Supporting the Family Affected by a Pediatric Cancer Diagnosis: Siblings Matter, Too

A cancer diagnosis in a child impacts the entire family unit. Parents often have to shift their focus from after-school activities and playdates to speaking with doctors and focusing on their sick child.¹ Although understandable, this can have unique and often negative consequences for the siblings of pediatric patients.

More than 82% of children live with a sibling, and sibling relationships are crucial to childhood development.² Sibling relationships are often the longest relationship in a person’s life.¹ Healthy sibling relationships promote positive social, emotional, and cognitive development.^2,3

Change in Family Dynamics

Families must re-identify their roles and responsibilities to meet the demands of a child’s cancer diagnosis.¹ Parents may spend more time at doctors’ offices and hospitals than in their own home, creating a change in caregiving at home and inconsistency for their healthy children.³ Family members such as grandparents, aunts, uncles, or friends may play a role in caring for the patient’s siblings. The change in support can affect their routine and the attention they receive.¹

Based on number of siblings and their ages, older siblings may have to take on a caregiving role to younger children within the family. Navigating medical appointments and treatments may force parents to stop working or limit their work hours to care for the sick child, which can create financial stress within the family.³

Challenges Faced Among Siblings

The healthy child may experience challenges while parents and other family members are focused on the care of the child with cancer, including feelings of uncertainty, disruption to their normal routines, and changes within their family dynamic.¹ Siblings of pediatric patients with cancer often feel like their emotional, cognitive, and physical needs are overlooked.

The healthy child may not want to burden their family members with their own concerns or feelings that may arise. This can cause them to feel withdrawn from the family or less worthy of receiving support.³ Children may have different emotions or reactions to their sibling’s cancer diagnosis and throughout their sibling’s treatment. Common emotions include feelings of anxiety, anger, sadness, uncertainty, guilt, fear, or helplessness.^1,4

A child’s age and developmental stage matters when discussing how they may be impacted by their sibling’s diagnosis.⁵

From birth to age 3 years, a child cannot understand what cancer is. However, they may notice the changes within their daily routine. A child of this age may be affected by the separation of their parents and siblings, and may become afraid of leaving their parents.⁵

At ages 3 through 7 years, a child may understand what cancer is in simple terms. They may need assurance that they did not cause the cancer and that it is not contagious. A display of magical thinking is normal in a child at this developmental age.⁵

At ages 7 through 12 years, a child may understand a more detailed explanation of cancer and is more likely to understand the role of the medical team and how treatments may affect their sibling. Within this age group, children start to have access to more information from outside of their home, which can impact their understanding of the diagnosis and treatment.⁵

Teenagers, ages 13 through 18 years, will have more of a complex understanding of cancer, and will think of cancer in terms of its symptoms and impact on their daily life. Children within this age group may want to have a role in the medical decision making, and may get information from many sources outside of their home.⁵

The birth order of siblings can also influence a child’s experience, as an older sibling may take on more responsibilities within the home and may serve as a support for their younger siblings and/or the patient. A younger sibling may experience feelings of helplessness as they may be unable to take part in the patient’s care.