When a child is seriously ill, their brothers and sisters are living through it too, usually with less information and less attention than anyone intends. Siblings commonly feel worry, jealousy, guilt, loneliness and anger, sometimes all in the same day. Many cope well when the adults around them keep them informed, protect some of their routines and make regular time for them.
Some siblings need more help than that, and the signs can be easy to miss while a family is focused on hospital visits and treatment plans. This guide covers what siblings are often going through, how it looks at different ages, and practical ways to support them.
What siblings are often going through
- Less time with parents. A parent may be at the hospital for long stretches. Siblings may be shuttled between relatives, friends and after-school care.
- Not knowing what is happening. When children are not told much, they fill the gaps with their imagination, and what they imagine is often worse than the truth.
- Guilt. Younger children may secretly believe they caused the illness, perhaps by being angry at their sibling. Older children may feel guilty for being healthy, or for feeling jealous.
- Jealousy. The sick child may get gifts, visitors and attention. Wanting some of that is a normal reaction, and it says nothing bad about the sibling.
- Fear for themselves. Some children worry they will get sick too, or that a parent will.
- Pressure to be easy. Many siblings decide, without being asked, that their job is to cause no trouble. They hide their own problems so they will not add to the family's stress.
- Grief. Siblings can grieve the family life they had before, the playmate who is now too tired to play, and the plans that were cancelled.
How reactions can look at different ages
Young children
Preschool and early school-age children often show distress through behavior. You might see clinginess, tantrums, trouble sleeping, or a return to younger habits such as bedwetting or baby talk. Their play may include hospitals, doctors or illness. This is often how young children work through what they see, and it is usually a healthy sign.
School-age children
Children in elementary and middle school tend to have lots of questions, and a strong sense of what is fair. They may complain of stomachaches or headaches, struggle with schoolwork, or act out at school while seeming fine at home. Some become worriers who need frequent reassurance that everyone is okay.
Teenagers
Teens may pull away and spend more time with friends or online, which can be a reasonable way to cope. Others step into adult roles: cooking, caring for younger siblings, or acting as a stand-in parent. Teens often hide their feelings to protect their parents and may feel resentful and guilty at the same time. Some take more risks or lose interest in school.
Practical ways to support siblings
- Tell them the truth, in words that fit their age. Name the illness. Explain simply what it does and what treatment involves. If the illness cannot be caught, tell them so directly. Make clear that nothing they did or thought caused it.
- Keep them updated. Children cope better with hard news from a parent than with something overheard. Short, regular updates help more than one big talk.
- Protect their routines. School, activities, bedtime rituals and time with friends give siblings stability when home feels unpredictable.
- Make one-on-one time. Even fifteen minutes of a parent's full attention, without hospital talk, tells a child they still matter.
- Offer ways to be involved, without forcing it. Some siblings want to visit, make cards or join video calls. Others need distance. Both are okay.
- Name a go-to adult. A grandparent, aunt or family friend who is reliably there for the sibling can fill some of the gap when parents are stretched.
- Let the school know. Teachers and school counselors can watch for changes and offer a little extra patience.
- Allow mixed feelings. Saying "It makes sense to feel jealous sometimes, and you can still love your sister" gives a child permission to be honest.
- Watch how much a teen is carrying. Helping out is fine. Being the main caregiver, or the parent's main emotional support, is too much for most teens.
Our article on behavior as communication in kids can help parents read what a sibling's actions may be saying.
Signs a sibling may need more support
Changes in behavior are expected for a while. Consider reaching out to a clinician if you notice:
- Sadness, worry or irritability that lasts for weeks and does not ease with extra attention
- Refusing to go to school, or a clear drop in grades
- Frequent stomachaches, headaches or other physical complaints that the pediatrician cannot explain
- Withdrawing from friends and activities they used to enjoy
- Ongoing anger, aggression or trouble at school
- A teen taking serious risks, or using alcohol or drugs
- A child saying they wish they were sick, or that the family would be better off without them
These signs do not mean something is wrong with your child. They mean the load may be heavier than they can manage alone, and a clinician can help sort out what is going on. Our guide to anxiety in children describes how worry often shows up in younger kids.
If anyone in your family talks about suicide or self-harm, or you are worried about their safety right now, call or text 988 (Suicide & Crisis Lifeline) or go to the nearest emergency room. Mind Body Seven provides outpatient care and is not an emergency service.
How therapy can help brothers and sisters
For a sibling, therapy offers something rare during a family illness: a space that is entirely theirs. They can say they are angry, jealous or scared without worrying that it will upset a parent. A therapist can help them understand what is happening, build coping skills for worry, and feel less alone.
Family therapy can also help when everyone is stressed and communication has broken down. A few sessions together can make room for each person's experience, including the ill child, the siblings and the parents, and help the family find a new rhythm. Parents benefit from support of their own as well. Caring for a sick child while trying to be fully present for the others is exhausting, and it is not a sign of failure to need help.
Getting support at Mind Body Seven
Several clinicians at Mind Body Seven work with children, teens and families during medical illness. You can read more about our approach to mental health support during serious or chronic illness.
- Katie Tallon, PMHNP Intern spent most of her more than 20 years as a nurse at Memorial Sloan Kettering Cancer Center in pediatric hematology/oncology and bone marrow transplant, and now works with children, adolescents, young adults and families on adjustment to medical and life challenges, under the supervision of Dr. Beata Lewis, MD, and Kathleen Fentress Tripp, PMHNP-BC.
- Peggy Kaplin Zaloga is a psychotherapist who works with adolescents and adults, including people coping with complex medical conditions, and focuses on steadying both the individual and the family during stressful times.
When you request an appointment, let our intake team know which family members are looking for support, and they will help find the right fit.
FAQs
How much should I tell my other children about their sibling's illness?
Tell them the truth in simple words that fit their age, and keep updating them as things change. Children usually cope better with honest information than with silence, which leaves them to imagine the worst. It is fine to say you do not know the answer to a question.
Is it normal for a sibling to be jealous of a sick brother or sister?
Yes. The sick child often gets more attention, visitors and gifts, and wanting some of that is a very human reaction. Let your child know the feeling makes sense and does not mean they do not care.
My teen has taken on a lot of caregiving. Is that a problem?
Helping out is healthy for many teens, but carrying adult responsibilities or acting as a parent's main emotional support can become too much. Watch for exhaustion, falling grades or withdrawal from friends, and look for ways to share the load.
When should a sibling see a therapist?
Consider it if sadness, worry, anger or physical complaints last for weeks, or if school and friendships are suffering. A clinician can help sort out what is going on and give your child a space of their own to talk.
Should siblings visit the hospital?
Many siblings find it helps to see where their brother or sister is and what treatment looks like, as long as they are prepared for what they will see. Others are not ready. Ask the medical team for advice and let your child have a say.
