Overlooked needs of the sibling of the sick child
When a child has a serious medical illness or condition, there is an obvious sense of urgency among parents and doctors in meeting the sick child's physical and mental health needs.
Unfortunately, this can sometimes have a negative impact on the well-being of healthy siblings. An article in the June issue of The Journal of Pediatrics outlines a new program that focuses on the needs of well children dealing with the complexity of having an ill sibling.
Joanna Fanos, Ph.D. and colleagues at the California Pacific Medical Center created The Sibling Center in order to identify at-risk well siblings. The authors estimate that approximately 18% of children in the United States have a chronic medical condition, many of which are severe enough to affect their daily lives. "Well siblings of children with chronic or serious illnesses can be 'forgotten' while the family's attention is focused on the sick child," says Fanos. Unfortunately, this can have an impact on the emotional, behavioral, physical, and psychosocial well-being of the healthy siblings and can lead to feelings of resentment, anger, anxiety, depression, jealousy, fear, and guilt.
Families who go to The Sibling Center first meet with a counselor for evaluation and treatment plan development. In the second and third sessions, the well siblings meet individually with the counselor to identify communication issues, alleviate stress, and work on coping skills. The fourth session is divided into two parts.
First, the well siblings meet with the counselor alone, and then the parents join them to review the emotional needs of the child. Parents may be encouraged to schedule time with only the well child to help compensate for time spent caring for the sick child, which could help the child feel that he or she is loved equally. A 6-month follow-up session reviews the progress the family has achieved. If further support is needed, the counselor helps the family find an appropriate therapist for ongoing care.
The authors note that preliminary responses to The Sibling Center have been very promising. Parents have reported less anger and acting out by the well sibling, improved communication within the family, and gratitude for the help. Dr. Fanos, who is now a faculty member in the department of pediatrics at Dartmouth Medical School, is working on establishing a Sibling Center at the Children's Hospital at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. The authors urge other pediatricians to develop similar interventions and incorporate the needs of the well siblings into treatment plans to prevent future emotional and behavioral problems.