This leaflet is designed to help the many adults who come into contact with the brothers and sisters of children with cancer. Family, friends, neighbours, teachers, babysitters, grandparents and aunts and uncles may all be involved in helping parents to look after brothers and sisters, especially while parents are having to spend so much extra time with the sick child.We hope this leaflet will provide some ideas on how best to help brothers and sisters to cope with the illness.
When a child is diagnosed with cancer it affects the whole family. Brothers and sisters naturally have concerns about the changes that they see in family life and in the sick child. It is often you who will have to deal with their questions and fears. An honest approach is nearly always best, but if you don’t feel able to tell them what is happening, there may be members of staff at the hospital and in the community who can help.
Each brother and sister will react very differently to the diagnosis and its consequences but the following problems can be encountered.
Problem... Brothers and sisters may feel jealous as the sick child gets more attention and treats than they do, or because adults are less strict with the sick child.
Suggestion... It is hard to tell a sick child off, but by trying to maintain a normal level of discipline with all children in the family you will reassure both the sick child and his brothers and sisters that family life is still as normal as possible.When normal discipline is very hard, for example when the sick child is on steroids, it can be helpful to explain to brothers and sisters why discipline has changed for a while. Encourage visitors to bring something small for brothers and sisters as well if they have a gift for the sick child.
Problem... Brothers and sisters may complain of feeling ill themselves. Sometimes this can become a real problem, making them anxious.They may panic even with a cold or become preoccupied with their own health or their body.
Suggestion... Brothers and sisters need reassurance that you can’t catch cancer and that because these illnesses in children are very rare that they are very unlikely to get them. Older children may need to know that although cancer can be caused by problems in genes, except in a few rare eye and kidney tumours, cancers are not inherited (that is they don’t run in the family). All complaints of illness should be listened to so that the child is reassured that they are getting the same attention as their sick brother or sister. However if a brother or sister is focusing too much on his or her health then some professional help may be needed.
Problem... Brothers and sisters may feel angry about the unequal attention shown, and behave differently or become withdrawn.They may also feel angry that the sick child is ill.
Suggestion... Anger can often hide many other emotions. Brothers and sisters need to know its OK to feel angry.They may need the opportunity to talk about difficult things. Explain that sharing worries with other people makes things easier. Asking questions like “Do you think your brother is getting better” may help children talk about difficult subjects.Your patience may be needed, as children may not have the words to express thoughts and feelings that they have never dealt with before.
Problem... Children can feel guilty about the illness.They may feel that it is their fault as they may have wished that something horrible would happen to their brother or sister or that fighting with them caused the cancer.They may feel guilty for being healthy.
Suggestion... Brothers and sisters need to be told that nothing that they or anyone else did caused the cancer. Problem... Concentrating on schoolwork may be difficult, due to the disruption to normal routine.
Problems at school may stem from other children teasing them or leaving them out as they might think that you could catch cancer.
Suggestion... Staff at school need to know what is happening at home so that appropriate support can be given at school.The Macmillan nurse will often be able to go to the child’s school to help staff and pupils understand about the illness and treatment. It may be helpful to include brothers’ and sisters’ friends in discussions about what is happening so that they can help their friend cope.
Problem... Brothers and sisters of children with cancer can be very scared and may have frightening fantasies about what is happening in the hospital.
Suggestion... Children's fantasies can often be more frightening than what is really happening to the sick child. Children are often reassured by visiting their sick brother or sister and by seeing where and how they are. Some brothers and sisters appreciate the chance to help care for the sick child, and may want to be present at hospital appointments. However others prefer not too and should not be forced as this may frighten them.
Problem... Brothers and sisters may worry because they can see that their brother or sister has lost their hair, has tubes attached or is unable to join in the games that they usually play.
Suggestion... Try to warn brothers and sisters before changes with the sick child take place. Reassure brothers and sisters that the tubes don’t usually hurt and explain what they are for.Tell them what activities the sick child can still do. They need help to understand that the treatment aims to make their brother or sister well again, even though it may make them more poorly to start with.
Problem... Brothers and sisters may miss their parents.
Suggestion... Brothers and sisters who are too young to talk and understand what is happening will appreciate extra attention, play and cuddles from trusted adults.This will help to make up for the contact they miss with other members of the family who may have to spend a lot of time at the hospital. If a parent can find even short periods of time that will be ‘special time’ with the brother or sister, this will help them feel important.
Problem... Brothers and sisters may worry about the chance that the sick child might die. Some may say nothing, but they have usually heard of cancer and that people can die from it. They may not mention it because they are scared to admit it or because they can see you are suffering and they don’t want to upset you.
Suggestion... Children may ask difficult questions about what will happen in the future.This may mean that they are worried that the sick child is not going to get better or worse still may die. It is helpful to explain that with cancer no one can be sure what will happen, but that the sick child is having the best treatment and that many children do get better.You may feel unable to answer some questions in which case you should tell the child this and make sure that someone (a parent or a member of staff) is aware so that the child can be answered as soon as possible.
It can be hard to give extra support to other children when you are tired and worried about the child who is ill. Spending time with healthy brothers and sisters and making them feel that they are still special is important. Giving them your time and support can help them to understand and cope. If you feel you would like some help with meeting the special needs of brothers and sisters, please ask a member of staff as individual or group support may be available.
Written by Katherine Ballard in association with the CCLG
Sibling Project Group and BCH Sibling Group
Publication Date: May 2004
This booklet has been funded by Macmillan Cancer Relief
(Charity number 261017)
