Q: Our son was diagnosed with type 1 diabetes a few months ago, and his 12-year-old big sister immediately volunteered to help out with preparing meals, watching for signs of hypoglycemia and learning how to inject insulin so she can babysit. It’s wonderful, but should I lean on my older child so much? I’m worried that her offer is motivated by guilt.

A: In the first few months following a child’s type 1 diabetes diagnosis, it’s typical for siblings to experience a mix of emotions, from fear and sadness to anger and even jealousy. It sounds like your daughter certainly wants to be a help, but you’re right to wonder whether her behavior is the result of feelings surrounding her brother’s diagnosis, especially if her eagerness is atypical for her or is interfering with her usual activities.

A good thing to do right now is to simply give your daughter a break. Take her out to the movies or spend an afternoon shopping together, or whatever special outing the two of you find enjoyable. When the time is right, ask her how she’s feeling about her brother’s diagnosis. Really listen and give her emotions the validation they deserve. And then have an honest conversation about family roles. Try something along the lines of, “Thanks so much for all the help. I’ve really appreciated it, but your job right now is to be a really great student. It’s my job to make sure your brother’s needs are met.”

For many children, hearing such concrete language from a parent will feel like a huge relief. Before you know it, instead of worrying about taking advantage of your daughter’s assistance, you may be right back to nagging her to clean up her plate after dinner (which will likely be a welcome return to normalcy for you both). For other kids, the need to help will persist. If that’s the case, it’s important to establish boundaries. Give your child ownership over one certain task that is helpful to you, but not directly involved with your child’s care. For example, assign your daughter the duty of setting the table for dinner while you give your son his pre-dinner insulin injection.

Be on the lookout for red flags that something deeper is going on. Watch for signs that your daughter is avoiding activities you know she enjoys in order to “watch over” her brother. Is she no longer spending Friday nights at her best friend’s house? Did she suddenly lose interest in joining the soccer team with the excuse that she just wants to spend more time at home? Was it difficult to convince her that it’s okay to leave her brother with his other parent in order for the two of you to spend time alone together?

If you pick up on these warning signs, it’s time for another check in. Your daughter may be harboring thoughts that her brother is going to die (even older children can hear the word as “die-abetes”) or simply feeling overwhelmed by the changes you’re all going through. We often say that siblings are a good barometer for how an entire family is dealing with a diagnosis of type 1 diabetes. Is your daughter mirroring your own feelings? It’s completely normal to go through a rocky adjustment phase. And that’s what your diabetes care team is for! Don’t hesitate to get in touch with the counselor or social worker on your son’s team for either a family appointment or one-on-one with your daughter.

Jennifer Rein–Jennifer Rein, MSW, LICSW, is a social worker and type 1 diabetes care team member at Children’s Hospital Boston.


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Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.