When a child suffers from an arthritic condition, the whole family suffers to some degree. Family dynamics are thrown awry. Schedules are squeezed and often require shifting to accommodate frequent checkups and therapy. Everyone is anxious and stressed.

To ease the pressure, keep the family routine as typical as possible. Siblings should continue their usual school and recreational activities, with friends and extended family members helping with errands, carpools, and meals to free you up for spending time with your children. Make time for everyone to be together on a regular basis. Be flexible, keeping in mind that there may be a new “normal.” For instance, clinic nights might require takeout pizza at 7:00 instead of the usual home-cooked dinner at 6:00.

It’s common for siblings of a chronically ill child to feel the loss of “normal” family life and their own identity within the family. They will naturally experience generalized worry or anxiety, but they can also be plagued with a wide range of conflicting thoughts and emotions. They may:

  • Feel guilty because they’re healthy and can enjoy activities that their sibling can't
  • Fear that they or other loved ones may “catch” the arthritic condition
  • Feel jealous and angry because parents are spending so much time and money on the sick sibling
  • Feel neglected and unloved
  • Resent the child who never does chores
  • Resent that there’s less money for fun things
  • Feel guilty for mistreating the sibling in the past
  • Worry that the sick sister/brother might die

Children express their needs and emotions in different, often uncharacteristic ways. Signs of stress in kids include changes in:

  • Appetite
  • Sleep patterns
  • Mood
  • School functioning
  • Social behavior

Some might become sullen or withdrawn, falling behind in their schoolwork. Some might act out by fighting or getting into trouble; others may attempt to be the perfect child; and many will do both. Younger children may regress in behaviors they’d previously outgrown.

Although you can’t fix the source of your kids’ emotional pain, you can help relieve some of their stress and ward off potentially serious problems by following some suggestions.

  • Pay close attention to your healthy children so they don’t feel slighted by the demands of their sick brother or sister.
  • Talk to them frequently about how they’re doing and what they’re feeling − the good, the bad, and the guilt-inducing. Giving your children multiple opportunities to express their emotions will lessen their emotional turmoil and should result in fewer behavioral problems. If they are hesitant to open up, read between-the-lines based on their actions and begin a dialogue there. It’s important that your healthy kids know they’re important and that their needs matter.
  • Enlist their teachers and counselors to watch for behavioral changes and signs of stress by letting them know a sibling in the family is ill.
  • Try to maintain family routine, treat your kids equally, and enforce existing rules as usual.
    Set aside time for your kids to spend with friends and family without focusing on the illness.
  • Set aside one-on-one time when the focus is on your healthy kids and what’s going on in their lives rather than their sibling’s illness.
  • Be patient with regressive behavior, but not to the point of allowing them to get away with inappropriate or defiant behavior.
  • Include them in the treatment process when possible − meeting the medical team, visiting the hospital, accompanying the sick child to doctor visits and treatment appointments − to demystify the illness and promote reassurance by showing them that caring professionals are doing their best to help.
  • Provide opportunities for the healthy siblings to connect with other patients’ siblings. Sibling counseling groups, workshops, and assorted programs help them realize they’re not alone
  • Personal counseling may be necessary in some situations.


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