Soon after my children were born, I made each a special blanket filled with colorful stars.  Most young children favor one item, often a soft blanket or stuffed animal, to snuggle with and to bring reassurance in transitional moments, such as bedtime, when a parent leaves for work, a new caretaker arrives, or a thunderstorm strikes.  As the child matures, the  object becomes less necessary as a constant presence, but remains a favorite object of comfort and creative play.

In my children's book, Daniel and His Starry Night Blanket: A Story of Illness and Sibling Love, Daniel's changing use of his beloved blanket reflects his growth during his sister's treatment for cancer. - Sally Loughridge

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This tale of a small boy whose older sister gets cancer and, from his perspective, far too much of their family's attention, illustrates how a young sibling may react and ways his parents can support him.  When one child is very sick, the whole family and daily life are affected. Routines are disrupted, emotions intensified, economics strained, priorities changed, and relationships stressed.  When a child is diagnosed with a life-threatening disease, parental focus naturally flows to that child.  Consequently, siblings often feel angry, sad, scared, lonely, guilty, and even envious.  Daniel and His Starry Night Blanket: A Story of Illness and Sibling Love is a resource for families on such a perilous journey through critical illness.

In little children, feelings can fluctuate quickly, from envy to worry, sadness to anger, tears to smiles. The younger and more stressed they are, the less they can exercise impulse control and delay gratification. Immediacy rules. Occasional normal friction among siblings may be intensified when one child becomes very ill.  The younger the sibling, the less cognitive and emotional understanding she will have developmentally.  Even a healthy small child who plays well independently still needs regular time, attention, and comfort from his parents.

Particularly in the stage of diagnosis when medical appointments and tests are frequent, daily life—including playtime, mealtime, and bedtime—may be disrupted and changed in significant ways. Caregivers may shift from parents to grandparents, neighbors, friends, or new faces. Parents become preoccupied with the medical situation, their own fears, and marshaling resources—medical, financial, energy, and time. Suddenly plunged into a medical world with new terminology, treatment choices, and outcome predictions, they must cope with the their own emotions as well as those of their children, both ill and healthy. The acuteness of the ill child's symptoms and impairment will impact home life and relationships. Once treatment or therapy begins, parents must adjust their routines to accommodate sessions, possible side effects, even resistance to intervention.

In the midst of their own distress, parents must create a "new normal" that provides care, structure, and comfort to all their children. Pre-existing Instability in the adult relationship or economics will increase the family's vulnerability during such a medical crisis. While the challenge is huge for a two parent home, it is even more so for a single parent.  Balancing the needs and wants of several children when one is very ill or physically compromised is extremely difficult. Indeed, it can feel impossible.  For many parents, it may not feel like balancing at all, but rather awkward juggling—with too many dropped balls. Maintaining parent-child bonds and consistency of family life often needs to be achieved in innovative ways using a broad support network and creative means to maintain connection and communication with the healthy children, especially very young ones.

Faced with the challenge of juggling the developmental needs of all their children during a pediatric crisis or one child's lifetime need, parents can use many strategies to help a healthy younger sibling feel loved and attended to. Parents will embrace some strategies intuitively, but others will need to be crafted deliberately in response to particular situations. Parents need to recognize (at times be lovingly nudged) when to accept or ask for help from extended family, friends, other caregivers, and professionals. Here are some ways to nurture the healthy sibling in a family on a journey through pediatric illness.

Ways to Nurture the Healthy Young Sibling

Continue connection and affection:

• Frequently express affection verbally and physically. Snuggle and cuddle!
• Reassure the child of continued love and caring.
• Facilitate quality time together for the healthy and ill children in favorite ways, as possible, and new ways.
• Encourage the wider family to frequently express affection for the child.
• Avoid the temptation to shower the child with physical gifts.
• Assure access to a transitional object, such as a blanket or stuffed animal, as needed.
• If a young child shows regression in achieved milestones or behaves repeatedly in unusual, hurtful ways, speak with the pediatrician to explore the need for therapy. 

Provide predictability and structure:

• Maintain regular family routines as far as possible for meals, play, naps, and bedtime.
• Stay in daily touch by phone, mail, and/or Skype when away overnight with the ill child.
• Maintain reasonable behavioral expectations for the younger child.
• Remember to stay in the parent role and let the child be a child, not your caregiver.

Be honest and empathic:

• Acknowledge the child's illness or condition to his sibling, in terms the young child can understand.
• Include the child in hospital or clinic visits if comfortable for the young sibling.
• Explain coming changes in household routine or caregivers with reassurance.
• Encourage the child to share feelings and express acceptance of them, however intense.
• Listen carefully to and answer a child's questions honestly, in age appropriate ways.
• Show empathy for the healthy child as well as the ill child.
• Include the child as appropriate in comfort care for the ailing sibling.
• Praise kindness to and sharing with the ill child.

Be playful and focused:

• Honor regular, private play with the child, with emphasis on involvement and quality, especially when time is short.
• Read and draw together.
• Go on excursions geared to the healthy child's interests, such as walking, biking, or going to the playground, park, zoo, or a movie.
• Arrange special visits for the healthy child with extended family and friends.
• Create mini-adventures lasting just a couple of minutes: for example, search for shapes, colors, birds, creepy crawlers, or anything that will engage the child.
• Whenever possible play actively, be silly, and laugh with your child.

Whether on a journey through an acute pediatric illness or adapting to a child's chronic condition, families can best balance all of their children's needs through connection, communication, creativity, predictability, and the resilient support of a wider net of caregivers and professionals. Each family needs to build a nurturing structure and pattern of daily life that responds to and celebrates every child's unique needs and promise.

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SALLY LOUGHRIDGE, PhD is a cancer survivor and retired clinical child psychologist with almost 30 years' experience. Now a professional artist, she wrote and illustrated Daniel and His Starry Night Blanket: A Story of Illness and Sibling Love. An  earlier book, Rad Art: A Journey Through Radiation Treatment, shares the 33 daily paintings she created during breast cancer radiation. Both books are available through bookstores and online at Amazon.  FMI: www.sallyloughridge.com.

• Gold Medal in 2015 Gelett Burgess Children’s Book Awards (Lifestyle: Emotions and Feelings Category)
• Honorable Mention in 2015 New England Book Festival (Children’s Books Category)