Common sibling reactions to hospitalization

When a child goes to the hospital, brothers and sisters can feel afraid, worried or confused. They are being faced with a new situation. They may hear and see things that they do not understand, may have a change within their daily routines or may be separated from their parents, brother or sister.

Each child has his or her own concerns when a brother or sister is in the hospital. Here you'll find information to help you understand the reactions children may have and some ways to help them cope during this time.

Siblings may be feeling:

• Confusion - siblings may not understand what is happening and why. This is very common, especially when the hospitalization is sudden.
• Guilt - siblings may have been in an argument with their brother or sister and think that they caused the hospitalization. They may also feel guilty because they are not sick, but their sibling is.
• Fear - siblings may fear that they might "catch" what their brother or sister has, especially if they are unsure of the reason for the hospitalization. They may also be afraid their sibling may not get well and come home.
• Anger - siblings may be angry at their brother or sister for getting sick. They may be angry that their parents did not prevent their brother or sister from becoming ill.
• Jealousy - siblings can feel jealous of all the attention the patient is receiving. The patient may receive gifts and relatives may travel to visit them. Siblings who do not know what is happening at the hospital often think that their brother or sister is there having nothing but fun.
• Rejection - siblings may feel left out. If they are unsure about what is happening at the hospital, they feel that they are not included and not important. The sibling may also worry that the parent cares about the patient more because the parent may need to spend a great deal of time with the patient.

Siblings may express these feelings by:

• Changing their eating and sleeping habits
• Acting out
• Clinging to parents
• Becoming withdrawn from family and/or friends
• Regressing to habits of an earlier age (such as bed wetting, thumb sucking)
• Saying they feel sick
• Playing aggressively with toys

Suggestions for caregivers

Parents and caregivers set an example for their children with their behavior. It creates the tone for sibling interactions and influences sibling relationships. It's important for parents to realize brothers and sisters need as much attention and support as the child with an illness or disability. Sometimes they need extra support.

Siblings need age-appropriate, accurate information about the needs of their brother or sister, and parents and caregivers should be open and honest when providing it. At times, siblings may simply need someone to listen to their frustrations about having a brother or sister with an illness or disability. Parents and caregivers can listen and validate these feelings without judging.

Here are some suggestions for parents and caregivers based on individual situations siblings may experience.

Do the siblings feel their time from parents or caregivers is becoming increasingly limited?

• When possible, try to protect certain times to spend alone with siblings (a bedtime story or night out at the movies)
• Organize short-term care for the ill or disabled brother or sister for important sibling events such as sports days or school plays
• Occasionally put the needs of the siblings first and let them choose what they would like to do

Are the siblings feeling guilty about having a brother or sister with an illness or disability?

• Emphasize that no one is to blame for their brother or sister's illness or disability.
• Encourage siblings to view their brother or sister as a person with similarities and differences to themselves.
• Make an attempt to meet other families who have a child with similar health needs. By joining support groups or Sibshops, siblings will have the chance to meet and interact with other children who share the same experiences of having a brother or sister with special needs.

Do the siblings have trouble interacting with the child with the illness or disability?

• Encourage siblings to develop their own independent social lifestyle
• Respect the privacy of siblings and find creative ways for them to preserve it
• Let siblings settle their own differences as much as possible
• Praise all siblings and recognize each child's unique qualities and family contributions

Are the siblings experiencing feelings of anger about having a brother or sister with an illness or disability?

• Make it clear to siblings that it is all right to be angry at times, as strong feelings are part of any close relationship
• Share some of your own mixed feelings or concerns when it is appropriate
• Allow siblings to work through their stress and frustration by engaging in play and other activities

Do the siblings feel their family activities have been restricted or replaced by care giving responsibilities?

• Try to find normal family activities that everyone can enjoy.
• Involve all siblings in family events and decisions when appropriate.
• Limit the care giving responsibilities of siblings. Take advantage of respite care and other supportive services offered by friends and family members.

Are the siblings protective of their brother or sister with the illness or disability?

• Help the siblings to recognize that they can be important and powerful teachers but that their brother or sister needs to be encouraged to do as much for himself or herself as possible.
• Encourage the siblings to keep track of their brother or sister's abilities and progress.

Are the siblings being teased or bullied by their peers for having a brother or sister with an illness or disability?

• Validate the siblings' feelings of frustration and become familiar with signs of distress caused by trouble with peers
• Talk with the siblings' teacher to encourage knowledge and positive attitudes about others' disabilities
• Rehearse with siblings how to handle unpleasant remarks

Do the siblings worry about bringing their peers into the home?

• Let siblings know how they can explain their brother or sister's health needs to their peers
• Invite the siblings' friends into the home both when their brother or sister is home and away
• Make it clear to siblings that it is all right for them to engage in activities without their brother or sister

Do the siblings have concerns about the future?

• Involve siblings in discussions about plans of care for their brother or sister
• Encourage siblings to leave home and pursue higher education or careers when they are ready without making them feel guilty
• In case of a genetic illness, explore genetic information when siblings are old enough and if they are interested

How to keep siblings involved

Siblings can feel more involved with the care of their hospitalized brother or sister by participating in activities at home or when visiting the hospital.

Activities to do at home

• Talk on the phone, video chat, or play games together on the Internet.
• E-mail, text message, journal back and forth, or send mail to each other.
• Help pack favorite toys, books, stuffed animals, pajamas, DVDs, music or games to bring to the hospital.
• Make a picture or greeting card to decorate the hospital room. Or send an e-card.
• Record messages to each other. Singing, reading stories, telling jokes, or sharing school information on tape are some additional ideas to share.
• Choose photos from home to be hung in the patient’s hospital room. The patient may enjoy pictures of themselves in the past, of family, friends and pets to keep them involved in what’s going on at home and to share with hospital staff and friends.
• Create a CarePage. It is a free, private, personalized web page that helps you keep friends and family up to date.
• Make a sign with information about the brother or sister who is hospitalized. Information can include:
  • Favorite toys, books, songs, TV shows, movies or games
  • Dislikes such as specific foods or getting up in the morning
  • Nicknames
  • Special words, such as "binky" for pacifier, that the patient uses to identify certain items

Activities to do in the hospital

• Play games or work on art projects with the patient if he or she is feeling up to it.
• Read a book, tell a story or talk about their day.
• Go with the patient to the playroom on the unit. If the patient is unable to go to the playroom, the sibling can choose an activity to bring back and share at the bedside.
• Decorate the hospital room so it seems more comfortable and relaxed.

Things to keep in mind about siblings visiting the hospital

It's important that siblings be allowed to visit whenever possible. Prepare siblings for what they will see and hear when they arrive, using honest, age-appropriate words. Describe how their brother or sister looks or acts if it is different from normal. If the brother or sister is very ill, injured, and/or not feeling well, suggest siblings pack a bag of things to do quietly while they are at the hospital.