Family Issues Archives

When One Child Gets Sick, The Others Suffer, Too
By Benjamin D. Garber, Ph.D.

Ask any auto mechanic or arm-chair philosopher: It's the squeaky wheel that gets the oil.

In the natural competition between siblings for a parent's precious time and attention, children learn the lesson of the squeaky wheel long before they can explain it, even long before they have words. Its exactly because our time and attention is in such short supply - split among the many demands of work and home, family and friends, bills and business - that its easy to overlook the wheel that rolls silently on, devoting our precious resources to those that squeak.

Ask yourself: Are you more likely to comment when your son takes out the garbage or when he forgets? Are you more likely to pay attention to your daughter's daily homework if she's on the honor roll or on the brink of expulsion? Are you more likely to talk to your child about another day of unremarkable classroom behavior or about the note sent home by the teacher?

Your answers illustrate a dynamic as old as it is potentially destructive to any family. Your time and attention are rewards that your children treasure more than anything else (although they may never admit it). When choice or circumstance combine to focus your attention more on one child, the other will respond to the perceived imbalance in a more or less mature and healthy way.

When your time and attention rewards success, siblings usually learn to succeed in their own respective niches. One becomes a scholar, another becomes a jock. One becomes a musician and the other an artist. One is more social and the other more bookish. But sometimes the ante is raised too high, the pressure is too intense to allow the luxury of rewarding success. Sometimes one child's health hangs in the balance.

There is nothing more important than our children's health. Not money. Not dignity. Not work. Most times we can not afford to dismiss these things as trivial, but in the larger scheme of things, nothing is as important as our son's and daughter's well-being.

When a child becomes seriously physically or emotionally ill, the world stops. Priorities change. Its easy - even crucial - to allow things that once seemed important to slip by unnoticed. All of the family's resources become focused around the ill child's welfare. Money for medications and appliances and doctors. Time for appointments and exams and more appointments. All those tiny little gifts from hospital gift shops to make the pain go away. Suddenly, one child is squeaking very loudly and getting all of the oil.

What about the siblings?

Because your time and attention are as necessary for a child's growth as any nutrient, children who grow up with an ill sibling are forced to discover their own unique means of coping with a thousand strong feelings, not the least of which is the anger and resentment, jealousy and confusion, guilt and self-blame that comes with feeling abandoned.

No, of course you haven't abandoned anyone.

Yes, you are doing the best you can.

This isn't about blaming you. This is about understanding the world from a child's point of view.

"I can squeak loudest!" This is the desperate cry heard from some children faced with a brother or sister's illness. Angry, resentful and jealous of the time and attention and compensatory goodies the ill or injured child receives, this sibling enters the competition like an Olympic athlete vying for the gold. The younger and less mature among these competitors often appear overly sensitive, crying or exploding in anger at the drop of a hat at times and about matters that may have no obvious connection to the sibling's illness and the resulting family turmoil. For some healthy sibs, the upsets occur at times that suggest loss. Leaving for school in the morning. Going to sleep at night. Transitioning between activities. Coping with the unfamiliar. For others, the explosions occur simply when the pressure and emotions and fatigue all add up to too much.

Older and more mature children find more developmentally sophisticated means of squeaking louder for your attention. Grades fall. Peer conflicts erupt. Defiance escalates. When these children are identified in the classroom, they are easily mistaken as having Attention Deficit Hyperactivity Disorder (ADHD), a very real neurological impairment diagnosed today in epidemic proportions. These children can appear fidgety and impulsive, distracted and unmanageable but not as a result of a neurochemical imbalance. Somewhere inside they are grieving. Angry and scared and resentful. Unless and until the real source of these kids' upset is identified, overzealous and uninformed professionals can unnecessarily label and medicate and deflate self-esteem to the point of creating a self-fulfilling prophecy.

And sometimes the healthy child complains of his own sympathetic symptoms, headaches or nausea, aches and pains, weakness or fatigue. These somatic complaints often echo the other child's genuine physical or emotional illness. Sometimes the complaints are the result of conscious manipulation ("I just wanted you to pay attention me, mommy…"). More often than not, these are real experiences of pain or discomfort generated in this case by anxiety and not physical pathology.

"I can help, too!" There are children who cope with a sibling's illness or injury by becoming surrogate parents either through self-appointment or a parent's more or less explicit request. "Billy, could you watch Sarah while I take a shower?" or "Billy, could you get Sarah's medicine for me?" These are natural and sometimes necessary requests in a family focused around one child's pain. Often, a healthy sibling will want some part of helping a sick brother or sister but when this role becomes part of the child's identity, problems can arise.

Parentification - that is, a child taking on or being forced into the role of parent - can be a healthy means of coping or a thin facade behind which waits anger and resentment. When parentification cheats a child out of her childhood, forces her to make decisions and carry responsibilities prematurely, it is one path to later unhappiness.

Silence is golden. Right? Wrong. The silent sibling, the child who conveniently fades into the woodwork, who sits by passively, withdrawn or isolated or scared, may seem conveniently out of the way. With one child off in her own world, your limited time and attention are less divided; you can focus more completely on calming or caring for your other child, your spouse or your own life. But the disappearing act comes with a price. Even more so than the parentified child, the silent sibling is burying her strong feelings, feelings that will inevitably come back to haunt her later.

This child may take your implicit acceptance (and even explicit gratitude) of her invisibility as validating her unspoken fear: She is unwanted; in the way. She feels like an invisible non- member of the family.

The silent child's silence is as much a plea for attention as the acting out child's disruptiveness, albeit without the oil-getting squeak. She fears she is unimportant, or worse, she has withdrawn into guilt in the belief that she is somehow responsible for her sibling's pain. These feelings, untreated, molder in the foundation of a child's budding personality, until they are exposed like landmines in some later relationship where they can explode into depression, anxiety and other serious dysfunctions.

So What's a Parent to do?

(1) Oil all of the wheels all of the time. Know that your time and attention are like gold to your children. Complement their efforts to succeed. Notice the things that are important to them. Keep this simple premise as a goal. In the moments when the pressure decreases, when you have time to come up for air, notice your other kids and your co-parents and let them notice you.

(2) Practice expressing your feelings in healthy ways. Start building your emotional vocabulary with the four basics: Happy, Sad, Mad and Scared. If you use these words clearly and often you'll soon find that your kids do, too. Do the same with the energy that accompanies strong emotions. Don't hide your fear or rage or guilt behind a cigarette or another drink, in that fourth candy bar or by screaming at an innocent nurse unless you want your kids to do the same. Find a healthy way to vent that energy (pace the hall? Squeeze a tennis ball? Write angry letters? Crumple paper?) and decrease the chance that buried feelings will erupt later.

(3) Validate statements of feeling. Validating a feeling simply means acknowledge that the feeling is real and important. Do this by avoiding put-downs like "get over it" and "act like a man." Every statement from "Pass the salt" to "It's not fair!" carries both an emotion and a content message. No matter how you feel about the content, validate the feeling first. Labeling it out loud ("You sound really mad.") before responding to the content message ("You're right. It's not fair.").

(4) Get rid of the myths. After you hear the feelings, correct the beliefs. Expect siblings to blame themselves and you and the doctors and the tooth fairy and anyone or anything they can think of for causing their sibling's illness. Hear them out, then set them straight. Don't make promises that you can't keep ("Everything's going to be alright"). Remember that you are the parent ("We'll always take good care of you") and that you are human ("I'm scared, too, champ.").

(5) Remember that your children are just children, no matter how exhausted you are or how mature they seem. Invite mature choices and responsible participation in family matters without parentifying your kids. Let them be kids and, in so doing, take the time to try to see the world from their point of view. Never make the mistake of relegating playtime as unimportant. Play is how children learn and cope and express themselves. It is at least as important as reading the newspaper, watching t.v. or getting homework done.

(6) Maintain as much consistency as possible. Your children's emotional security is built upon the consistency and predictability of your caregiving. When crisis hits, most of us drop everything and rush to the rescue. When the immediate crisis is past, resume as much of the familiar routine as possible. Do this not in an effort to pretend that the crisis never happened - talk about it often and openly! - but knowing that you and the home life you create are the foundation of who each of your children will become.

(7) Finally, seek out whatever help is needed. Sometimes a child's pain can't be relieved by a family member. Sometimes a healthy sibling needs a special someone. And sometimes, whole families need help to digest the latest trauma, to adjust lifestyles or to vent the strong feelings. Mental health professionals in your community can help, from specially trained helpers in your church or synagogue, to community-based professionals to "child life" personnel in the hospitals to private practices full of helpful and caring souls. Find someone you trust early on and leave them "on hold" or reach out in the midst of trauma. You don't need to do everything yourself.

 

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