The relationship between a parent and child is unique and powerful, making the death of a child a devastating experience for a parent. Bereavement negatively impacts the psychological and physical health of parents, but historically, 75% of parents studied in pediatric palliative care research have been mothers. Because of this, the experience of fathers is not well understood.

Although fathers have been underrepresented in the palliative care literature, shifts have occurred in sociocultural views of roles and parental expectations. Fathers are increasingly involved in their children’s care. Even with these changes, our understanding of paternal grief is limited. To address this deficit, we conducted a systematic review to critically assess current knowledge around the grief and bereavement experience of fathers following the death of children.

The silence and isolation of a father’s grief

We found several unique features of how fathers grieve. Fathers tend to grieve in isolation, in contrast to more open communication by mothers. While mothers seek interaction with others to discuss their grief, fathers tend to be more closed about discussing their experiences. These differences at times cause increased frustration between partners. Ironically, fathers also saw their spouses as their primary source of support and an integral aspect of their recovery process.

Work as a coping mechanism

Fathers use goal-oriented tasks at work and at home to “keep busy” as a coping mechanism to manage grief. Despite cultural shifts in income households and parenting roles, mothers continue to perform the bulk of child-rearing responsibilities, including care of children during progressive illnesses.

Paternal reliance on continuing work, using work as distraction, and returning to work after the death of a child as a coping mechanism for grief are notable — and likely a manifestation of ongoing gender disparities. However, in follow-up interviews, some fathers reported loss of fulfillment and satisfaction in their work and actively sought alternative meaningful activities to sustain their children’s legacies. The biggest regret reported by fathers was a wish that they had spent more time with their deceased children.

The mystery of how fathers process grief

Another important finding in our review was the intensity of the grief between mothers and fathers. Grief intensity was higher in mothers immediately following the death of children, marked by intense grief reactions. Post-traumatic stress disorder and its symptoms diminished over time in mothers, yet persisted in fathers. We concluded that for some fathers, gendered coping mechanisms (such as isolation, stoicism, work ethic) are not sufficient for processing grief across time. Further research is needed to better understand this hypothesis.

Some fathers grieve more on the inside

Additionally, the definition of grief intensity remains poorly defined in the literature and variable between studies, with most features of grief intensity reported as outward expressions of grief. Given data to suggest that fathers self-isolate themselves and avoid visible features of grief, these metrics may underestimate the true grief intensity experienced by fathers, and new measures may be needed to capture the depth of paternal grief.

Many fathers continue to navigate loss through stoicism, self-isolation and hard work. But the literature suggests that, for some fathers, these coping mechanisms may be inadequate. Even if a father remains stoic and silent, it does not mean he is not suffering. By recognizing the unique nature of the grief experience of fathers and the cultural, societal and religious influences on their bereavement experiences, clinicians can better support fathers during their grief journeys.

Our work on this topic, Grief and Bereavement in Fathers After the Death of A Child: A Systematic Review, was published in March 2021 in Pediatrics.