Michelle Brauntuch is M.S., CCLS. Certified Child Life Specialist, Englewood Hospital and Medical Center, Englewood, N.J.
The following are some questions that siblings may ask and some answers you may use as a guideline when talking to them about the hospitalization. Again, remember to keep the children’s age and developmental level in mind when answering them. When questions are asked, you may first want to ask the child what they think the answers to their questions are (ex: “Why do you think he’s in the hospital”, “How do you think he got sick”), clear up any misconceptions they have, as well as provide more information.
1. Why does “Michael” have to be in the hospital? You can say: “Michael has to be in the hospital because he is sick. The hospital has special medicine and equipment, and there are things that the nurses and doctors can do to help him get better faster than we could at home.” (Remind them that this is a different kind of “sick” that when they are sick.) If there is surgery, you may say “Michael will have an operation to fix _________, that is giving him trouble. An operation is when the doctor fixes something in your body that is giving you trouble or sometimes they take something out of your body that isn’t working well. People are born with parts of their bodies that they don’t need, like your appendix, and doctors take them out when they give you trouble and you can live just fine without them.”
2. When is “Michael” coming home? You can say: “Michael will come home as soon as he is well enough. The nurses and doctors will do every thing they possibly can to make him feel better and come home as soon as possible.”
3. Is “Michael” going to die? (The family may have had an experience where a relative or acquaintance went to the hospital and died, so they may associate hospitalization with death.) If the patient is terminally ill, you may want to prepare the children for this. For example: “ The nurses and doctors will do everything they possibly can to help Michael feel better and come home. We all hope he’ll be able to come home.” It is important to be receptive to the children’s feelings at this time and encourage them to let you know what they are feeling and thinking both now and later on. There are many books available on explaining death and dying to children of all ages that you may find helpful. If the patient is not terminally ill, reassure the children that the hospital staff is helping the patient to feel better and then focus on what will happen when the patient comes home again.
4. Will I have to go to the hospital? If the children have no foreseeable problem, let them know that when they are “sick”, it is different than the patient’s illness, and that they don’t have to go to the hospital. Tell them that if someday they have a problem that needs the special help from doctors and nurses or the special medicine or equipment, then they may go to the hospital, too. Reinforce that it they need to go to the hospital, you will be there with them also.
5. Will I catch it? Explain that the illness is not contagious (as long as that is true). Again, emphasize that this is a different kind of “sickness” than when they get sick (unless it is a hereditary illness). Then let them know that you will be there for them if they ever have to be hospitalized.
6. What will they do to “Michael” in the hospital? You can say : “The doctors and nurses will do everything they possibly can to make Michael feel better and get well as fast as possible. They may give him medicine, do a special test or take some special pictures to help them know what is going on inside his body and to help Michael get well the fastest”. Siblings may also be concerned with practical things like food, clothing, sleeping arrangements, friends, etc. Let them know how these things are provided for both the patient and yourself (ex: “Michael gets his meals on a tray in his room and Dad and I go to the cafeteria to eat”).
7. Why do you (the parent) have to go to the hospital? You can say: “There may be things that are very strange or may hurt or be scary for Michael, and I want to be there to help him feel more comfortable. I would want to be there if this was happening to you, too. The doctors and nurses aren’t trying to be mean to Michael. There are just things that need to be done to help them understand what is going on in his body and to help him get better the fastest. I will miss you when I’m not with you and I think you may be missing me and I wish I could be with you. You may be feeling scared or sad or even mad now, and those feelings are okay. I understand. Let’s plan something special for us to do together when I get home and maybe we can talk more about these feelings and help you feel better.”
8. Do you love “Michael” more than me? You can say: “I love you both. Michael needs some special attention from me right now. And when you need some special attention, I want to be able to be with you, too. I know you may be having a lot of different feelings now. What kinds of things might we do together to help you understand and feel better?”
9. Who will take care of me while you are gone? You can say: “I will make sure someone will always take care of you while I can’t be with you.” Give specific examples such as “During the day you will be at school and your teacher will be there for you. Then you’ll be playing at your friend’s house and his mom will be there if you need anything. I will be thinking of you and missing you when I can’t be there.” Be sure to let the children know if there are upcoming changes in routine. You may even want to make up a special calendar or daily schedule showing the children where they will be on each day and at what time. If possible, give the children a special list of telephone numbers, including emergency numbers, the number of the hospital room and/or where you can be reached, and numbers of friends and relatives they can call if they need help or are feeling lonely or upset. Friends and relatives may have misconceptions or fears about the hospitalization and may ask your children questions. This may be upsetting to the children, especially when they don’t understand everything. By discussing the hospitalization with your children, you help them with talking to others about it. After the patient comes home, continue to let the sibling participate in any home care that may be necessary. Spend some special time alone with them even after you have returned home.
Important Points to Remember:
- Siblings need help to make sense of the changes which occur in their world when a family member is hospitalized.
- Open communication provides an environment free enough for children to express concerns and questions.
- “Protecting” a child from knowledge creates anxiety. Children know about what is happening – they sense it.
- Without correct information, children make up their own explanations for changing and frightening events. The reality is never as frightening as the ideas children invent to explain things to themselves.
- The unknown can be more traumatic to children than the truth.