When a child has a life limiting illness it is important for health professionals to consider the impact on siblings. Like parents, brothers and sisters will also experience a grieving and adjustment process.
This is often because family dynamics change to accommodate the ongoing care of their unwell child. Family conversations change perspective for many reasons but one of them is the desire to “protect” siblings, and, at times extended family members. This in turn can be reversed when siblings and extended family members try to “protect” the parents. Open communication between parents and children can facilitate acceptance and normalisation.
When parents are grieving (throughout a child’s illness and into bereavement) they may be unsure about how to talk to their children. Parents who are dealing with anxiety and sadness themselves may be reluctant or unable to talk to their children.
Open, age appropriate conversations with siblings can help them to understand what is happening to their brother or sister. This can help to reduce feelings of worry and anxiety. Health professionals should always be guided by parents when talking with children about illness and death. Depending on the age of the child, a conversation with the parent or a health professional can help to reduce the anxiety a child has. Alternatively younger children may respond to therapeutic books or videos that help facilitate conversations targeted for their age group.
Children can sometimes ask questions that can be challenging for parents or health professionals to answer but it is important to answer the question as honestly and age appropriately as possible. Acknowledging the question the child has asked makes them feel heard and provides a safe environment to process their fears or concerns. In most situations children will not want additional details outside their question and will feel satisfied once an explanation has been provided.
While recognising the importance of the responses of children to the potential death of a sibling, it should also be remembered that children, like adults, show diversity in their responses to grief. Just as some adults are very keen to talk about the loss and others prefer not to talk, so too will children show variations in their responses to loss. It should not be assumed that because a child shows little inclination to discuss their sibling’s illness or death that they are in denial or are heading into a complicated grief reaction. Their emotional reactions and their adjustment to their continuing activities of daily living should be assessed over several months rather than making the assumption that they are in need of active therapeutic intervention.
In general a sibling’s response to the death of a child will be guided by the adjustment of their parents to the loss. If the parents are able to model healthy coping strategies, children will be more likely to cope in similar ways.