We work with children, adolescents, and adults with chronic conditions: mental illness, medical conditions, intellectual or developmental disabilities. We do the very best we can to treat the patient, but what about their siblings? What about them?

The first memory Nathan has is being in the hospital. He says, “I pretty well grew up in the hospital.” He wasn’t the patient; Nathan’s twin brother, Nick, was. Nathan’s parents devoted most of their time and attention to Nick, who had mucopolysaccharidoses, type 2. Nathan was essentially ignored.                                  

Alice was 10 when her older brother, Jack, was jailed for drug abuse, the first of many brushes with the law. Jack was diagnosed with bipolar and oppositional personality disorders, and the parents spent much of their time and attention on his mental health treatment and legal challenges. Neither parent saw Alice in her lead role in the school play.

When Monica was six, she always remembers being told by others to be a good girl because her parents have enough challenges dealing with her brother, Mike, with Autism. As Mike got older, his aggression increased, and Monica often became a target. She was hit, and frequently her treasured possessions were destroyed. As a senior in high school, she labored all night, perfecting an essay that would assure her “A” grade in English. The paper was never turned in; Mike got to it the morning it was due. Monica’s parents never knew; Monica didn’t tell them because they had “enough challenges.” She got a “B” and a lecture from her parents that she should have tried harder.

Glass children is a recent designation for children like Nick, Alice, and Monica. They aren’t called that because of their fragility; rather, because their parents look right through their needs to the demands of their siblings. According to the Sibling Leadership Network, an organization supporting siblings, “Glass children are healthy children who have brothers or sisters with special needs. They are typically emotionally neglected, experience severe pressure to be problem-free and perfect, take on parental responsibilities within the family at a young age, and have an overwhelming need to make others happy. All this while receiving little nurturing and support in their development years.”      

As clinicians, what can we do? As we gather historical information from patients, ask if they have a sibling with a chronic condition. If so, and the condition placed high demands on the parents, there is a high probability you may be seeing a glass child. They aren’t fragile, so don’t be afraid to address the issue with them. Ask how much of their parent’s time was spent caring for the sibling. Ascertain the expectations imposed on them and the source. Many expectations may have been self-imposed. Just because your patient has a sibling with a chronic condition doesn’t mean they are a glass child, nor does it mean their presenting issue is related, but it might be.

Our best guide is to learn from glass children. Watch this TED talk by Alicia telling her story of growing up as a glass child, this Orange Socks interview of Nathan, and this TED Youth talk by Jamie.

If you work with parents of a glass child, encourage the following: not take for granted the emotional health of the unaffected child; consider that their child may experience adjustment issues without adult coping mechanisms; be skeptical if the child says they “are fine,” that may not be true; seek to understand the child’s emotions often and repeatedly; express unconditional love for the child frequently; find ways to spend time with the child without the other child present; read books and have conversations on what it means to be a sibling of a child with disabilities; come up with their own solutions to the problem.

Fortunately, some resources can be helpful to glass children. For example: For young children, an excellent resource is sibshops. Parents can enroll their children in a nearby sibshop. If there isn’t one in the area, therapists should consider starting one. For adolescent siblings, parents should consider involving them in the Siblings with a Mission organization. For adult siblings, clinicians should refer them to national support groups like the Sibling Leadership Network or the Facebook group SibNet.

Are glass children fated to have emotional or related medical issues? No, and many siblings of high-need children credit their brother or sister with their life choices and carriers. But many are at risk and clinicians should be aware that their unique life experiences could be a possible antecedent to their presenting problem.