© 2005-2012 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.
- When one child has cancer, it can be challenging for parents to focus on the needs and concerns of the other siblings.
- It’s common for the brothers and sisters of a child with cancer to experience conflicting emotions. They may express these emotions through their behavior.
- Parents can help by keeping the normal routines as much as possible, spending time with the other siblings, talking with each child about their feelings, and letting the children know they are loved.
A child with cancer changes the family dynamics, and these changes are often especially difficult for the healthy siblings. Some parents find that they don't have much energy left to spend with their other children after looking after a sick child. Many parents find it difficult to think about the experience from the viewpoint of the healthy siblings. With a little effort, though, parents can help maintain a family life that feels more normal and takes into account everybody’s needs.
Common emotions experienced by siblings
Brothers and sisters of a child with cancer experience a variety of emotions—many similar to those experienced by parents and other adults. Your child’s age, maturity, and personality all affect their reactions and may include these common and normal emotional responses.
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 or 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. Sometimes a brother or sister is angry with their parents or with the sibling with cancer for not having time for them anymore. 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 or resent the fact that the sibling with cancer doesn't have to do chores or go to school.
Loneliness. A brother or sister may feel left out of the family activities, especially if they are centered around hospital stays and doctors visits. Or, they 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 when their parents can't take them to after-school activities or to a friend's house to play.
Guilt. Often, the healthy sibling experiences guilt for not being the sick child. In addition, a brother or sister may feel guilty for saying mean things to the sibling with cancer, having bad thoughts about their ill sibling, or for having emotions such as anger and jealousy.
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 observed in siblings
Children often lack the emotional maturity and experience to understand their emotions and 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 behavior. The following behaviors are common and normal among siblings of children with cancer:
- Misbehaving or acting out in negative, attention-seeking ways at home or school
- Increased separation anxiety, such as acting "clingy," not wanting to leave mom or dad, or not wanting to go to school
- Withdrawing from the family or wanting to be alone
- Regressing or acting younger, such as a preschooler wanting to go back to diapers or an older child using baby language or sucking his or her thumb
- 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, stomachaches, or bedwetting
- Having trouble sleeping and/or nightmares
- Being moody and irritable, including temper tantrums, fighting with parents or siblings, or crying a lot
- Performing worse academically or having difficulty concentrating
- Demonstrating "extra good" behavior; some children try to take care of the rest of the family by being behaving well and suppressing their own feelings
Helping siblings cope
It is impossible for parents to remove all the emotions and fears experienced by siblings; however, parents can help meet the needs of healthy siblings and help them cope with the sibling's cancer.
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, or asking someone to help you with grocery shopping to give you time to take the other children out for ice cream. 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-appropriate, accurate, and honest information without being overly frightening. Provide frequent updates and encourage them to ask questions. You can say that cancer is a serious illness and that the doctors are doing everything possible to help your brother or sister get better. Appropriate information helps children feel less anxious and prepares 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. Children need to know that they did not cause the cancer, that it is not contagious, and that you still love them.
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 desirable gifts, but "unlucky" to need medical interventions and to feel ill. Let them know they can talk to you at any time and that 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 sometimes you feel sad, scared, and even angry, and 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 after school or which parent should come to their concert or sporting event.
Let your other children help. This helps them feel more involved and less isolated. 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 overburden them with extra chores, and let them know how much you appreciate their assistance.
Help your children keep in touch. If the child with cancer must spend time in the hospital, encourage the siblings to keep in touch with cards, letters, and text messages or e-mail, if available. If possible, have the healthy siblings visit the hospital frequently, which can help ease anxiety about what goes on at the hospital.
Encourage the siblings to do things they enjoy. This includes continuing after-school activities and spending time with friends. Let them know that it’s okay for them to want to have fun and to enjoy time away from the worries of home.
Keep things consistent. Try to keep consistent schedules so your children 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.
Seek professional help. If your children seem to be struggling despite your efforts, you might consider seeking help from a mental health professional, 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 so you can best help all your children.
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, such as increased capacity for empathy and compassion, better coping skills, enhanced self-esteem, confidence in responding to adversity, closer relationships with siblings and parents, and greater insight into the things that really matter. When the entire family comes together during a crisis, it provides everyone with a renewed sense of commitment to each other.
Additional resources for parents
CancerCare: Helping Children When a Family Member Has Cancer
Additional resources for siblings
CancerCare: CancerCare for Kids