She’s crying. Can you please give her something for the pain?”
It was her sister, no more than eight years old, placing herself gently between me (the doctor) and her sibling after an injection. She wasn’t angry or scared, just protective of her little sibling.
That moment has stayed with me. It wasn’t just empathy I felt; it was a jolt of recognition- of my younger self. I recalled memories of myself that I hadn’t thought of in years- Me trying to ‘protect’ my baby brother (screaming the house down to scare away anyone approaching him as I regarded them all as threats) while he was in the hospital. I was barely five years old myself!
As a paediatrician, my training has always focused my attention on the child with the wristband, the charts, the one with the diagnosis. But in that moment, I realised the most powerful voice in the room came from a child I wasn’t even looking at, the “well child”, the sibling. Like me, I feel that other paediatricians, in the hustle of the job, forget to give attention to the siblings.
They are the quiet observers who wait in corridors or seem hidden while drawing in the corner. Yet, they have the most pertinent questions, which are often unexpected- “When will he be discharged?”, “Can I stay overnight too?”, “Will she be alright?”. When I speak to family members, I am advised not to give exact timelines for when the patient will be discharged home to avoid disappointment, but with siblings around advocating for them, there is little room for ambiguity.
I have heard parents praise the siblings for being so ‘mature’ or ‘helpful, but beneath the surface, I sense that the children are shouldering a complicated weight of worry, guilt, confusion, and possibly even jealousy. They are trying to make sense of a world built entirely around another person’s care.
I’ve seen siblings’ advocacy take many forms. I remember once in the High Dependency Unit (HDU), I went to review a new patient, but the parents were away. “I can help,” a small voice interrupted me just as I was about to leave. It was the patient’s nine-year-old brother. He then gave me one of the most detailed handovers I’ve ever received. Another time, a mother confided in me, that her eldest came daily to visit her sibling in NICU willing to do her school homework later in the day thereby forgoing her dedicated recreational time, because she wanted to be near her baby sister ‘just in case’. The baby was diagnosed with hypoxic ischaemic encephalopathy and was facing an uncertain future. The older sister understood more than anyone realised. Her quiet presence was a daily, fierce vigil of hope.
The mother told me how she felt guilty for being so focused on her child in NICU and was worried that she was missing out on spending time with her other children, who also needed her. Now, as a new parent myself, those memories sit differently. I understand that split — the guilt, the exhaustion, the longing to be in two places at once. I see it in so many families I meet, and it never gets easier.
I have started seeing things differently. I no longer only see the patient before me; I see the siblings and the family in their entirety. I look at siblings and wonder if they are coping. I actively interact with them and engage them in conversation. I pause during ward rounds or spend more time in clinic explaining their unwell sibling to them in words they might understand. I regret that in the past I left these conversations to the parents to sort, as I deemed them challenging, but my perspective has changed. I want to do more to help the already struggling parents and concerned siblings.
There are many resources that you can share with the carers/parents of such children, whom you will meet in the future. I have chosen a few that I hold dear to me with you, but undoubtedly, there are many more amazing resources out there that I might have missed in my list at the end of the article.
I wish I could go back and sit next to that little girl in NICU and ask how she was doing. Or check in again with that boy who gave me such a perfect handover. At that time, I didn’t do that. I just moved on to the next task on my to-do list. Alas, there is no going back in life, only forward, so I want to remind all of you (including myself) to notice the siblings, say their names and include them in our conversations. Siblings matter- every bit as much as the child with the wristband.
Resources for Families and Clinicians
🌍 Global:
🇬🇧 United Kingdom:
🇦🇺 Australia:
📚 Books:
- Views from Our Shoes – Donald Meyer
- Sibling Survival Guide: Indispensable Information for Brothers & Sisters of Adults with Disabilities – Meyer
