Helping siblings cope

Siblings are very vulnerable when a brother or sister has cancer. Parents aren’t there to guide and protect them like they used to, and they often feel like they’ve been left to fend for themselves. They miss you and their sibling when you’re at the hospital. They also realize that life itself is vulnerable and that anyone can get cancer.

Brothers and sisters of children with cancer must also deal with lots of changes and disruptions to their routines. Schedules get changed and life at home may become very different. Siblings themselves may be away from home or school spending time at hospital with the family or they may be cared for by relatives who don’t live in the same neighbourhood or town. School attendance is often affected as well. Siblings often have lots of strong feelings about the changes that cancer brings, but they may not know how to talk about them.

Make the time to talk to siblings about cancer. Siblings have a lot of fears of the unknown, and it may help to reduce these fears by having a better understanding of what is really happening.

By following the same guidelines as telling a child about their cancer, parents can make sure that the siblings at home are spoken to or given information as gently and as openly as possible and that all of their children are getting the same information the same way.

Be honest and direct. Depending on their age and understanding, brothers and sisters need to know as much about the diagnosis, treatment and side effects as the child with cancer. When talking to siblings it may help to have a doctor, nurse, child life specialist or social worker with you to answer their questions. Some hospitals or treatment centres offer services dedicated to siblings.

Give information in small amounts. Children and teenagers have limits to what they can learn at one time and need time to absorb what they have just heard.

Encourage open communication. Use the word “cancer” openly when talking about the disease. This shows that it is OK to say the word and avoids confusion and misunderstandings about other diseases. Encourage children to ask questions – sometimes they feel like they need permission to do so.

Be supportive. Explain that cancer is not contagious and that they won’t get cancer by touching or hugging their brother or sister. Reassure siblings that they did not cause the cancer and they are not to blame for it.

Prepare your child for what to expect. You might need to prepare your children for changes in how their sibling looks. This can be especially important before siblings’ first visit at the hospital. Cancer treatment can cause changes such as hair loss, weight gain or weight loss. Some treatments can cause changes in mood or behaviour. These changes can be frightening for brothers and sisters.

Let them know that strong feelings are normal. Share your own feelings and fears with your children. This helps the children learn how to express emotions and lets them realize that they aren’t alone in what they are feeling. Help them learn the difference between having feelings and acting them out in ways that hurt themselves or others. Show them different ways to release and express strong feelings through physical activities like running or sports and through art, music or talking.

When a child has cancer, a family’s routines quickly change. Some parents find it helpful to have family meetings to talk about the schedule for the week. As much as you can, tell your children what’s happening each day – who will be home, who is at the hospital and who will be looking after them. A calendar with pictures to show who will be at home and when can help young children understand the plan.

Try to keep routines as consistent as possible. Many families say that keeping some routines going helped them cope during a difficult time. When you can’t keep to a routine, try to give your child a choice. Perhaps your child can decide where to go after school or who to stay with if you are at the hospital.

Expect your children to follow your family’s usual rules of behaviour. Let them know that the child with cancer is expected to follow the rules too. There may be times for everyone when you have to be flexible but being consistent will help all your children feel that life is more normal.

Let your other children come to appointments to see for themselves what they are like. Let them visit their sick sibling in the hospital. They can get to know the staff, ask questions and spend time with their brother or sister. Even if you have to travel for treatment, it may be possible to take siblings along. Your social worker may be able to help find somewhere the family can stay or tutoring for siblings if they have to miss school.

You can also explain that things like proper hand-washing helps their sibling. They can help the whole family out with jobs like setting the table or feeding pets.

Hug your child. Tell them how much you love them. Try to spend some special time with them, doing things that they enjoy – reading stories, playing in the park, going to the movies or out for dinner. This will help them feel that you love and care about them even when they get less attention than usual. If you can, spend a short amount of time together every day – even 10 minutes can help.

Sometimes families of children with cancer are given tickets to events in the community. These can be great for a brother or sister, not just the child with cancer.

Try to keep routines as normal as possible. For older kids especially, keeping up with favourite activities and lessons is important. If other family members or close friends can spend this time with them, everyone will benefit.

Humour and hugs go a long way. Try to find time every day for something fun, even if it’s a moment. Laughter is good medicine that relieves stress and builds a supportive family environment.

Children may show their feelings about what’s happening at home by changing the way they act at school or daycare. If school or daycare staff know about the stresses your family is facing, they can help. They may be able to offer extra support, counselling or help with school work.

Despite your best efforts to help siblings cope, they may still struggle. Don’t blame yourself. Seek professional help through the psychosocial team at the hospital or your child’s doctor. Your hospital social worker, psychologist, child life specialist and art therapist can help with sibling’s issues. These people are trained to help children going through these situations, and your children may find it easier to talk to someone who isn’t directly involved in the family.

You may want to talk to the counsellor yourself or set up an appointment for your child. Counsellors may be able to recommend community or hospital programs especially for siblings of children with cancer.