieving child’s learning and new skills, it builds her confidence, self-esteem and hope. Heavy workloads on teachers can make it difficult to provide this support however, and many teachers are not comfortable talking to children about death. Teachers may not know that a child’s difficult behavior could be a sign of grief.

In communities with a lot of HIV, training teachers to better understand and support grieving children can help many children in need. In addition, someone may be willing to organize a support group at a school, where children who have lost a parent can share experiences and support each other. Schoolmates can be important friends. But sometimes when children’s parents die, those children are teased or rejected by other children. Teachers, families, and students need to work together to make this unacceptable and show that all children are worthy of acceptance, compassion, respect, and friendship.

Storytelling

Storytelling can help children of almost all ages to understand, think, and talk about illness, death, and grief. Telling a story can be a way to explore a child’s troubles without using real names or real people. You can also use animals in place of people. See the story that follows.

Stories can help children with grief
a woman talking to a sick looking child.
I have a story to tell you, June. It’s about a sad little elephant called Sylvia.
Once there lived a baby elephant named Sylvia and her family.
Mmm.

After Anabel dies, Rebecca carries on as head of the family, with help from their grandmother. Rebecca feels they are doing OK, but June is taking her mother’s death hard. During all the months of illness, June thought her mother would get well. Now June is very upset and does not want to eat. And she has even less patience with Sarah. One day June’s grandmother decides to tell June a story, to help them talk together about how she feels.

Sylvia loved to bathe and play in the river with her friends. But most of all, she loved eating tree bark! It was her favorite!

“What is your favorite food, June?” asks June’s grandmother. “Mango,” June says softly. June’s grandmother goes on with the story:


Most of the time Sylvia was a very happy little elephant. But one day she saw her mother taking medicine. Then she saw that her mother went to see the medicine elephant more than any other elephant in their herd.

Then her mother got very ill, and soon she could no longer walk and eat with the rest of the herd.

A little later her mother died.

2 young elephants playing
Come play!

This made Sylvia very sad and also very angry. She stopped playing in the river and refused to eat, even tree bark!

Sylvia’s papa said, “Baby, you must eat!” But she refused.

Sylvia’s friends called, “Come play!” But she refused.

an adult elephant speaking to a baby elephant.
I know how it feels to be sad.

Finally Sylvia’s wise old grandmother elephant asked, “My dear, what is troubling you? I see that you are not eating your favorite foods and not playing with your friends. Come tell me about it.”

After walking a while with her grandmother, Sylvia finally said, “I miss my mother. I hate that she is gone! When I think about her I don’t want to eat anything, not even tree bark!”

Grandma elephant took Sylvia in her trunk. She rocked her back and forth and said that she knew how it felt to be sad.

She talked about how sad she was herself when Sylvia’s mother died. Grandmother elephant had loved her too. They both cried a little.

But Grandma elephant knew that the whole family must still eat and care for each other and continue to live. She asked Sylvia what she liked to remember most about her mother. “Everything!” said Sylvia. Grandma elephant remembered how Mama elephant played splashing games in the river with Sylvia, and this made them both smile.


After talking for awhile, Sylvia and her grandma began to feel better. They walked back to the herd. That night Papa elephant gave Sylvia tree bark for dinner. And she ate it all up!

Sylvia still feels sad and misses her mother, but she thinks about what Grandma said and that usually makes her feel a little better.

a woman talking with a child
A little bit. I don’t like tree bark. But my mama died too.
June, do you think you are like the baby elephant in the story?
That’s right, like the mama elephant. Do you sometimes feel so sad that you do not want to eat?


Even if you provide lots of love and support to a child, he may still struggle a lot after someone’s death. It is common for a child (or anyone) to keep feeling very sad and even angry for a long time. Holidays can be worse as can any time something reminds them of the person who died. Many months later, children may misbehave or feel the same strong sadness they felt right after the death. This is to be expected.

But if a child continues to have a lot of trouble more than a year after the death of a close family member, you may want to get more help. This could come from a clinic, a social worker, a community organization, an HIV support group, or a religious congregation. Get support from your community. You and the child do not need to struggle alone.

3 adults speaking in a group of men and women.
John was punished for fighting at school again.
It’s over a year since his sister died. He is still so sad and angry, I don’t know what to do.
Do you talk about her with him?
My sister’s son took a long time to deal with her death. We found him a support group for children.
Being with children going through the same problems helped him. They also did fun things together.


This page was updated:27 Nov 2019