Elizabeth Edwards' Death: Children Face Piercing Pain

Dec. 8, 2010 -- When Elizabeth Edwards died of breast cancer Tuesday, she left behind two young children -- Emma, 12, and Jack, 10 -- who must now carry on without their mother.

Learning her disease was terminal, Edwards said she didn't fear death but was "very sad" for her youngest children, whose mother might never guide them through maturity.

"I'd like to be seeing them off in life, not as a distant mother playing Legos on the floor," she said last June on "Larry King Live."

Child development experts say that how well the Edwards children cope depends to a large extent on the support they receive from surviving loved ones in the years ahead.

Their adjustment, however, may be complicated by their parents' recent separation and the scandal over their father's affair and the 3-year-old daughter he had with Rielle Hunter.

The death of a parent can be devastating for children -- a pain that reverberates into their adult lives.

Pop star Madonna, whose mother died of breast cancer when Madonna was 6, said her mother's death was "like having your heart ripped out of your chest. Like a limb missing. The ultimate abandonment."

Actresses Rosie O'Donnell and Jane Fonda, Prince William, Beau and Hunter Biden and scores of other high-profile adults have described the loneliness and anguish they felt at the early loss.

And "Chronicles of Narnia" author C.S. Lewis, whose mother died when he was 9, wrote, "With my mother's death all settled happiness, all that was tranquil and reliable, disappeared from my life. There was to be much fun, many pleasures, many stabs of Joy; but no more of the old security. It was sea and islands now; the great continent had sunk like Atlantis."

One out of every four adults diagnosed with cancer in the United States has children younger than 18, according to the National Cancer Institute, and an estimated 3 million children live with a surviving parent after the death of their mother or father.

"It's amazing how resilient children are when they are supported," said Dr. Paula Rauch, a pediatric psychiatrist and expert on families coping with terminal illness. "While children who lose a parent early in life have some increased risk of anxiety and symptoms of depression, the majority of children who are well-supported will cope well."

Stability in Home Important After Death of a Parent

Rauch is the founding director of the Marjorie E. Korff PACT, or Parents at a Challenging Time, program at Massachusetts General Hospital and author of, "Raising an Emotionally Healthy Child When a Parent is Sick."

"Things that support a child's resiliency are stability in the home environment, good communication at home, caring adults interested in what the child's experience is and respect for the child's [grieving] timeline," she said.

Ideally, children will have a primary caregiver with whom they have "a strong bond and good relationship," said Rauch.

In June, Elizabeth Edwards denied reports that she wanted her 28-year-old daughter, Cate, a lawyer who clerks for a federal judge, to raise her younger siblings.

"My dad and I are still close," Cate Edwards told People magazine last summer. "We're working on rebuilding a family."

"The children would go to John and then, if he died, to Cate," Edwards told ABCNews.com. "That is what we always said in our wills."

"Legally, unless there are other directives, it's the biological father, not the older children," said Rauch. "You can't leave custody in a will, but you can make your wishes known."

Edwards told ABC News in 2007 that the family didn't "prettify" her impending death in any way.

"This is the way it is," she said she told her children. "But we also said, at the same time, you know, everybody who's sitting at this table who's not going to die, raise your hand. And they realized that we're all going to die. But we are also extraordinarily honest with them because there will come a day when they're going to have to accept that cancer has, at some point, taken me."

Many children as young as Emma and Jack won't feel the "enormity" of the loss until they are older and "re-experience" the pain during pivotal moments in their lives -- as a teenager picking out a prom dress or learning to drive, said Rauch.

Stability in Home Important After Death of a Parent

As adults, common themes expressed by those who have lost parents are that the family was disrupted, that the family had to move or became poor, and how they found it distressing when well-meaning loved ones took away photos of the parent and didn't allow them to talk about their loss.

But having multiple caring adults around can help children find someone who can help them remember the parent.

"Grief is a process and not a one-time event," said Rauch. "Children grieve over a long period of time, and it comes in waves."

Symptoms of grief include excessive crying, tantrums and regression in behaviors, according to Dr. Ari Brown, a Texas pediatrician and author of "Expecting 411."

Her advice to the surviving parent is to tailor the approach to the age of the child, not to hide your own grief, don't say death is going to sleep and let the child grieve.

"It's okay to let your child see you cry," she said. "No one ever likes having a conversation about death, but the surviving parent needs to be candid about the circumstances of the illness or death and about their own feelings about it."

Common reactions to grieving in young children include anger at the surviving parent or family members who "let" the family member die; denial of death and the hope the parent will return; and concern that the child has caused the parent to die.

The relationship between the dying and surviving spouse can also affect a child's well-being, according to child development experts.

Elizabeth Edwards wrote about her decision to divorce her husband after his infidelity and betrayal in her 2009 book, "Resilience: Reflections on the Burdens and Gifts of Facing Life's Adversities" (at the time of her death, they were legally separated) but took care to emphasize on her book tour that her husband was "still family" and her children "would need to have a good relationship with their father" once she was gone.

Rauch said that although families such as the Edwardses can be "fractured," whether by scandal or separation, what is most important is the love and respect the dying and surviving spouse convey about each other to their children.

In Elizabeth Edwards' final days, John Edwards had moved back in with his family.

"What people on the outside think is not always what is going on in a family," Rauch said. "And when looking at happy families from a great distance, there are many secrets and complications."