Information for parents and guardians
This page is for parents and carers, young people and children who have a child or sibling (brother/ sister) who is in hospital or ill.
It aims to provide information on the types of responses children can have when a sibling is ill and offers some practical strategies to help children cope. It also offers some practical advice about planning hospital visits for siblings and some strategies to help prepare children for the visit. We recommend that you tell ward staff of planned sibling visits so that they will be able to support your family during the visit.
How do children respond when a sibling is ill or in hospital?
Having a child who is ill and in hospital can be a very stressful experience for families. It can be difficult to care for the child who is in hospital and children who are at home. Parents and carers may often feel worried or experience guilt about having to manage the needs of their child who is ill and their other children and family life.
When a sibling is ill or in hospital it can be a confusing time for siblings. They will miss their sibling and parents and carers, particularly if they are staying in hospital and they may struggle to understand what is happening. Children may experience many different emotions. The following section explains some typical sibling responses; these are organised by a child’s developmental stage.
Children under 18 months
Babies and infants are developing their understanding of the world they need consistent caregivers and routine. Having a sibling who is ill can disrupt time with parents and usual family routines. Babies may respond to this by being more “clingy” (wanting to be with parents more than usual) or having disrupted sleeping patterns.
What can you do to help your child?
It is important to try to maintain your child’s usual routines e.g. bed and mealtimes. If one of your children is in hospital this can be very difficult. It might not be possible for you to have your young child with you all the time. It might be useful to ask a family member or friend to help you look after them and to try to establish a regular routine that fits around your baby/ infant and your child who is ill or in hospital. Planning regular times when you can be with your baby/ infant away from the hospital environment will also be beneficial.
Preschool children (5 years and under)
Preschool children may also experience similar reactions as younger children. In addition to this they are developing their independence and language skills. You may notice that their behaviour changes with them being more frustrated or strong willed than usual. They may even have temper tantrums or aggressive behaviour e.g. hitting or kicking or their behaviour may regress and they may act younger than their age. These changes in behaviour are often due to feelings of confusion or unfamiliarity and changes to family routines.
What might help your child?
Talk to your child using simple language about why their sibling is unwell or in hospital, use words that they will understand like “poorly” or “ow”. Repeat simple explanations and expect that children may ask questions repeatedly that have already been answered. In this age group it’s also important to maintain routines for your child e.g. bed and mealtimes and rules, boundaries and limits where possible.
School age children (age 5-11 years)
School age children may react in similar ways to young children in addition they are likely to have a developing understanding of what is happening to their sibling. They may experience worries and fears about their sibling and the future. They may even wonder if they had any role in their sibling’s illness. You might also find that children of this age may “imagine” or add details about their siblings illness if there are things that they can’t understand, this is them trying to fill in the gaps in their understanding and form a story about what is happening to their sibling.
You may also find that they begin acting out, with aggressive behaviour or asking frequent questions/ talking a lot. They may even display some resentment or jealousy about their sibling receiving what they perceive as extra attention.
What might help your child?
Talk to your child about what is happening using language they will understand. Encourage questions and give your child reassurance that it is not their fault that their sibling is ill and that everyone in the family still loves them very much, particularly their sibling. If possible plan to spend some time individually with your child away from their sibling, some families find it useful to plan regular times each week when they can spend time with their child either at home, outside of the hospital environment or via telephone.
If your child is at school it is important to let the school know what is happening in your family. This can be particularly helpful so that your child’s school can monitor your child’s behaviour and they can respond appropriately if your child gets upset at school or asks questions.
As with children of other ages maintaining a family routine is important, e.g. bedtimes, meal times, and family rules. It will also be important to talk to your child about their routine and if it has to change why. If your child is in hospital or has frequent appointments and you are not able to be at home with your other children, explain to your children on a regular basis who is looking after them and where they will be staying. Some families find it useful to make a family timetable so that everyone in the family knows what is happening for the week ahead.
Teenagers
At this age teenagers are developing their identity and independence, they naturally have an increased dependence on their peers and social relationships. If teenagers are missing school or are away from home and friendships they may find this very difficult. Teenagers may respond by being low in mood, with- drawn, having anxieties, irritability or having mood swings.
What might help your child?
Explain in detail to your teenager what is happening to their sibling. If your teenager has questions that you can’t answer or don’t feel confident to answer it might be useful to talk to your child’s medical team, they might be able to give you more information or arrange a time to talk to you and your teenager about their questions about their sibling.
Where possible involve them in family decision making. Listen to their concerns and answer any questions teenagers have, as honestly as possible. Encourage your child to maintain social activities and relationships. Also support and encourage them to find ways to keep in touch with their sibling.
If your child is staying in hospital
If your child has to stay in hospital and the family is separated the following strategies may help:
Planning visits
Often parents and carers are concerned about having siblings visit hospital, especially if your child is staying on PICU (Paediatric Intensive Care Unit). It is normal to worry about this; visiting hospital for the first time can be an overwhelming experience. It can be really helpful to do some preparation with your children before visiting. Generally most families find that having a sibling visit is beneficial for both the siblings and the child in hospital. The staff at the Great North Children’s Hospital Royal Victoria Infirmary (RVI) and the Freeman are very used to having siblings visit and will be happy to help you with planning a visit. Often wards have special toys or activities for when siblings visit, please speak to your bedside nurse, play specialist or ward sister about this.
Helping siblings to know what to expect on their first visit
Some families find it useful to show their child photographs of their sibling in hospital before the visit, particularly if they look different e.g. if they have bandages or dressings, or if they are connected to medical equipment or machinery e.g. nasogastric tube, intravenous drips, ventilators, heart monitors or mechanical heart support.
It might be useful to explain before the visit how their sibling looks and if they have medical equipment around them what the machines do. This can be a very basic explanation e.g. “the machines are helping your brother/sister, sometimes they beep and make sounds”. Expect that children may ask questions about their sibling’s appearance or about machines and equipment on their visit and have a short explanation planned about what you will say to your visiting child. Ward staff might be able to help you with thinking of an explanation if you are unsure of what to say to your child.
Timing of first visit
When planning for a first visit it is often useful to plan a short visit. You may find that particularly with young children they want to spend a short time with their sibling and then they want to play. It can be useful to bring toys with you for the visit or to ask your child’s nurse if they have access to toys on the ward that your child can play with on their visit. If there is a playroom on the ward where your child is staying it might be a good idea to allow your child who is visiting time in the playroom so that they can see positive aspects of hospital.
Familiar objects in the hospital environment
Your child may also feel more comfortable if they can see familiar things around their sibling’s bed. Some families have family photographs or pictures of the siblings together. Some families find it useful to get their child to draw their sibling a picture or write a card and to display this in their child’s bed space, so that your child can see this when they visit their sibling and increase their feelings of being connected and part of their siblings life in hospital.
Strategies that may help your children feel connected
If your child is in hospital for a prolonged period it might be helpful to make some plans to help them feel connected with their siblings.
- Planning regular visits can help as well as good night texts, phone calls or face-time.
- Have siblings choose toys to bring to the hospital for the ill child.
- Ask siblings to choose photos of themselves and the family to take into your child’s hospital room/ bedspace.
- Set up dates e.g. where your children can watch the same TV programme at the same time and then they can talk about it afterwards by telephone or during a visit.
- If your child who is in hospital is unable to respond or is too young to talk, ask their sibling to make a poster to put in their hospital room/ bedspace about their sibling’s likes and dislikes.
- Some families have found it useful to keep a family journal/ diary of what is happening each day for all siblings. Regularly sharing the content of this diary may help siblings feel connected. This diary could be in paper format or some families (particularly with older children) may find a computer based version by email, power point or video useful.
Friends and family
If someone else is doing most of the care for your other children. It might be helpful to agree with them about discipline and rules, so that there is some consistency when you return home. It could be tempting to show extra attention for these children because of the things they have missed. This could be extended to extra treats or later bedtimes. This will lead to the children expecting these things routinely and struggling to fit back into their normal routines. This may result is some challenging or distressed behaviour. Maintaining normal routines and rules will reduce the chances of this behaviour occurring.
Summary
Having a child in hospital can be a very stressful experience for families. It can be difficult to care for the child who is in hospital and children who are at home. Siblings can experience a range of emotional reactions. Explaining your child’s illness, planning visits to hospital and using strategies to help your children feel connected can help.
This information has been produced by the Department of Psychology in Healthcare. Clinical Psychologists are based at the RVI and Freeman Hospitals. If you have any further concerns about the issues discussed, please discuss these with your GP or medical team.
