April 20, 2026
THIMPHU – The steady outflow of Bhutanese parents seeking opportunities abroad, particularly in Australia, has opened new economic pathways for families. But for the children left behind, it is also creating a quieter, more complex crisis, marked by deep-seated feelings of abandonment, anxiety, and a fractured sense of identity.
Across the country, a growing number of children are being raised by grandparents or extended family members, giving rise to what experts describe as a “transnational childhood”. While remittances support household incomes, the psychological cost of prolonged parental absence is becoming increasingly evident.
Doctors at psychiatry department of the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) report a rise in attachment issues, emotional insecurity, behavioural problems and academic difficulties among children separated from their parents.
“Clinicians have observed a steady increase in child and adolescent mental health consultations over the past five to eight years,” a doctor said, noting that a proportion of cases are directly or indirectly linked to parental migration.
Medical observations point to a shift from short-term adjustment difficulties to more chronic conditions, including anxiety and depression.
School-based referrals for behavioural and emotional concerns are also rising, alongside a growing recognition of subclinical distress – conditions that may not meet diagnostic thresholds but nonetheless affect daily functioning.
“These observations are consistent with regional data suggesting that left-behind children are at elevated risk of psychological morbidity compared to their peers living with parents,” said a doctor.
Without systemic support and targeted interventions, the prevalence of psychological distress and psychiatric disorders is likely to increase in the coming years. Many children experience a sense of abandonment, confusion, or divided loyalty, particularly when communication with their parents is inconsistent.
Over the past decade, Bhutan has seen a sharp rise in outward migration, with more than 65,000 Bhutanese, roughly around 9 percent of the population, now living or working overseas. As a result, many children are growing up in households where grandparents have resumed caregiving roles, often without adequate support.
Experts warn that even if families eventually reunite abroad, years of separation can leave lasting emotional effects, which can lead to strained relationships and a greater focus on financial security over family bonds.
The absence of a mother, often an important emotional support, can also contribute to anxiety, low self-esteem, and depression.
The traditional family structure is under strain, and the long-term consequences are likely to include an increased burden of mental health difficulties across generations, as such arrangements may not fully replace parental care during key developmental stages according to medical doctors.
Concerns and incidences
Adolescents and young adults show the highest levels of depression and psychological distress, including anxiety, low self-esteem, aggression, and risk-taking behaviour.
Mental health issues in children often present differently from adults, with irritability, social withdrawal, school refusal, and declining academic performance.
“Many experience an ‘empty nest’ phenomenon compounded by role strain, as they navigate the dual burden of emotional separation from their adult children while simultaneously shouldering the responsibilities of raising young grandchildren,” said a doctor.
This can result in considerable emotional distress, chronic fatigue, and a diminished capacity to provide quality care, while also leaving caregivers vulnerable and without adequate support when they themselves fall ill or require assistance.
Children with parental absence commonly exhibit insecure attachment, emotional instability, and reduced academic functioning, which may progress to school drop-out, substance use, or conflict with the law, according to medical doctors.
Adolescents aged 12–17 years are particularly vulnerable due to identity formation, while early childhood aged 0–5 years is critical for attachment development.
Common clinical presentations include internalising symptoms such as depression, anxiety, and separation anxiety, along with behavioural problems such as oppositional behaviour, academic disengagement, and increased screen use.
Attachment difficulties and psychosomatic complaints such as headaches, abdominal pain, and sleep disturbances are also common. Risk behaviours such as substance use and self-harm are also reported.
Implications and interventions
The psychiatry department of JDWNRH provides care across the lifespan, from toddlers to the elderly, with greater concern in children with special needs.
Primary caregivers are often expected to act as co-therapists, requiring training, consistency, and active involvement in care, as parenting requires continuity and emotional availability that is difficult to maintain when responsibility is delegated.
Doctors said grandparents who assume caregiving roles face emotional strain, role overload, and limited support, affecting caregiving capacity.
Bhutan-specific data remain limited, but international evidence shows children with absent parents face 1.5–2 times higher psychological distress, with local trends indicating rising counselling cases and adolescent risk behaviours.
Parental absence is associated with behavioural difficulties, educational decline, and long-term risks such as insecure attachment and mental health disorders.
Cultural norms may also contribute to hidden distress, with many children appearing functional while experiencing significant emotional difficulties, highlighting gaps in early detection and systematic screening.
A multisectoral response is needed, experts said, with parents maintaining consistent emotional communication beyond financial support, and caregivers providing stable, nurturing environments with balanced discipline and emotional care.
“Schools must strengthen counselling services, integrate social-emotional learning, and support early identification of at-risk children, while the health system should expand child and adolescent mental health services and develop early intervention frameworks,” said an expert.
Policy and community efforts should promote awareness and establish support systems for left-behind children. Key priorities include national epidemiological research, stronger school-based mental health systems, and family-centred policies to safeguard children’s mental health and development.
Many children may stop seeing their biological parents as primary authority figures and sometimes prefer to call them by their names instead of “mom” or “dad”. In school, left-behind children may appear fine but still struggle with low motivation, feelings of isolation, and the pressure of handling household responsibilities alone.
Teachers shared that students whose parents are working abroad often display signs of social withdrawal, rarely mingling with peers and frequently expressing that they miss their parents. Some students are also reluctant to engage during phone calls with their parents, indicating possible emotional distress and a sense of disconnection.
Teachers said that certain students show little enjoyment during meals and tend to avoid friendships and group activities, preferring to remain alone.
A teacher said that children with one parent abroad generally face fewer challenges, while more significant concerns are seen among those whose both parents are working overseas.
“The issues are particularly pronounced among children left in the care of uneducated grandparents or distant relatives, especially where caregiving support and supervision is limited,” said a teacher.
Teachers also said that some grandparents and relatives care for the children as their own and take pride in doing so, often forming strong emotional bonds with them.
A grandparent said that while there is a difference between being cared for by parents and others, children raised from a young age in the same caregiving environment tend to develop strong attachments, with no major issues observed.
Having already raised their own children, they are now raising their grandchildren, noting that circumstances have once again placed them in this role.
“As they have gone abroad for the future of their children, there is no option but to look after them,” said a caregiver. “I have witnessed that some children do not respond during video calls.”
A parent who recently left the country for work abroad, leaving behind his two children in Bhutan, said he maintains daily contact with them in an effort to support their emotional well-being.
He said that their repeated questions about his return underscore the deep emotional strain caused by the separation and their constant need for reassurance.
“Although the separation is emotionally difficult for both my children and me, working abroad is seen as a necessary economic choice, with the hope that it is only temporary and I will soon return to reunite with my family.”
As Bhutan navigates the economic opportunities of global migration, the challenge is increasingly clear: how to ensure that the promise of a better future does not come at the cost of children’s present well-being. For many families, the trade-off remains unresolved – caught between financial necessity and emotional loss.