Brothers and sisters are shaken to the very core by cancer in the family. Parents, the leaders of the family clan, sometimes have no time, and little energy, to focus on the siblings. During this major crisis, siblings sometimes feel they have no one to turn to for help. They may feel concerned, worried, fearful, guilty, angry, sad, abandoned, or other powerful emotions. If you recognize these ever-changing emotions as normal, you will be better able to help your children talk about and cope with their strong feelings.

Although the years of treatment are emotionally potent for every member of the family, research has shown that siblings have good psychological outcomes, particularly if they have been assured that they are valuable, contributing members of the family whose thoughts and feelings matter. Siblings frequently report the experience as life-changing in many positive ways. Following are descriptions and stories about the emotions felt by siblings.

Concern for sick brother or sister

Children really worry about their sick brother or sister. It is difficult for them to watch someone they love be hurt by needles and sickened by medicines. It is scary to see a brother or sister lose weight and go bald. It is hard to feel so healthy and energetic when the brother or sister has to stay indoors because of weakness or low blood counts. The siblings may be old enough to know that death is a possibility. There are plenty of reasons for concern.

Fear and worry

It is extremely common for young siblings of children with cancer to think that the disease is contagious—that they can “catch it.” Many also worry that one or both parents may get cancer. The diagnosis of cancer changes children’s view that the world is a safe place. They feel vulnerable, and they are afraid. Many siblings worry that their brother or sister may get sicker or may die.

Fears of things other than cancer may emerge: fear of being hit by a car, fear of dogs, fear of strangers. Many fears can be quieted by accurate and age-appropriate explanations from parents or medical staff.

Jealousy

Despite feeling concern for the ill brother or sister, almost all siblings also feel jealous. Presents and cards flood in for the sick child, Mom and Dad stay at the hospital with the sick child, and most conversations revolve around the sick child. When the siblings go out to play, the neighbors ask about the sick child. At school, teachers are concerned about the sick child. Is it any wonder brothers and sisters feel jealous?

The siblings’ lives are in turmoil and they sometimes feel a need to blame someone. It’s natural for them to think that if their brother or sister didn’t get sick, life would be back to normal. Some siblings develop symptoms of illness in an attempt to regain attention from the parents.

Guilt

Young children are egocentric; they are not yet able to see the world from any viewpoint but their own. Some children believe that they caused their brother or sister to get cancer. They may have said in anger, “I hope you get sick and die,” and then their sister got sick. This notion should be dispelled right after diagnosis. Children need to be told, many times, that cancer just happens, and no one in the family caused it. They need to understand that no one can make something happen just by thinking or talking about it.

Many siblings feel guilt about their normal responses to cancer, such as anger and jealousy. They think, “How can I feel this way about my brother when he’s so sick?” Assure them that the many conflicting feelings they are experiencing are normal and expected. As a parent, share some of your conflicting feelings (such as anger at the behavior of a child due to a treatment side effect, guilt about being angry).

It is also common for some children (and parents) to feel guilt about being healthy. It is important for parents to provide many opportunities to remind their healthy children that there is no connection between their health and their sibling’s illness and that no one, including the sick brother or sister, wants them to feel bad about feeling good.

Abandonment

If parental attention revolves around the sick child, siblings may feel isolated and resentful. Even when parents make a conscious effort not to be so preoccupied with the ill child, siblings sometimes still perceive that they are not getting their fair share of attention and may feel rejected or abandoned.

Sometimes it is necessary to have the siblings stay with relatives, friends, or babysitters. Parents may have to miss activities, such as soccer games or school events, they would otherwise have attended. Vacation plans may be scrapped. The reasons may seem obvious to parents, but the siblings may interpret these changes as evidence that they are not as well-loved as the sick child. Parents should explain in detail the reasons for any alterations in routines, solicit feelings about the changes from the siblings, and try to find solutions that work for everyone in the family.

Sadness

Siblings have many very good reasons to be sad. They miss their parents and the time they used to spend with them. They miss the life they used to have—the one they were comfortable with. They miss their sick sibling. They worry that he or she may die. Some children show their sadness by crying often; others withdraw and become depressed. Sometimes children confide in relatives or friends that they think their parents don’t love them anymore.

Children’s lives are disrupted by the diagnosis of a sister or brother with cancer, and siblings often feel very angry. Questions such as “Why did this happen to us?” or “Why can’t things be the way they used to be?” are common. Children’s anger may be directed at their sick sibling, their parents, relatives, friends, or doctors.

Anger

Children’s anger may have a variety of causes. They may resent being left with babysitters so often or having additional responsibilities at home, or they may notice that the sick child isn’t always held to the same standards of behavior as the other children. Because each member of the family may have frayed nerves, explosions of temper can occur.

Worry about what happens at the hospital

Children have vivid imaginations, and when they are fueled by disrupted households and whispered conversations between teary parents, children can imagine truly horrible things. Seeing how their ill sibling looks upon returning from a hospital stay can reinforce their fears that awful things happen at the clinic or hospital. Or, the sibling may think they are missing some grand parties when they see their sister or brother and parent come home from the hospital with presents and balloons.

Age-appropriate explanations can help children be more realistic about what they think happens at the hospital, but nothing is as powerful as a visit. Of course the effectiveness of a visit depends on your child’s age and temperament, but many parents say that bringing the siblings along helps everyone. The sibling gains an accurate understanding of hospital procedures, the sick child is comforted by the presence of the sibling(s), and the parent gets to spend more time with all the children.

Another way to help a worried sibling is to read age-appropriate books together. Many children’s hospitals have coloring books for preschoolers that explain hospital procedures with pictures and clear language. School-age children may benefit from reading books with a parent (see Appendix C, Books and Websites). Adolescents might be helped by watching videos, reading books, or joining a sibling support group.

Several parents suggested that another way to reduce siblings’ worries is to allow even the youngest children to help the family in some way. As long as children have clear explanations about the situation and concrete jobs to do that will benefit the family, they tend to rise to the occasion. Make them feel they are a necessary and integral part of the family’s effort to face cancer together.

Concern about parents

Exhausted parents are sometimes not aware of the strong feelings of their healthy children. They may assume children understand they are loved, and that they would be getting the same attention if they were the one who had cancer. Siblings frequently do not share their powerful feelings of anger, jealousy, or worry because they love their parents and do not want to place additional burdens on them. It is all too common to hear siblings say, “I have to be the strong one. I don’t want to cause my parents any more pain.” But burdens are lighter if shared. Parents can help themselves and the siblings by acknowledging their own conflicting feelings and encouraging children to share their feelings, especially the difficult ones. Try to listen without becoming defensive and use those moments as an opportunity to grow together and strengthen each other.