The fields of child psychology, behavioral pediatrics, and pediatric endocrinology all have populations of dedicated professionals who are devoted to the understanding and care of children with diabetes. Children with chronic illnesses, such as diabetes, provide health practitioners and parents with incredible challenges. These children are usually the focus of intense attention, both medically and behaviorally. For health-care professionals, children with diabetes present additional concerns not typically involved in the care of adults with diabetes. Parents of children with diabetes-in addition to their usual parenting tasks-are called upon to monitor their children's blood sugar levels, insulin dosages, food intake, and moods in a daily basis.

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One of the effects of such intense attention on a child with diabetes is a dramatic shift in family dynamics. Such shifts in family systems can have a tremendous impact on the siblings of the children with diabetes. Yet the psyche of the sibling can easily get lost in the shuffle and chaos of caring for a chronically ill child. To preserve good parent-child relations and good sibling relations, however, it is extremely important for families and professionals alike to address the issues of siblings of children with diabetes.

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Sibling Relationships

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In general, the significance of sibling relationships on people's lives is ignored or, at best, downplayed. Yet relationships with siblings can and often do have powerful and profound influences on our lives. Experiences with siblings can produce intense positive and negative feelings, both during early childhood years and throughout adult lives as well. Such feelings have the potential for shaping behaviors, thinking patterns or styles, and emotions for life.

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In a sense, sibling interactions provide the first experiences in peer relationships. They may therefore form the mold from which future peer or intimate relationships emerge. Relations with brothers and sisters can teach children to love and act lovingly even when they are not feeling love in the immediate moment. They can teach the attitudes and skills necessary for all caring and enduring bonds between people. Sibling relations provide opportunities to learn about conflict resolution and can show children how to respect differences between people and even celebrate them. They can encourage kids to truly listen to one another. These relationships can also provide the most significant lessons they learn about sharing, whether it be sharing parental love and attention or sharing tangible resources, such as toys or books.

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Sibling interactions can teach children to delay gratification and to negotiate with and respect others. They may also illustrate the benefits of having different strengths. Additionally, sibling relationships can shape children's views on competition and rivalry, as well as on closeness and trust versus distance and mistrust. They certainly can teach children about friendship, and they may help form their views on appropriate roles for individuals, both in families and in society. Brother and sister relations can also give children models of acceptance or rejection and thereby influence self-image, self-approval, and self-acceptance.

 

Given the breadth and depth of influence that siblings can have on our lives, it seems worth the effort to devote some thought to sibling relationships. When one sibling has diabetes and the other does not, even more complex issues can arise within the sibling relationships, making examination of it even more important.

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Taking On Roles

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Typically, the siblings of children with any kind of chronic condition-diabetes, juvenile rheumatoid arthritis, asthma, cancer, mental illness, or anything else-are given a secondary role in their families. When it comes to the total amount of time allotted to each child, the so-called "healthy, less needy" child usually receives proportionately less time.

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Because these children are not the focus of intense, daily attention the way their siblings are, they may feel ignored and unimportant. In response to these feelings, such children will often take on specific roles in their families. For example, some siblings take on the role of the "helper" or "aid." These children typically both protect and help their sibling and parents with the routines of medical regimes and with other household duties. Other children become "ghosts," and basically remain silent, never cause trouble to the parents or family unit, and seem to live a quiet life separate from the concerns of the sibling with the chronic illness. Another possible role is that of the "rescuer," in which a sibling acts to always be there to "save" the child with the chronic condition from harm or danger.

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There are also children who become "distracters" and operate in such a way as to gain attention from their parents and significant other through unique behaviors and needs of their own. Such behaviors may be positive or negative in nature. For instance, a child may excel in a sport and draw attention and time through competitive games, while another child may develop a behavioral problem that requires ongoing attention from parents and teachers.

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Still other children take on the role of the "police officer" and vigilantly monitor their sibling's management of diabetes self-care regimes. Such siblings may offer genuinely helpful and tactful bits of advice, or they may "tattle" or "rat" on their siblings for eating an unplanned piece of cake or for forgetting to take an insulin injection.

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There are also those kids who play the role of "partner in crime." These siblings may encourage their brother or sister with diabetes to binge with them or to keep important information about their diabetes care from parents or doctors.

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Some siblings of children with diabetes don't take on specific roles at all and just function as regular family members, often reacting in a variety of ways and playing different roles at different times.

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The most significant issue to consider about role-taking on the part of children is that it inevitably shortchanges all children involved. When children experience themselves as existing in a specified role, they cease to appreciate the full complexity of who they are, what they can accomplish, and what they might enjoy trying. Although we live in a society where roles are highly valued and provide us with a lot of comfort, it is important to continually attempt to encourage all children-both those with and without chronic conditions-to explore all possibilities and potentials and to discourage the limitations of one or two specific roles.
 

The consequences of role-taking are that children become imprisoned or locked in to their roles. They are then cut off from experiencing the freedom of limitless possibilities and change. But life demands that we be able to take on many roles if we are to function fully and effectively. As much as possible, therefore, taking on roles should be discouraged, and no child should be labeled into any role, be it a positive or negative one.

The emotional consequences of labeling or role-taking are far-reaching. Children often feel resentful or angry at having to play out their part of the family drama. Or they may feel guilty or sad about deviating from their prescribed role. Some kids may experience a sense of being unimportant, while others may feel an unfortunate sense of relief at not having to take risks and be happy to avoid trying out new opportunities.

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It is important to stay attuned to the needs and issues confronting all children and not to ignore or minimize the needs of the so-called healthy child. Siblings of children with a chronic illness need, as all children do, the encouragement to explore their whole selves. Allowing each child in the family to be a complex, multifaceted, changeable human being will help prevent the antagonism that often results between siblings when role casting is adhered to rigidly.

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Challenges For Siblings

 

The siblings of children with diabetes face some interesting challenges. At the time of initial diagnosis of diabetes, the family system typically undergoes sweeping changes. Usually, the routines of daily life are temporarily put on hold while the parents struggle to adjust to the reality of the diagnosis and to the many new tasks that they are required to learn and master.

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The sibling of the child with diabetes, at least in the beginning, typically gets lost in the ebb and flow of the new adjustments. It cannot be stressed enough just how important it is for this sibling to be included as part of the process of family adjustment, as well as for the needs of this child to be attended to in some way, even at this most difficult time.

As life settles into the new routines involving care of the child with diabetes, siblings run the risk of continuing to feel ignored or less important. Tremendous care and attention needs to be given to this still very significant family member.

 

As time passes, the issues for the sibling will probably change. There are a number of problem areas that often arise within families, and they warrant addressing. However, the following discussion of potential problem areas is not meant to be an exhaustive list of the difficulties that can arise in families in which one child has diabetes and at least one other child doesn't.

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Labeling. The first problem area is related to the previous discussion of role-taking and involves the child with diabetes taking on the role of the "identified patient." Such an identification renders the "patient's" sibling as being less in need of resources and attention. Potential consequences are cheating the sibling out of a full exploration of self and of decreasing the amount of nurturing that every child rightfully deserves.

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Parents are best off avoiding the label of "patient" and treating each child as a unique individual, rather than thinking of the child with diabetes as requiring more from them. This sends a healthy, adaptive message to each child that no one person's needs are any more important than the others. The needs and desires may be different, but they are equally and distinctly important.

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In a family with two children, one with diabetes and one without, for example, parents can, while attending to the medical needs of the child with diabetes, otherwise treat both these children in as normal and as similar a way as possible. Specifically, this means disciplining both children in the same way for the same issues, giving equivalent amounts of parental time and attention to each child for his particular celebrations and difficulties, and focusing on each child's strengths rather than his shortcomings.

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Sibling Fights. When the issue of fighting, arguing, or disagreeing between siblings arises, most parents cringe with dismay and intervene less than is perhaps ideal. Certainly, when the disagreement appears to be benign, and no physical or emotional harm is threatened or inflicted, it is best for parents to stay out of things and allow children to negotiate their own issues. However, when the physical or emotional harm enter into the picture, it is important for parents to intervene.

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When intervening, it is important not to favor or protect the child who has diabetes; such treatment is unfair to both children. For example, statements such as, "Don't upset your brother; just give him your toy. After all, he has diabetes, and his blood sugar may go up too high if he gets very upset," discriminate against both children. In this scenario, neither sibling learns to share, take turns, or otherwise negotiate the situation. Let the kids work out the issue of sharing toys for themselves, unless the situation begins to get too heated or volatile. For instance, if one child says, "You can't have this toy because you're not as good as I am; you're diseased with diabetes," it is certainly appropriate for a parent to intervene and to put an immediate stop to this verbal abusiveness.

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Comparing Siblings. Another problem area involves comparing children and their attributes. Comparisons between children should always be avoided at all costs. No two children are identical, and to compare and contrast them accomplishes nothing more than generating self-consciousness about what is lacking in comparison to the sibling.

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Children (and adults alike) tend not to hear what their assets are when their strengths are compared to those of a sibling or any other person. So rather than saying, "You are so outgoing and social, and your sister is so studious and intelligent," make efforts to praise each child separately and at different times. In situations where more than one child is present, focus on describing the behaviors you observe rather than evaluating or judging them.

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Recognizing the Individual. Staying focused on the uniqueness of each child is crucial in building self-esteem and in fostering positive sibling relations. Many people confuse the individualized, unique treatment of children with the equal treatment of children. Children are not equal; they are unique and special in their own magnificent ways. So treating each child in unique and special ways can never lead to adverse consequences. When parents manage to interact with the sibling of the child with diabetes in a way that communicates that this child is uniquely important and special, the child then comes to experience himself as valid and special in his own right, and relationships between parent and child and between siblings are maximized and may flourish.

 

It is impossible to treat each child in exactly the same way. So why even try? Instead, try to interact with each of your children in an individualized, personally tailored style. The child with diabetes clearly requires specific, personalized care and attention. The child without diabetes also requires unique, personalized care and attention. Different, unique, special, and important-but definitely not equal or equivalent.

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Allowing Free Expression. One last problem area to be discussed involves the expression of feelings on the part of siblings. Often, the siblings of children with diabetes are stifled by parents, significant others, or themselves when it comes to expressing their feelings about having a sibling with a chronic condition. But such expression needs to be encouraged rather than discouraged or punished. Having a wide variety of feelings, including some negative ones, is part of being human and is completely normal. Families are best off giving permission to the sibling of the child with diabetes to fully, respectfully, and tactfully communicate their emotions.

 

Children need to have an environment they perceive as "safe," nurturing, understanding, and receptive to the full range of human emotions. So when a child tells you of his jealousy, resentment, anger, guilt, worry, or any other feeling, even if it pertains to the child with diabetes, welcome the openness of this child. Try to provide a constant and consistent environment in which all private communications about one's feelings and thoughts are received with love and understanding.

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Each One Is Special

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The siblings of the children with diabetes are children with unique needs, desires, and hopes that need to be nourished and nurtured. Remember that all children are significant and require time and attention. This is particularly important when one child in a family has a chronic illness. When raising the sibling of a child with diabetes, an awareness and devotion to the issues covered in this article can greatly influence the course of the parent-child and sibling relationships. Basically, when children, with or without diabetes, are treated fairly, with love, respect, and as distinct, important individuals, healthy relationships are much more likely to ensue, and healthy senses of self are more likely to result.