Introduction
	Age
	Gender
	Birth Order
	Help for Siblings

Introduction

Children who are chronically ill or disabled require so much of their parents’ time and energy that the remaining children in the family may be left to cope with emotional turmoil on their own. Many siblings adapt to their family circumstances, but others feel isolated, resentful, and angry, and are at risk for long-term emotional problems.

Understanding how age, gender, and birth order affect children in this situation can help parents find ways to address the challenges that siblings face.

Age

Children as young as age one are keenly aware of family dynamics. They may not have the ability to voice their feelings, but they know when a brother or sister receives more attention than they do.

Depending on their developmental stage, children interpret the way that family members behave and draw conclusions, sometimes incorrectly, about why one child receives extra attention. They may feel jealous of a sibling who seems to capture more than their fair share of their parents’ time and energy.

Two- to four-year old children, specifically, are naturally self-centered and are not able to conceive of chronic illness or pain or understand why an ill sibling receives special toys and treats.

Children aged five to nine are known to confuse cause and effect. Consequently, they may feel guilty about their resentment and anger.

Teenagers can understand their ill sibling’s plight, but they may still have mixed feelings about their own role in the family.

Gender

Girls are more vulnerable than boys to feelings of resentment. Girls who closely identify with their mothers in the nurturing role often take on additional caregiving responsibilities. For example, older sisters may feel that they must always be available to babysit their siblings.

Feelings of guilt are common for children who wish to run away from their responsibilities, especially when these responsibilities are overwhelming.

Birth Order

In many families, the youngest child receives favored treatment. When an older ill child essentially displaces the youngest by becoming dependent on others, this role reversal causes confusion, which also leads to emotional distress.

Studies have shown that middle children have adjustment issues more often and feel more isolated than their siblings. While the oldest child tends to have the most emotional resources, the middle child has the fewest. One study found that among siblings of children with a chronic illness, the middle child of both genders experienced more depression, anxiety, and stress.

Help for Siblings

Understandably, parents may be preoccupied with a child who is ill or disabled. However, they should also be aware of how the illness or disability affects the rest of the family.

The National Association of Social Workers (NASW) provides these suggestions for parents:

• Allow healthy siblings to talk about their concerns regarding the ill child. Talk with children at their comprehension level.
• Discuss how you feel and explain your expectations for each child. Avoid causing children to feel shame or guilt.
• Let healthy siblings know that unpleasant feelings are normal. Help them eliminate feelings of guilt.
• Encourage all children to share their feelings, and in particular, support the middle child’s efforts to be more assertive.
• Help children to understand that they are not expected to compensate for what may be perceived as lacking in the ill child. Too much responsibility can be harmful.

Families with an ill child may need community support to develop coping strategies, resiliency, and tolerance. Social workers employed in mental health facilities, hospitals, and in private practice are an excellent resource for family and individual counseling. Siblings of children who are ill or disabled may benefit from counseling to cope with family stress and make their own needs known.