All parents who have more than one child have to deal with sibling arguments and sibling rivalry.
Add to the equation one or more children with special medical needs, and siblings can have even more feelings of jealousy, resentment, helplessness, and guilt.
However, they can also develop empathy and compassion for others.
Nurses in home care, schools, physicians offices, and hospitals have unique opportunities to assess the needs of siblings and help to ensure that they are met. It is essential not to generalize each childs needs are as exceptional as he or she is.
Whereas an older sibling may feel cheated out of part of his or her childhood that is spent caring for a brother or sister with medical needs, a younger child may wonder why he or she has outpaced an older siblings abilities. Another factor to consider when meeting a family is whether a special childs condition is congenital or something that developed later in life.
Essential communication Vanessa Malcarne, PhD, from the Psychology Annex for Research and Training in San Diego, says that communication is key to discovering the healthy siblings needs, assessing their knowledge base, and providing accurate, age-appropriate information about their sibling who has special medical needs.
According to Malcarne, older children may want to assist with caretaking, and even though it would not be acceptable for a 5-year-old to push digoxin into an infants gastrostomy tube, it would be appropriate for him or her to hold items while the nurse gives the medication.
Trying to make family life as normal as possible is another appropriate goal, which could translate to having one child read a book to a sibling while the parents spend time with the one who has special medical needs (www.jsdn.org).
Support along the way
Nurses can help by exploring options for family support. For example, Camp Nejeda in Stillwater, New Jersey, a camp for children who have diabetes, gives children a chance to be kids and be safe while providing respite for families.
The camp offers Family Camp, which provides fellowship and education for patients, parents, and siblings (www.campnejeda.org).
In one study, siblings of chronically ill or disabled children were sent to their own camp, where they focused on self-esteem, education, and coping skills.
The children who participated in the study showed significant and sustained improvements in social support, self-esteem, and attitude, compared to a control group that was not provided with the same opportunity. (Abstr Acad Health Serv Res Health Policy Meet 2002; 19:3).
In a Canadian study that looked at siblings of children diagnosed with cancer, the researchers found that sadness was the most commonly reported emotion.
The siblings felt sadness about the trauma their brother or sister was going through, the loss of their previous family life, and their own altered roles in the family structure. Even if a child was successfully treated and survived the cancer, the most common description of the event was sad.
In addition, when a child with cancer was hospitalized, it was the most stressful time for the entire family. What made the healthy sibling feel the best was to participate in the care of the ill child and to be there for him or her, whether by providing physical care or just by treating the sibling nicely (Cancer Nurse 2006; 29).
Ways to cope
Nursing interventions will depend on the patients diagnosis and the setting in which the nurse works.
A school nurse may want to organize an assembly presentation on disabilities, raising everyones awareness and decreasing the stigma of being different.
An office nurse may connect the family with an organization such as Starlight Starbright Childrens Foundation or an organization specific to a patients condition (www.starlight.org).
A nurse in a hospital that has age-restricted visits for infection control purposes may arrange a family visit off the unit. Because a pediatric home care nurse often has the greatest time for family interaction, he or she has a unique opportunity to hear how everyone is feeling and to help family members with what they might need.
Every nurse who cares for children with special medical needs can identify ways to give the whole family the support they need during difficult times.