By Jennifer Costa, MSW, CCLS, Friends of Karen

Sibling relationships shape who we become, helping us learn to express emotions, develop social skills, and feel a sense of security and belonging. While siblings commonly engage in rivalry and bickering, these interactions also provide valuable life lessons.

Parents hope their children will grow up to support each other through life, but reality often brings challenges that shift family dynamics. When a child faces a life-threatening illness, the emotional strain can intensify sibling tensions, causing feelings of guilt, fear, jealousy, anger, and sadness.

As a Friends of Karen Sibling Support Specialist, I work with families navigating these difficulties. Friends of Karen, a nonprofit founded in 1978 that supports children with life-threatening illnesses, guides families through these challenges daily. Its mission is to provide emotional, financial, and advocacy support for children and their families to keep them stable, functioning, and able to cope. Our team of social workers, Certified Child Life Specialists, and Licensed/Board-certified Creative Arts Therapists help parents manage sibling conflicts and maintain strong family bonds.

Addressing Feelings of Favoritism

Children often perceive an imbalance in attention and affection, which can be magnified when a sibling requires extra care due to illness or disability. One child may excel in sports or academics while another struggles, leading to feelings of resentment.

It’s important to help each child understand that their needs differ but their worth remains equal. Explain that at times, one child may need more attention, but it does not diminish the love you have for the others.

Even with a packed schedule, carve out one-on-one time with each child and provide undivided attention. This can be as simple as sharing a meal, watching a favorite show together, or discussing the highs and lows of the day before bedtime.

Encouraging Open Communication

Create a family culture that encourages open communication and honest expression. It is important to create an environment where siblings feel safe to share their emotions - whether anger, jealousy, or sadness - without fear of judgment. Validate their feelings by encouraging them to express themselves through statements like “Even though I am sad my brother has cancer, I still feel mad that I don’t get to spend time with you while you’re at the hospital.”

Encourage children to express their emotions through drawing or writing. Additionally, provide clear explanations about why certain situations unfold as they do. If a neurodivergent child requires special accommodations, help their siblings understand that their brain functions differently. Similarly, if an ill child has medical restrictions, such as a central line preventing roughhousing, explain why typical play may need to be adjusted.

Maintaining Routine and Individual Attention

Children thrive on routines and structure. When one child requires intensive time and care, strive to maintain normal routines for the entire family. Prioritizing family activities, keeping bedtime rituals intact, and ensuring each child gets quality time with parents and caregivers can make a big difference.

Helping Children Feel Important

Assigning each child a role in family life fosters a sense of value and importance. Encourage siblings to be involved in each other’s worlds – whether by visiting a hospitalized sibling, helping with household tasks, or participating in preparations for games or events. Ensure they feel included in family moments, from pictures to shared experiences, while encouraging them in their hobbies and nurturing their talents.

Knowing When to Seek Support

Parenting is an ongoing learning process, and some challenges are complex and require outside support. If sibling tensions escalate beyond everyday conflicts, professional guidance from social workers, therapists, child life specialists, or creative arts therapists can be invaluable.

While sibling rivalry is a natural part of growing up, it can become even more complex when families face extraordinary challenges. By fostering open communication, maintaining routines, and ensuring each child feels valued, parents can help strengthen sibling bonds rather than allowing hardships to drive them apart. With the right support and guidance, families can navigate these difficult moments and emerge with deeper connections and resilience.

Jennifer Costa, MSW, CCLS, is a certified Child Life Specialist and Sibling Support Specialist at Friends of Karen with more than 17 years of experience working with seriously ill children. She is also an adjunct professor at Montclair State University in New Jersey teaching in the Department of Family Science and Human Development in the College for Community Health and at Bank Street College in New York City, in the Department of Education, teaching in the Child Life Specialist Master’s degree program.