The effects of chronic renal failure on siblings

Abstract

It is well recognised that chronic illness in children can have a significant effect upon siblings, but their viewpoints need to be sought if we are to change our practice. We conducted semi-structured interviews at home with 15 siblings (8 males) aged 8-12 years whose brother/sister were on chronic dialysis or had received or were waiting for a renal transplant. The interviews were analysed using a grounded theory approach. The children also completed the Spence Children's Anxiety Scale (SCAS), which revealed no statistically significant evidence that they were exhibiting chronic clinical anxiety. Qualitative data indicated that siblings had a variety of concerns concerning their own health and that of their siblings and worried about the effects on family routine and separation from parents. The siblings felt more protective towards their chronically ill sibling and felt that they themselves needed to be more grown up. The study has implications for our clinical practice in that our psychosocial assessment of families needs to include an assessment of sibling needs and siblings should be involved when preparing patients for chronic renal failure treatment. The importance of maintaining family routines should be emphasised, as well as trying to involve siblings in unit activities.

Amplified ambivalence: Having a sibling with juvenile idiopathic arthritis

“…They also risked being 'out of time' due to the vicarious medical career they sometimes had to adopt when living with, and assisting, an ill sibling as this involved responsibilities often beyond their years. Our interpretation that siblings may feel 'out of place and out of time' is compatible with examples offered by Britton and Moore (2002) in relation to JIA, and Batte et al (2006), Dunn (2000), Harding (1996), and Ratcliffe (2001) with regard to chronic childhood illness more generally.…”

“…A semi-structured interview format was selected for data collection (Pidgeon & Henwood, 1996). Interviewing was chosen as a way of eliciting the participants' experiences in their own words and to gain insight into the social context of siblings' experiences (see Batte et al, 2006;Bluebond-Langer, 1996). This was also deemed important as the researchers did not wish to impose theoretical understandings on the data collection stage of the research prematurely.…”

“…Siblings were found to be more aware, often, than parents of their ill brother or sister's adverse social experiences (see also Batte et al, 2006;Dunn, 2000) and to be distressed on their sibling's behalf. This supports Harding's (1996) assertion that siblings can be as emotionally affected as the ill child and concerned that they, themselves, may be susceptible to JIA.…”

Psychosocial support for children and families requiring renal replacement therapy

“…It also gives an opportunity for siblings to be involved in the discussions, which may help to allay some of their anxiety [37]. A 15-month community-based, family-supported intervention by "experienced mothers" and child life specialists in children with diabetes mellitus, sickle cell anaemia, cystic fibrosis or moderate/severe asthma, showed modest positive effects in all diagnostic groups and may be particularly relevant to those with low self-esteem, which also occurs with CKD [38].…”

“…A child on CPD will become landlocked in their own home, as even close relatives may not feel competent enough to babysit the child on home dialysis or overnight feeds. Babysitting can be provided by experienced nurses from the unit and extended to daytime nursing support so that carers can have time to themselves as well as attending to the needs of other siblings [37]. Transport and parking issues are constantly referred to by families with a child on haemodialysis and the provision of escorts to accompany children and relieve parents has been recommended.…”