A child with cancer changes the family dynamics, and these changes can be especially difficult for the healthy siblings. After spending so much time and emotional energy looking after the child with cancer, some parents find that they don't have 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. While it is natural for parents to want to focus on the child with cancer, it is important to remember that healthy siblings need their parents more than ever to help them cope with the emotions and changes caused by cancer.
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. A sibling’s age, maturity, and personality all affect their reactions and may include these common and normal emotional responses.
Fear and anxiety. Siblings may be afraid that they caused the cancer or that they might "catch it." They may be worried that the sibling with cancer may die, worried about what will happen to the family, or anxious about things they don't understand, such as the cancer itself.
Anger. Siblings may be angry with their parents or with the sibling with cancer for not having time for them anymore.
Jealousy and resentment. Siblings 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. Siblings often feel left out and at the same time feel that they have just lost the support and friendship once provided by the sibling with cancer. Siblings 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. Siblings may experience guilt for not being the sick one. Or, they may feel guilty for saying mean things, 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" or not wanting to leave mom or dad or 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 from 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.
Talk to siblings about cancer. Give them age-appropriate, accurate, and honest information without being overly frightening. Provide frequent updates and encourage them to ask questions. You should be honest that cancer is a serious illness, but that the doctors are doing everything possible to help the sibling with cancer 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 siblings. Children need to know that they did not cause the cancer and that it is not contagious.
Talk to siblings about their feelings and worries. Encourage them to share their feelings with you and reassure them that these feelings are normal and okay. Do not scold 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 siblings that sometimes you feel sad, scared, and even angry, and what you do to help yourself cope with those difficult feelings. Tell healthy siblings often how much you love them and give them lots of extra hugs and kisses.
Spend time with healthy siblings. If possible, at least one parent should spend time with the healthy siblings every day. If you can't be there physically, talk to them on the phone. Ask them about their day and tell them how much you miss them when you can't be there.
Involve siblings with decision making. When possible, let siblings make choices about things that affect them, such as whose house they would like to go to after school or which parent should come to their concert or sporting event.
Let siblings help. Giving siblings ways to help makes them feel more involved and less isolated. Let them pick toys to take to the hospital or read a book or play cards with their ill brother or sister. While it is okay to ask siblings to help out, don't overburden them with extra chores, and let them know how much you appreciate their help.
Help siblings keep in touch with each other. If the child with cancer must spend time in the hospital, encourage siblings to keep in touch with cards, letters, and text messages or e-mail, if available. If possible, have healthy siblings visit the hospital frequently, which can help ease anxiety about what goes on at the hospital.
Encourage siblings to do things they enjoy. This includes continuing after-school activities and spending time with friends. Let them know 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 schedules consistent so siblings know who will be picking them up from school or where they will be eating dinner each night. As much as possible, keeping discipline fair and consistent at home helps both healthy siblings and the sibling with cancer.
Get help. 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, so you can take siblings out for ice cream.
Seek professional help. If healthy siblings 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 a workshop or summer camp for siblings of children with cancer. Read more about finding a counselor.
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.
Positive outcomes 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, closer relationships with siblings and parents, and greater insight into the things that really matter.
More Information
How a Child Understand Cancer
ASCO Expert Corner: Talking With Your Child About Cancer
Family Life
Additional resources for parents
CancerCare: Helping Children When a Family Member Has Cancer
Additional resources for siblings
CancerCare: CancerCare for Kids
National Cancer Institute: When Someone in Your Family Has Cancer
Candlelighters Childhood Cancer Foundation: Websites for Siblings and Just for Kids (medical sites that can be used to explain cancer to children)
Last Updated: February 03, 2009
