Explaining the Illness to a Sibling (How do I explain the illness to the healthy sibling?)

When a child gets sick, the family’s attention turns to that child. The healthy sibling notices this early on, often before they can even put the situation into words. They see doctor’s appointments, packed hospital bags, and tense faces at the breakfast table. Without an explanation, the child fills in the gaps with their own assumptions, and these are usually more frightening than the truth.

Explaining the situation to a sibling means telling the healthy child, in an age-appropriate way, what is going on with their brother or sister. Experts from the Family Handbook advise talking to the child as early, as honestly, and as thoroughly as the child can handle. More about these children’s experiences can be found under “Siblings.”

Children understand illness differently depending on their age. The explanation below reflects this.

• Toddlers (about 2 to 4 years old): They think in magical terms and relate events to themselves. For them, a bad thought or an argument might be the cause. They need short, concrete sentences and plenty of repetition.
• Preschool and elementary school children (about 4 to 9 years old): They ask about causes and whether the illness is contagious. They remember simple explanations but easily confuse technical terms.
• Older children and adolescents (ages 10 and up): They want more detailed information, do their own research, and sense their parents’ concern. They quickly pick up on half-truths.

The following applies to all age groups: Whatever is explained to the child must be accurate. They don’t need to know everything, but everything that is said should be true.

Ready-made phrases help parents overcome their fear of having this conversation. They can be adapted to suit your own child.

• For young children: “Lena is sick. There are cells in her tummy that are acting up. The doctors are giving her medicine to treat it. It has nothing to do with you, and you can’t catch it.”
• For elementary school children: “Ben has a condition called anorexia. His mind is telling him the wrong things about food. Specialists are helping him with it. Sometimes I’m quiet because I’m worried. It’s not because of you.”
• For teenagers: “Mira has depression, a serious illness. She’s currently receiving treatment. Ask me anything you want to know, even if I don’t have an answer for everything.”

If the diagnosis is recent, the article “Telling Your Child About the Diagnosis” can help during the first conversation.

The GPOH Pediatric Oncology Center lists three messages that healthy siblings should hear time and again. These messages apply to many illnesses beyond cancer.

• It’s not your fault. No argument, no wish, and no thought caused the illness.
• You can’t catch it. Many children secretly fear that the illness is inside them too.
• You’re just as important. Your sick sister just needs more time right now, but your worries still matter.

If these words go unsaid, some children carry silent feelings of guilt for years. This can lead to sibling parentification or chronic stress, described as sibling burnout.

A single conversation isn’t enough. Children process things in small doses and come back with the same question weeks later. Someone who honestly says, “I don’t know,” remains more credible than someone who makes reassuring promises that they later break.

Feelings like anger, jealousy, or relief at being healthy yourself are all part of it. Parents can name them: “You’re upset because we’re at the hospital so often. I understand that.” A regular weekly appointment with the healthy child—without any mention of illness—provides stability. Friction between the children increases under constant stress; see the article “Sibling Rivalry Under Stress” for more on this.

Some children withdraw, complain of stomachaches or headaches, fall behind in school, or become conspicuously compliant. Such signs indicate that the burden is becoming too much. In Germany, there are sibling seminars and sibling groups where children can meet others in the same situation. The FamilienBande Foundation maintains a nationwide directory listing several hundred such programs, and organizations like Caritas host sibling weekends in a safe environment.

If withdrawal, anxiety, or sleep problems persist for weeks, the child should be evaluated by a professional. Rückenwind provides coaching support to parents but does not replace a professional diagnosis. An evaluation and treatment can only be provided by a child and adolescent psychiatry clinic or a medical or psychotherapeutic specialist.