Helping siblings cope

Talking to them about cancer

The diagnosis of cancer affects the entire family. For the siblings, the initial period can be a time of confusion and fear . Children, even young ones, are sensitive to what is happening. They are aware of a brother's or sister's hospitalization and of trips to the doctor and clinic. They notice their parents crying and trying to comfort one another. They may overhear parts of conversations that are difficult to understand. Children often conspire to figure out what is going on. Pieces of information are gathered, pooled, and analyzed. Because of this, it is important to take time early in the diagnosis and treatment process to have an honest discussion of the situation with the siblings. Encourage them to ask questions and answer these as honestly as possible.

Explain the facts about cancer, keeping in mind the age and maturity of each child, and update the information periodically as the siblings and patient get older and are able to understand more.If the siblings are very young, it may be enough to say that their brother or sister is sick, will have to stay in the hospital for a while, and will need to take medicine for a long time. Older children will require more detailed information about cancer and its implications. Siblings should be prepared for physical changes in the patient, such as hair loss or amputation. If you wish, the doctors or nurses who care for the patient may be called upon to explain the diagnosis, prognosis, and treatment to the siblings or to discuss it with the entire family.

All of the children need to know that cancer is not contagious and that they will not become sick from contact with the patient. They need to be reassured that they are healthy themselves and that the possibility of cancer running in the family is highly unlikely. Siblings also need to be told emphatically that they are in no way responsible for the illness. Angry outbursts, such as "Drop dead! " or "I hate you," which are said by all normal children at one time or another, frequently haunt a child after learning about a sibling's illness. Feelings of guilt or wrongdoing need to be dealt with immediately. Failure to do so may result in problems later on.

Emotional concerns of siblings

Feeling left out

Siblings of cancer patients may have many different feelings about the patient, the illness, and the attention the patient receives. While sympathizing with their brother or sister who is ill, they may still feel some resentment and believe that they are being neglected. In many cases, this is true. During times of hospitalization or when the patient is not feeling well, attention may focus on the sick child. As parents, you may not be able to pay as much attention to the siblings as you did before. You may have to miss school functions or ball games in which the siblings are participating. You may have little emotional reserve left after dealing with your sick child to talk with siblings about their concerns, to play with them, or help with their homework.

When you do have the energy, try to make special time for the siblings. Encourage them to become involved in outside activities and make a point of recognizing their achievements. When you can, make plans to spend time alone with them and do things that interest them.

Others may focus special attention on the sick child. It is not unnatural, then, for siblings to resent the "privileged status" of the sick child in the family, neighborhood, and school and the lack of attention to their own needs. Talking with siblings about the special attention paid to the sick child, letting them know that feelings of resentment are natural, and enabling them to share in the family crisis will encourage healthy growth and maturity. Efforts should be made to give equal attention or explanations when this is not possible.

Get them involved

One way to help them to understand their brother's or sister's illness is by involving them in the treatment. Older children in particular welcome the opportunity to be taken into their parents' confidence and will often respond in helpful ways. Finding things for them to do for their sick brother or sister, or their worried parents, gives many young people a sense of belonging and usefulness that might otherwise be lacking in the family's focus on cancer.

Siblings may accompany you to the clinic when the patient gets treatment or, if possible, visit when the patient is hospitalized. This will allow them to see for themselves what the hospital, clinic, and treatment are like. If this is not possible because of distance, try to describe the setting and situation. Photographs may also be helpful.

Siblings may need such concrete experiences or explanations to prevent the construction of fantasies about the hospital and the hospital experience. Fantasies may range from fearing that the patient is being tortured to believing that the patient is having a good time; siblings may be terrified or jealous.

Remember, the patient's brothers and sisters may be asked questions about the illness by schoolmates or others in the community. They should have enough information to answer these questions. In fact, you might want to help them anticipate questions or comments and discuss possible answers.

Behavior changes in siblings

Behavior changes among siblings of young people with cancer are common and can indicate that they are having trouble dealing with the situation. They may become depressed , have headaches , or begin to have problems in school . If necessary, counseling can help them cope with their feelings, and treatment center staff can help with this. If their teachers are aware that a brother or sister has cancer and that this might affect the student, teachers can alert you if problems arise at school. Remember that siblings, like all children, don't care about tomorrow and want equal treatment and attention today. It helps to appreciate them as individuals and to make a special effort to keep in touch with their needs.