Don’t Forget the Siblings

Written by Melodee Gerber Mancuso, PHD on November 2, 2019

Family + Friends
Guilt + Shame
Grief + Loss
Trauma / PTSD

When a child suffers a burn injury, the world stops existing as it did. Parents must put their “everyday lives” on hold and attend to much more important events. All of the parental attention must shift and focus on the injured child, their care, rehabilitation, comfort, and development. So, what happens to the sibling member when a brother or sister suffers a severe burn injury and the family must adapt to caring for and attending to the needs of the burn patient? How does this shift and reorganization in the family impact the other children, and the sibling relationship? This is a question that has not yet been explored in the area of burn care, but it’s beginning to receive some much needed attention.

Siblings are very important members of the family and provide some of the most significant interactions in preparing the child for adulthood. Interacting with our siblings is where we figure out how to exist in the larger social world. It is with our brothers and sisters that we learn to play, negotiate, argue, and sometimes even physically defend ourselves. We also learn how to share space, objects, and attention and love from our parents by interacting with our siblings.

The life span of siblings overlaps to a much greater extent than the child-parent life span. In addition, brothers and sisters spend up to twice as much time interacting with each other than with their parents and research is showing that the quality of the relationship established in childhood extends well into adulthood. In 80 percent of 186 cultures studied, brothers and sisters serve as the principal companions and caregivers to their siblings. The older children not only act as parents do (nurturing, feeding, establishing rules and order), but the younger children respond to their siblings in a manner that suggests a quality of attachment similar to that of a child-parent relationship.

Taking this background information into consideration, we might ask if siblings of children with burn injuries feel left out, or feel obligated to participate in helping more with caring for the injured child? Do siblings feel resentful of the attention that their injured brother or sister might be getting or feel they are getting preferential treatment from their parents? We might also ask how the dynamics of the sibling relationship changes following an injury and how this influences their affiliation with their brother or sister in adulthood.

To begin answering some of these questions, we completed an exploratory study at Shriners in Galveston, Texas to look at how siblings were adjusting after the crises of brother or sister suffering a burn injury. Seventy-nine families answered questionnaires to assess how the sibling closest in age to the injured child was adjusting socially, academically, emotionally, and behaviorally. We also began collecting information from siblings themselves to get their views on how the burn injury had changed their lives and their relationships among family members.



The parents that have participated in the project are saying that, overall, the brothers and sisters seem to be doing quite well and are telling us that they have even developed some positive means of helping them cope with life circumstances, especially in families where the injury is moderate to severe in nature. Those brothers and sisters of children with minor injuries are not different from the average child. Parents tell us that the brothers and sisters of children with moderate and severe burn injuries are mastering life challenges quite well and are less depressed, less anxious, and less withdrawn than the average child. Siblings of children with moderate burn injuries also have fewer behavioral problems and are easier to get along with, less aggressive, and get into trouble less often.

The study also asked parents how the non-injured child’s behavior has changed since the accident. Parents are telling us that the brothers and sisters are more protective of the injured sibling, more cooperative, more helpful with chores, more in touch with their injured sibling’s feelings, and more careful and understanding with the injured sibling. These changes are very positive changes of behavior. The brothers and sisters seem to be very sensitive to and aware of the injured child’s feelings. They also are understanding about the need for the family to attend to the medical needs of the injured child.

However, parents tell us that brothers and sisters are performing less well in social competence. This means that the siblings are participating less in organizations, have fewer contact with friends, have fewer people over to their home, and are having some problems relating to other children. This may be due to the close family bonds that seem to be emphasized in families experiencing burn trauma. Perhaps siblings are spending more time at home with family due to loyalty and the desire or need to assist in caring for their injured brother or sister. This may be seen as having both positive and negative consequences. Families are developing close ties, but the siblings may be sacrificing important social relationships and friendships outside of the family. This is of particular importance in light of what the noninjured siblings themselves report.



Of the siblings that have participated in the exploratory study (ages 11-18), the children generally tell us that they often feel that their injured brother or sister is getting special treatment and that their parents do too much for the injured child. The siblings also say that they have become less involved in activities since the accident and that they attempt to do well in school so that their parents do not have to worry about them. This lends support to what parents are reporting in that siblings are experiencing fewer opportunities to develop social experiences outside the home.

The siblings also seem to take on an extra burden of worrying about their loved ones. They not only worry about their injured brother or sister, but they also worry about their parents. They are concerned that their parents think that they, as parents, could do more to help the injured child and that the injury was their (the parents’) fault. The brothers and sisters appear to be sensitive to the needs and feelings of other family members in that they do not want others to worry about them, but they are spending time worrying about everyone else. Parent may not be aware of this problem, since it seems that the children may be protecting their families by hiding their concerns. At the same time the children appear to be holding themselves to high standards to reduce the burden on their parents by doing well in school, helping out at home, and quietly being the “perfect” child.

Even though brothers and sisters are reporting some concerns, they also have developed many areas of positive adaptive coping. It is important to note that siblings are also saying that they do not feel that their parents show favoritism toward the injured child, they do not have feelings of rejection or resentment toward the injured brother or sister and they do not feel the injured child is a burden to the family. They do not feel that the injury has limited them socially or financially, and that they feel that they can discuss their problems concerning the injured brother or sister with their parents.

This exploratory study indicates that families and siblings of children with burn injuries are adjusting well in many areas and may even be developing mechanisms that are assisting them in coping with life in general. However, “one Swallow does not a Spring make,” so we will continue to explore with parents and siblings about relationships, adjustment, coping, and where professionals can help in their adjustment after family crises. 


Parents can help siblings cope:

  1. If your child’s behavior changes suddenly and drastically, he/she is trying to get your attention. Talk with them to see what they are feeling about family interactions.

  2. Let your child’s participation in the care of his/her injured brother or sister be a choice as much as possible. Try not to make caregiving a requirement.

  3. Have the same rules and guidelines for behavior for all children in the family. Don’t have separate rules for the injured child.

  4. Make it known to your children that they can still have friends over and can have relationships outside of family.

  5. Try for each parent figure to have uninterrupted, scheduled quality time with each child. Do something the child enjoys: i.e. play a computer game, read a book, play cards, work on the car, kick a ball around. Have some time for talking, laughing, or even arguing.