Brother and sister: the family system cope with congenital hand malformation

Taking care of children with congenital hand malformation and their family is of the utmost importance for our surgical team, first of all to take care of the complex needs of our patients, and also to ensure compliance with therapeutic protocol process. At the Hand Surgery Unit led by Prof. Giorgio Pajardi we work like a multidisciplinary team, taking care of our patients not focusing only on their malformation. This way of working includes involving in the process the whole family system. Comparing family groups with different compositions, we found an increasing frequency in psychological consultation requests from parents who have to cope with the hand congenital malformation of their child in relationship of this child whit his/her brothers or sisters. We conducted a qualitative study through the analysis of psychological interviews carried out in our department with 55 family groups. In 26 cases the child affected by congenital malformation was the eldest son, while in the remaining 29 cases the child was the second or third child. How to deal the problem of congenital hand malformation of one child with his/her siblings is the main issue of parents when the child concerned by malformation is the second or third child, while the request of psychological consultation was made only by two families whose child with hand congenital malformation was the first child. In this case, parents can develop a strategy on how to cope with the malformation through the confrontation with the family and social system, and this makes it easier for them to face the problem of the relationship between the child with malformation and younger brothers or sisters. Siblings are inevitably involved in the situation of our young patients. It is at the same time important to be aware of the psychological resources proper of these children and to avoid their excessive involvement or, on the other side, feelings of exclusion. The presence of a psychologist as part of the team helps the family to cope with malformation, not only by supporting compliance through the whole treatment process, as we have already pointed out in other studies, but also by facilitating effective strategies to cope with this malformation in important relationship and in the social context.