Supporting Siblings of Children with High Support Needs

by

Leonardo Rocker

Supporting Siblings of Children with High Support Needs

Siblings of children with disability, chronic illness or significant mental-health needs can experience love, pride, closeness, frustration, worry, jealousy and responsibility, sometimes on the same day. Their experience is not automatically harmful, and it should not be romanticised as a guaranteed path to empathy or resilience.

The most helpful approach is to notice each sibling as a child in their own right. Give clear information, make space for mixed feelings, protect ordinary childhood opportunities and ensure that caring responsibilities remain appropriate, voluntary and supported.

Recognise that sibling experiences vary

Family circumstances differ widely. A child’s experience may be shaped by the nature and unpredictability of their brother’s or sister’s needs, family resources, discrimination, medical crises, parental stress, age differences and the quality of support around the family. Some siblings report close relationships and valued learning. Others experience distress, isolation, conflict or limits on school and social participation.

A 2022 systematic review and meta-analysis found higher depression rating-scale scores among siblings of children with chronic conditions than comparison groups. Anxiety scores were not substantially higher, and the evidence for diagnoses, physical health and mortality could not be combined because studies were limited and varied. These findings support paying attention to siblings without assuming that every child will develop a mental-health problem.

A 2024 umbrella review similarly identified varied experiences across existing research syntheses. This means families should ask the individual child what life is like for them rather than relying on stereotypes about being the “well sibling”, the “responsible one” or the child who “copes”.

Use respectful and family-preferred language

Some people prefer identity-first language, such as “autistic child”, while others prefer person-first language, such as “child with disability”. Follow the child’s and family’s preferences where these are known. Avoid contrasting a disabled child with a “normal” sibling. Phrases such as “other sibling” or the child’s name are usually clearer.

“High support needs” can describe the level of assistance required, but it should not become the child’s whole identity. Where possible, explain the actual situation, such as support with communication, mobility, emotional regulation, medical care or daily living.

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Share truthful, age-appropriate information

Children notice appointments, changes in routines and differences in adult responses. Without an explanation, they may create their own account of what is happening. Give simple, factual information that answers the child’s question and can be expanded over time.

For example: “Your brother’s brain processes noise differently, so the shopping centre can feel painful and overwhelming. We leave early to help everyone stay safe.” Check what the sibling understood and invite future questions. It is acceptable to say that you need time to find an answer.

Balance openness with the other child’s dignity and privacy. A sibling does not need access to every medical discussion, diagnosis detail or appointment. Ask before including them in appointments and explain what will happen. Attendance should serve a clear purpose and should not be used to prove that they are included.

Make room for mixed feelings

A child can love a sibling and dislike how a situation affects them. Listen without correcting the emotion or asking the child to be grateful. Responses such as “You wish we could stay longer at the party, and leaving suddenly felt unfair” show understanding without blaming the child who needed to leave.

Some children talk directly. Others communicate through play, drawing, humour, behaviour or physical complaints. Offer opportunities without forcing disclosure. If a child does not want a formal sibling group or counselling session, ask what kind of support would feel acceptable.

Explain fairness without promising sameness

Children notice differences in attention, rules, equipment and expectations. Explain why a decision was made while protecting private information. Fairness means that each family member receives what they need, not that every response is identical.

Keep some family expectations consistent, especially around safety, dignity and respectful behaviour. Disability or distress can explain behaviour, but siblings still need adults to protect them from hitting, intimidation, property damage or repeated verbal harm. A safety plan may require physical separation, additional adult support and professional advice.

Quirky Kid’s guide to sibling conflict offers more detailed strategies for safety, mediation and repair. Not every difficult interaction is ordinary rivalry, particularly when one child is frightened or repeatedly harmed.

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Related Quirky Kid resource

Resolve

Sibling Rivalry

Keep caring roles appropriate and voluntary

Siblings may enjoy helping, teaching a game or spending time together. The important questions are whether the task is safe, chosen, age-appropriate, supervised and easy to stop. Helping should not make a child responsible for therapy, behaviour management, intimate care, medication, crisis response or the family’s future.

Ask rather than assume: “Would you like to show Maya the game, or would you prefer to play separately?” Accept either answer. Check that praise does not lock the child into being “the helpful one”. Adults and formal services retain responsibility for care.

Watch for signs that a sibling is carrying too much, such as missing school or activities, persistent worry about leaving the house, managing emergencies, regularly providing personal care or believing the family will collapse without them. Young carers and their families may be eligible for practical, educational and emotional support. Avoid making the child prove that their experience is difficult before seeking advice.

Protect individual time and identity

Reliable one-to-one attention can help a child feel known, but there is no required one-hour block or perfect weekly schedule. Use what is realistic: a conversation during a drive, a short walk, a shared task or time following the child’s interest. If plans change because of an emergency, acknowledge the disappointment and reschedule where possible.

Protect the sibling’s own friendships, hobbies, school events, privacy and rest. They should be able to celebrate achievements without immediately comparing them with the needs of another child. They also need permission to have boundaries around possessions, bedrooms and social time.

Include the school where useful

With the child’s knowledge, tell a trusted school staff member when family demands, hospital admissions, sleep disruption, transport or caring tasks may affect attendance, concentration or wellbeing. Agree on practical supports and who the child can approach. Preserve privacy by sharing only what is necessary.

Siblings Australia provides Australian resources, parent learning and sibling-support options. Peer connection can reduce isolation for some children, but it should remain a choice. A sibling might prefer an ordinary club, sport, arts activity or time with friends where disability is not the focus.

The Quirky Kid Building Resilience and Encouraging Independence workshop is the closest current workshop match for supporting a sibling’s separate identity and age-appropriate independence. It is not a sibling-specific intervention. The Siblings! picture book is the most directly related product for opening conversations about brothers, sisters, differences and shared family life.

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Notice when a sibling needs more support

Changes deserve attention when they are persistent, intense or affecting daily life. Look for withdrawal, loss of interest, marked irritability, sleep or appetite changes, frequent physical complaints, school difficulties, anxiety about separation, repeated conflict, hopelessness or feeling responsible for everyone’s safety.

Start with a calm conversation and describe what you have noticed. A GP can consider physical and mental-health factors. A psychologist may help the child and family understand stress, communication, relationships and practical supports. Seek prompt help if the child talks about self-harm, suicide, abuse or being unsafe. Call Triple Zero (000) when there is immediate danger.

Quirky Kid’s guide to supporting emotional regulation in older children may help families respond to strong feelings without shame. The guide to signs a child may need psychological support explains broader help-seeking thresholds. Families can also explore child and family psychology consultations or contact the Quirky Kid team for non-urgent service questions.

Review support across the whole family

Ask siblings privately what helps, what feels unfair and what they would like adults to understand. Review practical pressure points such as mornings, appointments, transport, noise, shared spaces and emergency plans. A whole-family approach does not mean asking every child to contribute equally. It means recognising each person’s rights, relationships, safety and support needs.

Parents are often managing complex systems with limited time, funding and respite. Supporting siblings should not become another standard families are blamed for failing to meet. Health, disability, education and community services also have roles in making family life more sustainable.

This article provides general educational information. It does not replace individual medical, psychological, disability, safeguarding or legal advice.

View article references

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  1. Martinez, B., Pechlivanoglou, P., Meng, D., Traubici, B., Mahood, Q., Korczak, D., Colasanto, M., Mahant, S., Orkin, J., & Cohen, E. (2022). Clinical health outcomes of siblings of children with chronic conditions: A systematic review and meta-analysis. The Journal of Pediatrics, 250, 83–92.e8. https://doi.org/10.1016/j.jpeds.2022.07.002
  2. Blamires, J., Foster, M., Rasmussen, S., Zgambo, M., & Mörelius, E. (2024). The experiences and perceptions of healthy siblings of children with a long-term condition: Umbrella review. Journal of Pediatric Nursing, 77, 191–200.
  3. Mitchell, A. E., Morawska, A., Vickers-Jones, R., & Bruce, K. (2021). A systematic review of parenting interventions to support siblings of children with a chronic health condition. Clinical Child and Family Psychology Review, 24(3), 651–667. https://doi.org/10.1007/s10567-021-00357-1
  4. Siblings Australia. (2026). Resources for parents.
  5. Siblings Australia. (2022). Talking to young siblings about disability.
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