Siblings and Cancer

Approved by the Cancer.Net Editorial Board, 12/2015

A child with cancer changes family dynamics. These changes are often extra difficult for the healthy siblings. Some parents spend most of their time caring for their sick child. They find that they don't have much energy left to spend with their other children. Many parents find it difficult to think about the experience from the viewpoint of the healthy siblings. Yet parents can take some steps to maintain regular family routines. This will help to take care of each family member’s needs.

Common emotions experienced by siblings

Brothers and sisters of a child with cancer experience a lot of emotions. Many of these feelings are similar to those felt by parents and other adults. Your child’s age and coping skills will affect their reactions and may include these common and normal feelings.

  • Fear and anxiety. Younger children may fear they caused the cancer or that they might catch it, like the flu. Others may worry about what will happen to the family because of the illness. They may fear that their sick brother or sister may die. It is important to allow children to express their fears and to make it safe for them to do so.

  • Anger. A brother or sister is often angry with their parents for no longer having time for them. The sibling may also be mad at the child with cancer about this. Parents can help by allowing the sibling to express this anger in a safe way (see below for suggestions).

  • Jealousy and resentment. Along with anger, a sibling may be jealous of the attention focused on the child with cancer. He or she may also resent that the sibling with cancer doesn't have to do chores or go to school.

  • Feeling alone. A brother or sister may feel left out of the family activities. This feeling may be even stronger if most of the activities are hospital and doctors’ visits. Or, he or she may feel that they have just lost the support and friendship once provided by the child with cancer. A sibling may also miss time with friends, if parents are no longer able to take him or her to regular social outings.

  • Guilt. Often, the healthy sibling feels guilty for not being the sick child. A brother or sister may feel guilt for having bad thoughts or saying mean things to the sibling with cancer. Also, children often feel guilty for feeling jealous or resentful.

  • Sadness and grief. Siblings may feel sad for their ill brother or sister and for their parents. They may feel sad that everything seems to have changed. Also, they may grieve the loss of normal family life and a carefree childhood.

Common behaviors in siblings

Children often do not understand their emotions. They may not have words to describe how they feel. Because children often don't talk about how they are feeling, they frequently express their feelings and needs through actions. The following actions are common and normal among siblings of children with cancer:

  • Misbehaving or acting out in negative, attention-seeking ways at home or school

  • Increased anxiety, such as not wanting to leave mom or dad, or to go to school

  • Withdrawing from the family or wanting to be alone

  • Acting younger, such as a preschooler wanting to go back to diapers or an older child using baby language

  • Demanding or entitled behaviors, such as wanting new toys during every trip to the store or demanding special foods

  • Increased physical symptoms, such as headaches, tummy aches, or bedwetting

  • Having trouble sleeping and/or bad dreams

  • Being moody and irritable, including temper tantrums, fighting with parents or siblings, or crying a lot

  • Performing worse in school or having a hard time focusing on homework

  • Doing "extra good" deeds to try to take care of the rest of the family

Helping siblings cope

It is impossible for parents to remove all the emotions and fears felt by siblings. However, parents can help meet the needs of healthy siblings and help them cope with the sibling's cancer. Here are some steps that can help.

  • Get help. Coping with cancer as a family is difficult so don’t feel like you have to do it alone. Neighbors, friends, and family members often want to help but aren’t sure what to do. Give them specific tasks, such as taking siblings to sports practice. Asking someone to help you with your chores will give you more time to spend with your other children. Coordinate these tasks among family and friends by using the tools offered by online communities.

  • Talk with your other children about cancer. Give them age-specific, accurate, and honest information without being overly frightening. Also, explain to them that cancer will not spread to other people, like colds do. Provide frequent updates and encourage them to ask questions. You can say that cancer is a serious illness. Also, the doctors are doing all they can to help your brother or sister get better. Correct details help children feel less anxious and prepare them to answer questions from teachers and friends. Read more about talking with your child and talking with your teen about cancer.

  • Reassure your children. Let them know that they are equally loved. And, that if they were sick, you would be just as focused on helping them get better. You can also let them know how happy you are that they are healthy.

  • Talk with your children about their feelings and worries. Encourage your children to share their feelings with you and reassure them that these feelings are normal and okay. Do not scold the siblings for having negative feelings. Acknowledge that the child with cancer is "lucky" to get special attention and nice gifts. Yet he or she is "unlucky" to need medical care and to feel ill. Let them know they can talk to you at any time. You will love them no matter what they tell you. Help them find other ways to express themselves, such as writing in a journal, doing art, or playing.

  • Share your own feelings and fears. Tell the siblings that you often feel sad, scared, and even angry. Explain what you do to help yourself cope with those difficult feelings.

  • Spend time with the healthy siblings. If possible, at least one parent should spend time with the other children every day. If you can't be there physically, talk with them on the phone or make a video call. Ask them about their day and tell them how much you miss them when you can't be there.

  • Involve the siblings with making decisions. When possible, let your other children make choices about things that affect them, such as which friend’s house they would like to go to.

  • Let your other children help. This helps them feel more involved and less alone. Let the siblings choose toys to take to the hospital. Or, allow them to read a book or play cards with their sick brother or sister. Although it is okay to ask siblings to help, don't load them with extra chores. Also, let them know how much you value their help.

  • Help your children keep in touch. Encourage siblings to keep in touch with cards, text messages, or e-mails when your child with cancer is in the hospital. If possible, have the healthy siblings visit the hospital frequently. This can help ease anxiety about what goes on at the hospital.

  • Encourage the siblings to do things they enjoy. This includes continuing after-school events and spending time with friends. Let them know that it’s okay for them to want to have fun.

  • Keep things consistent. Try to keep consistent schedules, so your children will feel safe in their daily routines. For instance, let them know who will pick them up from school or where they will be eating dinner each night. As much as possible, keep discipline fair and consistent at home. This helps both healthy siblings and the sibling with cancer.

  • Model good behavior. Sometimes, when stressed or frustrated, parents may say things that add to a sibling’s guilt. If this happens, take time to apologize. Explain that it is a stressful time for the family and you regret what you said.

  • Seek outside help. Your children may be struggling with their feelings despite your efforts. If so, you might consider seeking help from a mental health expert, such as a social worker or child psychologist. Many hospitals have sibling support groups or can recommend counseling for siblings and families of children with cancer.

  • Take care of yourself. Make sure that you are taking care of your own physical and emotional needs. You can best help all of your children by taking good care of yourself.

Upsides for siblings

Many children respond to a sibling with cancer with enormous love, care, and support. Parents often observe positive changes in siblings of children with cancer. You may see an increased amount of empathy and compassion, enhanced self-esteem, closer relationships with siblings and parents, and greater insight into the things that really matter. When the entire family comes together during a crisis, everyone may feel closer to each other.

More Information

How a Child Understands Cancer

Family Life

Camps and Retreats for Families and Children Touched by Cancer

Additional resource for parents

CancerCare: Helping Children When a Family Member Has Cancer

Additional resource for siblings

CancerCare: CancerCare for Kids