"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead

The Impact of a Sibling's Death in Intensive Care Unit: Are We Doing Enough to Help Them?


As physicians, we have lost many children who were under our care despite our best efforts. For most of us, after breaking the news to the family, we move on to treat our next patient who needs help. However, the family and most importantly the siblings have a harder time. The aim of this report is to try to understand how they cope with the loss of a sibling who was previously in intensive care unit.


Having worked in the Neonatal Intensive Care Unit (NICU), the Pediatric Intensive Care Unit and the Emergency Department, we have come across many cases where despite multiple attempts and efforts we lost the patient. After breaking the news to the family, we, as physicians, are usually done with our roles; but is it not our duty to provide additional care for the siblings?

To answer this question, we decided to go through different research articles that investigated the impact of such major event on the siblings. Brooten et al. studied the question and they found out that most adolescents were shocked and in disbelief after a sibling’s death. Eighty percent were told about the cause of the death and getting through burials was a very difficult phase for them. From seven to 13 months after the death, most experienced a rise in the fear of losing someone close and the thoughts of dying and girls were more affected than boys. Adolescents started being more considerate to their loved ones and showed more maturity by 13 months. Some also reported a sense of abandonment from their friends after the tragic event [1].

Many NICUs have different approaches to exposing siblings to their sick brother/sister [2]. A study done by Fanos et al. showed that most siblings acknowledged that they wished they could be involved with their sibling through that hard phase of life and they cherished any moment they got to spend with them while they were in intensive care [3]. In a paper published by Sandler et al., one such sibling described that although the death of her baby sister left her sad, shocked and mad, the only good memory she had from that experience was when she got to hold her baby sister in her arms. She dealt with the grief by talking about her baby sister with her parents and together they even wrote a song to honor her memory [4].

A wider survey was carried out by Foster et al. in 2012 where they included 40 families and 69% of the participants confirmed that there were changes in the siblings, some in terms of personality, school work, goals, life perspectives, activities and interest. Forty-seven percent said that they noticed changes in the relationship with family members and peers, while only 21% showed no changes attributed to death [5].

It seems undeniable that most siblings will not be left unaffected by a loss of their sibling. Sadly, not all hospitals provide appropriate follow-ups for the families in terms of psychological help and support. The ideal situation would be to create a follow-up program with a trained psychiatrist for the family, each interviewed alone at first, then as a family, on how they are dealing with the loss. Most developing and underdeveloped countries do not have support groups where family members who went through the same traumatic experience can meet and be each other’s support. Major hospitals in developing countries such as India and Mauritius should follow the path and example of many major health care centres and consider such alternatives to provide a better care for both the patients and their loved ones. Allowing them to open up to someone they can talk to and seek help from, will hopefully ease the pain they feel.


  1. Brooten D, Youngblut JM, Roche RM: Adolescents' experiences 7 and 13 months following the death of a brother or sister. J Hosp Palliat Nurs. 2017, 19:247-255. 10.1097/NJH.0000000000000336
  2. Meyer EC, Kennally KF, Zika-Beres E, Cashore WJ, Oh W: Attitudes about sibling visitation in the neonatal intensive care unit. Arch Pediatr Adolesc Med. 1996, 150:1021-1026. 10.1001/archpedi.1996.02170350023003
  3. Fanos JH, Little GA, Edwards WH: Candles in the snow: ritual and memory for siblings of infants who died in the intensive care nursery. J Pediatr. 2009, 154:849-853. 10.1016/j.jpeds.2008.11.053
  4. Sandler CL, Robinson E, Carter BS: Loss in the NICU: sibling matters. Am J Hosp Palliat Care. 2013, 30:566-568. 10.1177/1049909112460331
  5. Foster TL, Gilmer MJ, Vannatta K, et al.: Changes in siblings after the death of a child from cancer. Cancer Nurs. 2012, 35:347-354. 10.1097/NCC.0b013e3182365646

The Impact of a Sibling's Death in Intensive Care Unit: Are We Doing Enough to Help Them?

Author Information

Shaheen Sombans Corresponding Author

Internal Medicine, Bharati Vidyapeeth University Medical College and Hospital, Pune, IND

Kamleshun Ramphul

Pediatrics, Shanghai Jiao Tong University School of Medicine/Shanghai Xin Hua Hospital, Shanghai, CHN

Ruhi Sonaye

Bharati Vidyapeeth Deemed University Medical College and Hospital, Thane, IND

Ethics Statement and Conflict of Interest Disclosures

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Scholary Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. Learn more here.