Michelle Brauntuch is M.S., CCLS. Certified Child Life Specialist Englewood Hospital and Medical Center, Englewood, N.J. To children, the hospitalization of a brother or sister can be frightening. The children in these families may experience turbulent feelings, may be separated from their parents for an unusual or uncommon length of time and the familiar routines of their daily lives may be disrupted. Parents and other adults may act anxious or worried, and the children may hear words and phrases that sound very confusing or frightening. The needs of children whose sibling is hospitalized are too often forgotten in the midst of the tension and worry about the patient. During this experience, these children often feel mixed emotions that can be misunderstood by the adults around them. This article was written to help the family members recognize and understand some of the reactions and concerns children may have when a sibling is hospitalized and to provide some suggestions on helping children understand and cope during this experience.
Several factors influence how a child will react to the hospitalization of a sibling :
- the age and developmental level of the child
- the seriousness of the illness of the sibling
- the length of time the sibling has been ill and/or in the hospital
- the amount to which the child’s daily routine is disrupted
- the amount of time, if any, the child is separated from the parents/significant others with whom he/she lives
- the attention that is given to the child’s reactions and feelings
- the quality of explanations and answers the child receives to the questions about the ill sibling
A variety of feelings about the hospitalization of a sibling may be experienced by children of all ages. There also may be a variety of reasons why they experience these feelings. Depending on the child’s developmental level and on their perception of the hospitalization, some feelings may be more prominent than others. Their feelings may change from day to day or hour to hour. They may have any one or many of the following feelings. They may feel conflicted because they are having multiple feelings at the same time.
Confusion as to what is happening and why, particularly, if the hospitalization was very sudden or unexpected. Younger children may not even know what a hospital is – it needs to be described to them , for example, as “A place where doctors and nurses take care of people who are sick . These sick people (adults and children) are called patients. These patients may need either surgery (also called an operation), which is when the doctor fixes something in their body that isn’t working well or he takes something out of their body that is giving them trouble, like tonsils, etc. Patients also go to the hospital when they need to get medicine in a special way or they can’t take that medicine at home.”
Guilt about angry wishes or thoughts that they had toward the ill sibling. Younger children, especially, may even have feelings that they are in some way responsible for the illness and its cause. Young children are developmentally egocentric and view their actions as the cause of what happens in their world. In addition, it is not uncommon for school-aged children to “wish” negative things about a sibling (ex: to wish for the moment that their sibling was “dead” or “sick”). It is common for them to feel they somehow caused the hospitalization. In addition, they may also have feelings of guilt because they aren’t sick themselves.
Anger toward parents for not protecting the sick person from illness and also concern that the parents will not protect them from getting sick. Their trust in their parents may be shaken, and they may have feelings of insecurity.
Fear that they may become sick themselves or “catch it” and have to be hospitalized, especially if they are unsure of the reason for the hospitalization.
Abandonment and worry about not having their own needs and wants met. They may wonder who will be taking care of them or making sure they are all right.
Rejection or being left out. If the children are not kept involved or updated about the hospitalization, they may begin to feel like “outsiders” to the situation and not as important family members. They may also be jealous of all the attention and concern the patient is given and be disappointed that they don’t seem to receive or deserve an equal amount.
Resentment because there are two sets of rules or standards: one for the hospitalized child and one for the other children.
Embarrassment because of the sibling’s condition. The hospitalization may draw a great deal of attention to the children from friends, relatives, teachers peers and even hospital staff. Children may not know how to interpret this. There are many ways in which children express their concerns and feelings. Reactions depend on the individual child’s temperament as well as their age and developmental stage. Children understand and cope with stressful situations in different ways. Some of the ways children may express their feelings include:
- separation issues – clinging to parents or caregivers
- eating disturbances – lack of eating or overeating
- behavior changes – withdrawal, outbursts, misbehaving, “acting like the perfect child”
- regression – returning to earlier self-soothing behaviors (thumb sucking, blankets), bedwetting, baby talk
- displaying feelings of jealousy and competition, becoming argumentative, fighting with others
- declining school performance
- changing social patterns – decrease in interest or involvement with peers or withdrawing from family unit
- becoming obsessed with the patient and the patient’s things
- hypochondria – complaining of similar ailments to that of the patient
Helping Children Cope There are many ways that you can help children cope with and understand the hospitalization of a sibling. It is important to remember that incomplete information may create fantasies that are often worse than the real situation. Allow and encourage children to ask questions and express feelings. They may be hesitant to ask questions, especially if this is a very stressful time for the family. Give honest and understandable answers to their questions. Simple, direct answers are usually most helpful. The following are other ways you can make the hospitalization of a sibling easier to understand for children.
- Be honest before, during and after the hospitalization. It is better to give correct information, rather than tell them something you will have to change later on or something that could cause incorrect fantasies.
- Let the children know that it is okay to ask questions and talk about the hospitalization. Reassure them that if you become upset or cry, that this is all right, too. They may be afraid to ask questions because they may upset you. Help them understand it is all right to have and to express their feelings and they can do so without losing control. They will turn to you for examples of appropriate behavior.
- Allow children to help in the preparation and planning of events. This is as important to the healthy children to have some control over the situation as it is for the hospitalized child. For example, letting them help with packing things for the hospital. These are also excellent opportunities for talking and answering questions.
- If the hospital provides a tour for patients before hospitalization, allow the siblings to also attend. If an emergency hospitalization occurs, explain it as soon as possible. Let them know how serious the illness or injury is and how soon they can see their sibling.
- For younger children, you may act out the hospital experience with people, dolls or puppets. Using puppets is a good way for younger children to share feelings they may be uncomfortable saying otherwise.
- Read or color books with stories about hospitals or let the children make their own story-picture books on what it is like to have a sibling go to the hospital. They could draw the pictures and you could write the story as they tell it to you.
- If the children seem to be displaying a lot of anger or frustration, find an active or vigorous play outlet for them. Through play, children work through their feelings. It helps release their anxieties as well as burn off excess energy in a constructive manner.
Things You Can Do If you are staying at the hospital with the child that is ill and/or if the healthy sibling is staying somewhere other than at home, try to have contact with them daily. Let them know where you are and what arrangements you have made for them and for yourself. When you are with them, spend some special time alone with them if possible. This may be a good opportunity for them to share some of their thoughts, feelings or fears with you. You can help them find ways to cope and understand when you are not with them. Also try to provide maintain as much of the daily normal routine as possible. Try to continue the special activities of your child as much as possible, such as school or sport activities, birthday parties and holiday celebrations. These are still an important aspect of their life. Activities that may help both the parent and the patients stay involved with the healthy sibling are:
- Write, e-mail or tape record “letters” to each other. Talk on the telephone as often as you can. Even if they cry when hearing your voice, allow these feelings to be expressed.
- Tape record bedtime stories or read to them over the phone
- Send a new piece to a puzzle to them every day
- Send safe, unused trinkets from the hospital to the healthy sibling, such as seasoning packets, plastic silverware straws, plastic syringes without needles and other safe, disposable hospital items.
- Have both the patients and the sibling make greeting cards, pictures and picture books for each other.
- If you cannot be with the siblings, ask them to keep a special item of yours for you until you can be with them. It should be an item that they specifically associate with you, for example, your pillow from your bed or something from your pocketbook. This helps them feel connected to you and reassures them that you will be coming back.
- Have a photo exchange between the patient and the sibling. Let the sibling select photos of themselves that they would like to send to the hospital for the patient. Place these on the patient’s bed or in a place where they can be viewed easily by the patient. If possible, take a picture of the patient actually in the hospital and send it to the sibling. A digital camera is useful for doing this, and if you do not have one, check to see if the hospital has one available. Pictures throughout a hospital stay can help keep the sibling updated on the patient’s progress as well as help prepare them for what to expect then they visit or when the patient comes home.
If possible, allow the sibling to visit the patient in the hospital. This allows them to see firsthand where the patient is and helps clear any fantasies or misconceptions that may have occurred. It offers an opportunity for questions to be asked. It may also help reduce stress for the patient and reassure him/her that the rest of the family is all right and that things will be the same when they go home. Before the visitation, however , prepare the sibling for the experience. Give the children a simple explanation of the situation. You may say that his brother/sister is in the hospital so that the doctors and nurses can help him get better. If the patient can have visitors in the room, you may say you will see his room, where he eats and sleeps and where he plays. In order to prepare them for some of the medical equipment they will see, you must use developmentally appropriate language. You should say that they may see some of the special things or medical equipment that help get the patient better. Encourage them to ask questions about what they don’t understand but , especially for younger children, provide information in case they don’t feel comfortable or can’t formulate the questions to ask. Depending on the age of the sibling, more or less information should be provided. Remember, there are Child Life Specialists or nurses available in most hospitals to provide any additional support or information that your children may need concerning the hospitalization.