Supporting Siblings

“He didn't eat for a week. He couldn't articulate at the age of 5 what any of this meant.”

Siblings who witnessed the injury

The psychosocial professionals at the burns service where you child is treated can help siblings who are distressed by what has happened to their brother or sister. Please contact them if you have any concerns.

“She had post-traumatic stress from having witnessed it, as well as then dealing with all of the emotional side of it as well. Watching mummy and daddy basically fall to pieces, you know, I can’t imagine what that must have been like.”

Coping with separation

While your injured child is (was) in hospital, your other children may be (or may have been) cared for by friends or relatives. This temporary separation can be stressful for you and your children.

“We ended up separating her siblings and have one go to one set of grandparents, and one go to the other. They were thoroughly spoilt, which I think made things a lot easier for them.”

Children can feel anxious when they are separated from siblings and their parents. Depending on the age of the siblings, they may be concerned about whether they had a role in the separation, or whether their parents or sibling will come back. It is OK to tell them about the injury and the need for the hospital stay. Provide as much honest information as they can comprehend. It is also important to give them the opportunity to ask questions and express their feelings.

“At the time, she couldn’t tell us what she felt, but two years later, randomly in the back of the car she started talking to her brother. She said to him that she thought he was going to die, she didn’t think she was going to see mummy ever again, she didn’t know where mummy had gone and it was just her and daddy, she didn’t like the smell of the hospital, she didn’t like the macaroni cheese that they made… it must have been a really rough time for her.”

When siblings have been separated from their injured brother or sister, it is also important to prepare them for what they will see when they are reunited, whether this is their bandages and dressings, wounds, or scarring. Siblings might be unsure of how to deal with a brother or sister who looks different. The team at the burns service where your child is treated can be really helpful in preparing siblings to see their brother or sister in hospital.

“I was really impressed with the play specialist in the hospital because they were really good in terms of prepping her brothers for seeing her. They chatted informally but also arranged where it would be best for them to see her where it wasn’t so scary.”

Non-injured adolescents might ask to stay at home or with friends when you are in the hospital with their brother or sister. They can rely on the emotional support they get from their friends as much as that which they get from their parents. Giving them the freedom to switch back and forth between friends and home can be helpful to them. Speak to them as often as you can by phone.

Maintaining usual routines

It is important to try to maintain as many of the sibling’s familiar daily routines as possible. Following usual rules and expectations gives them a sense of continuity that is reassuring for them.

“I think the uncertainty affected her most. We tried to keep things as normal as possible, like her Brownie group and when she had a party to go to. I think parents need to be told it’s OK to keep the other child’s routine in place, it’s OK to take your eye off the child in hospital for 10 minutes to spend some time with them, they need that bit of normality.”

Siblings who feel neglected

“We feel like we neglected our oldest child at the time. About 6 months after the accident she got very upset one night and said that she felt unloved.”

When parents focus on the injured child, siblings can feel uncared for and unimportant. They can feel angry with the injured child and, at the same time, they can feel guilty for this. The intention of parents might be to protect uninjured siblings from unnecessary burden, but it is important to involve them as much as possible in discussions about what is happening, what is going to happen next, and what might happen in the future. A consequence of not doing this is that siblings feel excluded from family activities.

“As well as having the huge trauma of seeing what he saw, he was jealous as well. Because he wasn’t with you and she was getting all of the attention.”

For this reason, it is important to maintain contact with children and include them as much as you can in decisions about changes to routines and roles. This can be of particular relevance if the injured child has to return to hospital later for further treatment.

Visitors and gifts

“So many people brought him presents. We were overwhelmed with presents and it was lovely but, you know, kids that age, they love a gift too!”

People are likely to bring the injured child presents following their injury because they want to help them feel better. This can be hard for the siblings who can feel like they are overlooked. It can be helpful to remind visitors of this because siblings are also likely to have been upset by the injury.

“She had so much of the attention from everyone, and then you’ve got people turning up left right and centre with gifts for her, and there’s only so far that they understand. She’s been through a lot but they have too… it’s frustrating.”

Changes in family dynamics

After the injury, siblings may adopt new roles to adapt to changes in family dynamics. When one child is in hospital, other children may feel an extra burden of responsibility, temporarily becoming the only child at home, or perhaps the oldest child. They lose a playmate, friend, rival and other familiar interactions and expectations associated with their relationship. Therefore, it can be useful to talk about, and plan, how you will all keep in touch whilst their sibling is in hospital. When you can, set time aside just for the sibling so that they have the opportunity to spend time with you.

Outside of the hospital, siblings may take on the role of helper for their injured brother or sister, and also for you because they see you dealing with the medical regimes and other household chores.

“They deal with the fact that she looks different very differently. My eldest gets very angry when people stare or say something but the other, he worries about her and is protective.”

Some siblings might try to keep a low profile to avoid causing further problems, whilst others might act out to gain attention and distract the family from the injured child. Therefore, it is essential that you communicate effectively with siblings and include them as part of the process of family adjustment following a burn injury.

“Even now he gets all the attention and she gets overlooked. But she’s been the one left with more scars in some respects.”

The physical and emotional healing after a burn injury can be a lengthy process. Therefore, it is important that siblings have all of the information that they need and are not overlooked. You can always ask for help and advice with this from the burn service where you child was treated.

What can you do to help them?

Click on the tiles below to read more.

  • Keep the routine as normal as possible

During the separation, the remaining parent/caregiver should try to keep the routine as normal as possible.

  • Keep track of time

It can be useful to keep track of time using a calendar so that siblings are reminded when they should expect their parent(s) and brother or sister home again.

  • Tell them if there are going to be any changes

If there are any unanticipated changes then these should be communicated to siblings. A child is less likely to be upset by what they are told, than by their own interpretation of what has happened to their family.

  • Tell them who is going to be taking care of them

Parent(s) spending time at the hospital should make it clear to siblings at home that they trust the person who is taking care of them, and that this person is in charge.

  • Tell them what will change and what won’t change

It is important to talk about what will change and what will go on as usual, how you will keep in touch, and whether they will have any additional responsibilities.

  • Ask them if there is anything they would like to do

It is also important to ask whether there is anything special that they would like to do with you and their brother or sister before they are separated.

  • Prepare them for hospital visits

If siblings are going to be visiting their brother or sister in the hospital, prepare them for what they will see and how long they will be able to stay. For example, explain that their sibling might not look the way they remember. This could be because the injury or bandages make them look puffy, or because they will be lying down in the hospital bed and may have tubes or wires attached to them. There may also be noisy equipment in the room and many doctors and nurses taking care of them. It is also important to explain whether their sibling will be able to talk to them or not, and that, even if their sibling is asleep, they can still talk quietly to them if they want to.

A useful workbook for children preparing to visit a family member in hospital can be downloaded here.

This is particularly relevant if the injured child has to return to hospital later for further treatment.

  • Tell them who is going to be taking care of them

When one child and/or a caregiver are going to be away for a period of time, it is a good idea to tell the siblings as far in advance as possible. This allows for the discussion about what is going to happen to take place several times before the separation occurs. This gives siblings time to understand that their parent and/or brother or sister will be leaving, to picture where they will be, and to anticipate what will be different whilst they are gone.

A useful workbook for children preparing to visit a family member in hospital can be downloaded here.

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