Help with the Coping Process When a Child is Sick or Injured, the Entire Family Is Impacted

Imagine a parent’s worry seeing their child sick and hurting in the hospital.

Now imagine how siblings must feel, especially younger brothers and sisters who don’t have the coping mechanisms most adults have to help them through such emotional turmoil.

Children may experience a variety of feelings and emotions that are normal reactions to the hospitalization of a brother or sister. They may feel sad because they miss their sibling or even guilty because of the notion that they may have caused the illness, while they are healthy. Fear that their sibling will never return home, anger for their getting sick, and jealousy over the fact that their sick sibling is getting all the attention are also common reactions. Fantasies about what is really going on at the hospital, accompanied by feelings of confusion and being left out and the fear of catching what is ailing their sibling, are just a few of the additional concerns children may face.

These feelings and concerns may also be accompanied by a variety of behavioral changes that will normally go away after the hospitalized child returns home. Depending on the sibling’s age, behaviors to expect may include acting out, eating and sleeping changes, spending more time alone in their room, seeking more attention than usual, clinging to caregivers more, and exhibiting regressive behaviors such as thumbsucking and bedwetting.

Parents and caregivers, including grandparents, babysitters, foster parents, and others, need not feel alone when faced with helping a child cope with a sibling’s hospital stay. One of the ways Baystate Children’s Hospital provides support and assistance to pediatric patients and their families is through its Child Life program. Certified child-life specialists (CCLS) are well-aware that, when a child is injured or becomes ill and enters the hospital, it affects the entire family, including brothers and sisters. Child-life professionals have experience in dealing with children’s and teens’ concerns and reactions to a variety of health care experiences, and that includes providing emotional support for siblings.

The fear of ‘not knowing’ for children and their ‘fantasy’ as to what may be going on in the hospital is sometimes worse than the reality of the situation. One of the best things a parent or caregiver can do is to share information about the illness or injury using age-appropriate language. It is also beneficial to let the sibling know in simple, honest terms what steps are being taken to help their sibling recover.

Certified child-life specialists collaborate with each family to review options for education and support — unique to each sibling’s needs and respectful of the parent’s or caregiver’s choices for information sharing. If they are not comfortable sharing information with the siblings, the CCLS will partner with them in relaying the information or, on rare occasions, delivering the message for them.

Parents and caregivers are encouraged to invite their children to visit their hospitalized sibling, but not to force them if they are apprehensive about a visit. Certified child-life specialists can help prepare them for a visit by telling them what they will see and hear. They may also share a photo of the hospitalized child prior to entering the room. Siblings may be extremely nervous about visiting their brother or sister, so the CCLS may work out a signal with them for when they need to take a break from the visit. For others who are very afraid, it is suggested that they start by just standing at the doorway to the sibling’s room.

And, when children simply cannot visit because of distance or they are emotionally unable to see their sibling in a hospital bed, there are ways they can remain connected to their sibling. Parents and caregivers can encourage them to send a text message or e-mail their brother or sister in the hospital, or they may make a phone call or even Skype. They may choose to color a picture or banner to hang in the patient’s room or mail a handmade card, letter, or photograph of themselves. Simple, special gifts are provided to siblings of long-term patients as a message that “you are special too, and not forgotten.”

It is recommended that parents and caregivers inform teachers when a family member is in the hospital, so that they will understand that the child or teen’s behavior while at school may vary from his or her norm. They may be jumpy, edgy or more aggressive, while some siblings may outright refuse to go to school because they don’t want to be separated from a parent during this time of great family stress.

Assisting the sibling to become an expert about their hospitalized sibling will help them feel more in control, especially at school. Concerned teachers might ask about their sick brother or sister, or misinformed classmates might come up to them and ask about their ‘dying’ brother or sister.

Siblings need to know their fears and concerns are important, because it may seem to them that much of the parent’s attention is given to the ill child. They should encourage the sibling to talk about how they are feeling and to discuss their day or any special events that may have taken place. Reassuring siblings that they did not say or do anything that caused the illness or injury to their brother or sister helps address this normal sibling response.

Siblings may also be feeling that everything in their world is topsy-turvy and daily routines are out of order. Explaining the schedule for their day, so they know who will be caring for them and when the parent may call or be home, will help soothe their fears. This also supports the child’s need to have some control in an environment that feels out of control.

Although it may be difficult, finding time alone with siblings to listen to their questions and to provide honest and timely information about the hospitalized sibling’s illness and progress will help caregivers and their children better cope with the stressors that a hospital stay can bring upon a family. Planning special ‘healthy child’ dates, especially when the hospital stay is extended, is also suggested.

At the end of the day, as certified child life specialists, we know that we have done the best job possible for a family if we were able to open the door for a sibling — empowering them to ask a parent or one of us a question or educating them to ‘be the expert’ in fielding a classmate’s comment. For the CCLS, this collaboration is one of our richest experiences. It is superseded only by the knowledge that the feeling of empowerment gained by the sibling not only helps them through this experience, but may be relied upon for the rest of their life. v

Jacque Bell, B.S. CCLS, is child life manager at Baystate Children’s Hospital. Rachel Alley, B.S. CCLS, and Betsy Arseneau, M.A. CCLS, both at Baystate Children’s Hospital, contributed to this article.