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At the University of Maryland Children’s Hospital, we encourage you to involve siblings in the care of their hospitalized brother or sister by visiting the hospital and participating in special activities at home.

For your child's health and well-being and for that of the other children in the hospital, check with your child's medical team about sibling visitation in that area.

When Siblings Visit

  • Give siblings the choice to visit and respect their choice. Some may feel comfortable visiting and some may not.
  • Parents should prepare children for what they will see and hear during their visit. Describe what their brother or sister will look like or how they may act if different than normal. Child life specialists are available to help you with this preparation.
  • If their brother or sister is very ill, injured and/or not feeling well, we suggest siblings pack a bag of quiet things. We have a Ronald McDonald Room with toys and games where siblings can play, but sometimes those favorite things from home are most comforting.
  • If their brother or sister is feeling up to playing, siblings can play games or work on art projects together
  • If a quiet time activity is more appropriate, siblings can read a book, watch a movie or talk about their day with their brother or sister.

Preparing Siblings for a Visit

When preparing your children for a visit to their sibling in the hospital, parents should try to understand what's on their mind. For instance, what do you think your children's fantasies are of what their sibling is like right now? And which do you think is worse -- their fantasies or reality?

To better understand what your child is thinking, these helpful books can be used to prompt discussion.

In addition to trying to understand your children's thinking and expectations, consider these things that you, as a parent, already know about your children:

  • Ages of the visiting children
  • What they know about the hospitalization
  • How they usually handle stress
  • How they learned that their sibling was hospitalized

Developmental Considerations

Children's developmental levels influence how they understand and process events and information. The following section includes information about thoughts, fears and feelings common in children of various ages, as well as possible responses of interventions to address these developmental needs.

When possible, use a photograph to aid in preparing children for what they will see and experience at the bedside. Briefly describe the room and medical equipment.

Preschool Children

How Children May Think or Feel How to Respond
Believe that their thoughts, actions or wishes caused the accident or illness.  Learn from children what they believe made their sibling sick or injured, then address any potential issues…"Lots of children think that, but it rarely happens that way." 
Fear that this will happen to them. Reassure them that this will not happen to them, if that is accurate. If the patient was involved in a trauma, ask the child what can be done to prevent that sort of accident. 
Feel anger and/or see a sense of abandonment with separation from parents during stressful times. They may believe that they deserve punishment or that further abandonment will result.  Acknowledge and accept their feelings…"If you were in the hospital, where do you think your parents would be? What do you think your parents would do?" 
Believe that staff members are hurting their sibling.  Say, "The nurses and doctors job is to help stop the hurting, or keep it from getting worse." "Here is how the nurse and doctor help…"  
Have a weak understand of internal bodies.  Use illustrations or children's anatomy books. Ask the children to draw what they think or imagine. 
Explanations of their siblings illness or injury may have nothing to do with reality.  Provide honest, accurate information, updating as necessary due to changes in patients condition or due to sibling needs. 

School-Age Children

How Children May Think or Feel
How to Respond
Wonder if something they did caused the illness or injury. "If I had done something differently, this wouldn't have happened". Ask "What makes you think that?" Explain, “Lots of children think that, but it rarely happens that way." Give concrete examples: "If you wished this object to fall, could you make it happen?"  
Worry, "Can I catch it?" and may not want to touch or go near the patient. Ask, "Do you think that you can catch this from touching?" Explain, "We wouldn't let you touch him or her if that would happen."  
Wonder, "Will the patient be the same?"   Possible responses:
  • Probably, we hope so. 
  • He/ she need lot of help to get better. 
  • It may take a long time. 
  • We are not sure that all of the parts of his/her body will work the same way. We can hope that they will.

Adolescents

How Children May Think or Feel
How to Respond
Are likely to have a sense that they are being watched   Provide privacy as appropriate. Ask if they prefer to be alone or have family/staff close by.  
May talk in medical jargon without fully understanding meanings.   Ask what they understand about what is going on. Reassure them that there are adults who don’t understand many parts. Ask, "What does that mean to you?"

When Siblings Are at Home

When at home, your children can continue to work through their feelings about their siblings illness or injury, and do things to comfort their sibling. They can:

  • Draw pictures to decorate their brother or sister's hospital room
  • Record themselves reading a book so their brother or sister can hear a favorite story read by a familiar voice (singing, general talking, music and storytelling are good ideas too)
  • Pick favorite or funny photos of family, friends and pets for their brother or sister to hang in their hospital room and share with hospital staff and friends
  • Pack a 'goody' bag of their brother or sister's favorite toys, books, stuffed animals, blankets and pajamas (including a special picture or note as a wonderful surprise)
  • Write a note in a journal and send to the hospital so their brother or sister can write a note back to them
  • Pick their brother or sister's favorite videos and music to send to the hospital
  • Make a sign with information about their brother or sister that can be hung at the child's bedside. This could include information like their sibling's favorite toys, books, colors, TV shows, songs, foods, dislikes, pets and special nicknames their sibling uses to identify certain items
  • Have friends from school make a "get well" or "we miss you" poster to send to the hospital
  • If the child in the hospital can take phone calls, arrange for a special phone call between siblings