Coping with the death of a loved one is a difficult process. When her husband died suddenly of liver cirrhosis, Mdm Mary Tan (not her real name) and her three children aged five to nine struggled to come to terms with it.

Soon, it became clear that her son, now 10, and the older of her two daughters, now 8, were unable to cope.

Three months after her husband’s death, Mdm Tan, an administrative assistant, noticed that her elder daughter was very withdrawn. “She used to be lively, but became unwilling to talk. She closed herself off and was always in a sad state,” she said.

Her son complained of recurrent stomach aches, chest pains and headaches, and was admitted to hospital four times that year. Doctors found nothing medically wrong with him and suspected that his complaints stemmed from psychological issues.

The two children were referred to mental health professionals at KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group. Since then, Mdm Tan has noticed improvements in their behaviour. Her daughter is now more willing to talk and her son’s complaints have stopped. He has also become more caring and attentive to his sisters – a marked change from previously, when he wanted to hog all the attention.

Mdm Tan hopes that her children will emerge from this time of grief more resilient, and better able to cope with future challenges in life. “This is a process and we don’t know when it will be over. We just have to keep going,” she said.

Children can face emotional and mental health issues

According to Ms Rebecca Lo, Educational Psychologist, Child and Adolescent Mental Wellness Service, Department of Psychological Medicine, KKH, emotional and mental health problems such as anxiety, depression, phobias, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD) and eating disorders are common issues faced by schoolgoing children nowadays. She said that if parents respond negatively to their child’s concerns and there is no timely specialised intervention, a child’s mental well-being can worsen.

Dr Lois Teo, Senior Psychologist, Psychology Service, KKH, said that stress need not be due to traumatic, dramatic or catastrophic events such as divorce, death, disability or natural disasters. It can be caused by the prolonged accumulation of minor everyday stressors such as conflicts between siblings, friends or parents, being teased or bullied, and academic pressure.

Ms Estelle Lim, Senior Medical Social Worker, Child and Adolescent Mental Wellness Service, Department of Psychological Medicine, KKH, said, “While children experience common psychosocial difficulties daily, support from resources like parents, school counsellors and teachers can help reduce the risk of a child developing a mental health issue.”

Building resilience in kids to enhance well-being

One way to enhance children’s well-being is to help them build resilience. “Resilience is the ability to bounce back, cope with crises and challenges, and have the strength to recover and turn the stresses of life into opportunities. Resilient children bend but don’t break,” said Dr Teo.

It is more than just coping. Resilient people are more prepared to seek new experiences and opportunities, and take reasonable risks to achieve their goals. She said: “Resilience is not a trait that people have or don’t have. It involves behaviours, thoughts and actions that can be learnt and developed in anyone.”

However, Dr Teo said that there is no magic formula for building resilience in children, as they develop at different rates and react differently to different situations. Supportive relationships in and outside the family can help, and parents can play a crucial role in this.

How to tell if a child is not coping

There are some signs which show that a child is not coping, said Dr Vicknesan Jeyan Marimuttu, Associate Consultant, Child and Adolescent Mental Wellness Service, Department of Psychological Medicine, KKH. These include becoming more irritable and grumpy, complaining of tummy aches, headaches and nausea when there is no underlying medical reason, withdrawing from family and friends, loss of appetite, and having difficulty sleeping.

If parents are worried and their child is unwilling to talk, they should share their concerns with their child in a loving and non-judgmental way. “Tell him what you have noticed and why you are worried, and encourage him to share what he is going through. An answer may not be immediately forthcoming if he senses that he may be judged or scolded. Young people often need space and time to share their worries,” said Dr Marimuttu.

Resilient children have...

  • Strong feelings of self-esteem and self-efficacy, which is a person’s belief in his ability to succeed in a particular situation
  • Developed systematic problem-solving skills, especially within the social context
  • The ability to identify and describe their feelings to an interested adult
  • Parents who clearly and consistently demonstrate warmth, care and support, and teach them positive skills and attitudes

Ref: R14