It is a challenge for patients in the hospital to connect with loved ones outside. When there is a sibling at home, the challenge is twofold. As a nurse with ten years of experience in the pediatric intensive care unit, I often see parents wanting to bring siblings to visit. Sometimes visits are feasible, other times they are not. During the covid pandemic, hospital patients experienced increased loneliness and isolation due to guest restrictions.

Reasons why visitation is discouraged

• Medical instability. Meaning there is a critical illness, and the patient experiences frequent vital sign changes. There can be several providers in the room assessing and intervening. A nurse, respiratory therapist, physician, and other helpers can be there at the same time, making it crowded. Added visitors make it more challenging for medical professionals to maneuver at the patient’s bedside to provide care because of the lack of space. Besides people, there is also equipment and supplies. The small rooms can fill up quick.
• Flu season is a high risk for all pediatric populations. Both parties are at risk of getting the flu and spreading it to each other. Because the hospitalized sibling is already ill, bringing in a secondary virus can make the situation worse. Also, bringing a sibling into the hospital puts them at risk of getting the flu or another respiratory virus. It places the parents at risk with two sick kids.  
• Immunocompromised. The sick child has a weakened immune system and cannot fight infection. Any cold, virus, or bacteria can make them very ill and cause a blood infiction like sepsis.
• Trauma. If the individual is critical, they can have a lot of medical tubes attached, including a breathing tube, feeding tube, IV lines, and drainage devices. Also, there is monitoring equipment with wires connecting to loud alarms. A child life professional is sometimes available at the hospital to prepare siblings for a visit. However, depending on the time of day, a child life specialist is not on service.  

There are other ways for brothers and sisters to connect with the child patient through hospital walls during these difficult times. These actions can help connect siblings, create memories, and be therapeutic for both kids in the hospital and at home.

Five ways to help family bond through hospitalizations

1. Write letters or make cards. Both the patient and the sibling at home can write letters or draw cards for each other, serving two purposes. It is an activity the individual can complete at the bedside, and it can be a gift for a family member. If the patient receives cards and letters, they can view them during their stay and hang them up if allowed. A folder is useful for keeping the cards and letters together.
2. Create crafts. An ill child can create different crafts for the siblings. Depending on the facility, there is child life, volunteers, and occupational therapists who can help coordinate craft creation. Occupational therapists sometimes use crafts to facilitate therapies. Children in the hospital also need muscle rehabilitation, cognitive development, and fine and gross motor control. With kids, doing therapies through play and craft creation is fun.
3. Send current photos of the siblings and family members. Photos help the patient remember their siblings, bring joy into the room, and provide a memory tool for healthcare workers to use. For example, the nurse can hold up a picture and ask who each person is. The nurse can assess memory and cognitive level. It also allows the healthcare workers to get to know family members too.
4. Call and talk. Kids enjoy conversation. It helps to hear familiar voices. If there are two parents, the one at home can call the one in the hospital and let the siblings talk. Or if the nurse has a phone or if there is a room phone, the family can call, and the nurse can put the phone by the bed. There may not always be a response, but hearing the voices of the family members can still calm the youngster. Video calls count as phone conversations and is a great way to engage in communication.
5. Send videos. The siblings and family at home can record themselves. It can be a greeting, reading a story, telling a story, or singing a song. The sick child can watch the videos on their own time. Sometimes ill individuals spend significant time in bed because of their sickness. Having videos of family members to watch can give them a distraction and entertainment. It also gives the siblings at home something to do for the sick sibling. Marco Polo is an app available on smart phones that allows a safe way to send videos. The app also saves the videos for long periods of time. 

Connecting siblings through hospital walls is possible. With creativity and effort, it can be therapeutic for both the patient and the siblings at home. Write letters, create crafts, send photos, have conversations through phones and video calls. These activities can create fresh memories and are helpful for occupational therapies at the bedside.