The children we don’t see

I still remember the moment I realized I had been missing something important in the hospital.

I was on my hospital medicine rotation, caring for a child who had been admitted many times. His parents were always at the bedside. They knew every medication, every lab result, every update from the doctors. But I rarely saw his older sister.

Later in my rotation, I met another family whose child had been hospitalized for more than a month. To protect their medically fragile child, the parents began homeschooling their other children to reduce exposure to illness. It made sense medically, but it also meant those siblings were growing up without school, daily contact with friends and many of the ordinary experiences of childhood.

There is a term for children like this: “glass children.” These are siblings of children with chronic illnesses or disabilities. They are called glass children because they are often seen but not truly noticed. Their needs can become invisible as a family’s attention is understandably focused on the sick child.

Once I learned the term, I began noticing glass children everywhere. They learn to wait while doctors talk to their parents. They learn that hospital visits come first. They learn that family life revolves around one child’s medical needs. Some begin to feel as though they cannot take up space in their own family because someone else always needs it more.

One conversation has stayed with me. A mother told me that she and her husband were considering in vitro fertilization to have another child without their daughter’s rare genetic condition. Part of their reasoning, she explained, was that one day, after the parents were gone, that child could help care for their daughter.

I understood where the thought came from. Caring for a child with complex medical needs can be overwhelming, and many parents worry deeply about the future. But her comment raised a difficult question: what does it mean for a child when part of their expected role is to become a caregiver for a sibling?

This is not about one family. It is about a system that increasingly helps children survive serious illnesses while often overlooking the impact on their brothers and sisters.

Research suggests these effects are real and long-lasting. A 2022 systematic review found that siblings of children with chronic health conditions were at increased risk for depression compared with their peers. Other studies have reported higher rates of anxiety, emotional distress and difficulties with social relationships. Many glass children develop remarkable empathy, resilience and maturity. But those strengths can coexist with loneliness, guilt, and unmet emotional needs.

In hospitals, we routinely discuss medications, test results and discharge plans. We almost never ask how a sibling is coping. We rarely ask who is caring for the other children at home, whether they are struggling in school, or how a family’s medical challenges are shaping their childhood.

We do not need to choose between caring for sick children and caring for their families. We can do both.

Hospitals can make conversations about siblings a routine part of care. Social workers, child life specialists and respite care programs can help families support all of their children, not just the one receiving treatment. Schools and pediatric clinics can identify siblings who may need emotional support even when they appear healthy.

Most importantly, we need to talk about glass children more openly. Their experiences should not remain hidden simply because they are not the patient in the hospital bed.

When I think back to that rotation, I do not just remember the sick children. I remember the quiet spaces around them, the siblings I rarely saw, and the childhoods unfolding just outside the hospital room. Glass children are not invisible because they are unimportant. They are invisible because our healthcare system is not designed to see them.

It’s time we changed that.

By Dr. Elizabeth Bradshaw, resident in the Department of Pediatrics at Baylor College of Medicine.