Sibling Support
In my opinion, providing sibling support has always been kind of tricky. One of the main reasons being that siblings aren’t coming to the hospital as often or during the day. A lot of siblings over the age of 4 are in school and if they do come to the visit, it’s usually in the evenings or weekends when Child Life Specialists aren’t working. Then, to make things more challenging, the pandemic caused many hospitals to really crack down on visitor policies. Siblings weren’t allowed at all, preventing us from being able to meet them in person and assess for coping needs. All of this is to say, that many siblings don’t usually get as much psychosocial support as they need when their brother or sister is sick. And they are left trying to navigate the many changes happening all at once. Some of these changes include:
Being separated from their sibling for long periods of time
Being separated from one or both caregivers/parents
Change in schedule and routine
Inability to participate in some recreational activities due to family being unable to take them
Less quality time as a family
Limitations on what activities they can partake in due to the sick child’s immune system and health status (i.e. avoid large crowds, certain outdoor spaces, etc.)
It’s a lot, right?! So let’s talk about how sibling support can be successfully provided throughout the medical journey.
Start Support Early
When the sick child is initially diagnosed, I like to quickly check in with caregivers about how the sibling is doing and what they know thus far. By including us right at the start, Child Life Specialists can build repoire and trust with the sibling early on. In addition, we can better understand where to begin when providing illness education , avoiding possible misconceptions.
With an established connection in place, siblings know and understand they can come to us if they have questions, concerns, or other needs.
Creating a Space for Self Expression
One of the most helpful sibling support interventions is providing room for self expression. I say this because it can be difficult for parents to remember to check in with their other children when all their focus is on the sick child. Of course, this is not intentional but tends to happen at some point during treatment because the sick child tends to have more immediate needs. Therefore, Child Life Specialists are able to create time and space to hear from the siblings.
We use a lot of various art activities to allow for children to share their thoughts if they don’t feel comfortable talking openly about them. For example, I love to introduce a kinetic sand activity that involves cards that say all the different things a sibling could be worried about. These can be: “I’m worried my brother/sister isn’t going to come home;” “I’m worried my parents are going to forget me at school again;” “I miss seeing my brother/sister;” “I miss my mom.” I then have the sibling put as little or as much sand as they want on each card to symbolize what is really bothering them. In other instances, a sibling may benefit from playing out some of the experiences they’ve had in coming to the hospital. In these situations, Child Life Specialists use medical play so the child can assert control over hospital related toys and objects and play out different experiences they need to process further.
In sum, siblings are experiencing a lot of different thoughts and feelings that require special attention. They could feel worried, frustrated, or even guilt, throughout the medical journey so it’s important they have someone they can talk through them with.
Consistency in Care
One of the best perks of providing in-home community services is my ability to see families on an ongoing basis. As I noted in the introduction, sibling support was difficult to achieve when I was working in the hospital. Fortunately, now, that isn’t an issue because I can come in and see families on their terms when siblings are available.
Because siblings are also impacted by the ups and downs of treatment, it is important that Child Life Specialists are able to provide consistent care and support. As these changes happen, we may play different roles. For instance, one day we may be the play partner for the sibling, giving them some quality 1:1 time. Then, we may be the educator as treatments change or surgeries come up. We also will be the sibling advocate, talking to caregivers about what their other children are needing or could benefit from during these stressful times.