An estimated twenty-seven percent of children are living with one or more chronic illnesses. Chronic illnesses are diseases that last more than several months or those with the impossibility of a cure. Most people are well aware of the impact that physical symptoms and treatment can have on the life of the sick child. However, the lives of all members of that sick-child’s family are changed by the illness, including caregivers and the well-siblings. Siblings’ lives may be impacted in many ways: parents may need to spend a disproportionate amount of time with the sick-child, going to medical appointments and in therapies. Siblings may need to perform more domestic chores that are vacated by parents performing other duties for the sick-child; this may result in “parentification” of the well-sibling, which has negative consequences. Parental emotions of depression, anxiety, guilt, and general overwhelm may also negatively impact the well-sibling.
In general, well-siblings of sick-children are more at-risk for symptoms such as anxiety and depression as compared to siblings of healthy children. However, there is significant variability in the functioning of these well-siblings, where some are more impacted than others. Research suggests that older well-siblings of children with a more life-threatening illness are more vulnerable to negative impacts. In families of children with chronic illness, there may be “double protection” occurring; parents try to protect well-siblings from their own fears and negative emotions, while well-siblings simultaneously try to protect parents by keeping their emotions and worries to themselves.
Parents of children with a chronic illness certainly have significant constraints on their time. Thankfully, quality of time spent together is more important for improving parent-child relationships than quantity of time spent together. Parents should make efforts to allocate regular time together to each of their children. Ideally, this would be an event that the parent could schedule with their child every day or week where both child and parents can positively anticipate the quality time together. Family friends and extended family are also excellent sources of support for well-siblings. They might schedule a regular event or outing with the well-sibling to support these children when parents are over-taxed. Perhaps this is helping with transportation to the well-siblings sporting events or a regular weeknight outing to a local playground or coffee shop. Again, the most important thing is for the well-sibling to have regular quality time with a trusted adult.
Parents and other loved ones should be aware of the emotional adjustment and mental health of their children. If they notice any children struggling, they should seek out connection with a therapist (either for that child as an individual or for the whole family) for treatment. During medical appointments or hospital visits, Child Life Specialists are often available to help support the well-sibling. Parents may also inquire with medical specialities about support groups or workshops for well-siblings.
Though there are possible negative effects, well-siblings may also develop some positive outcomes. For example, well-siblings report a feeling of being closer together as a family after facing chronic illness. Well-siblings also frequently demonstrate an increased sense of empathy, greater maturity, and pride in their sibling’s ability to navigate an illness. They may also develop positive advocacy skills as a result of watching parents navigate the health system for the sick-child. With intentional efforts, parents and other loved ones can help well-siblings navigate the difficulties of having a sibling with chronic illness and maximize the possible positive outcomes.