Rhianna Alvarado is a budding artist who loves animals. She spends time designing animations on her laptop and caring for her cat, Heathcliff, two dogs and a hamster.

During a break from her online classes, Rhianna watches her dad play a video game.

Brian Alvarado was diagnosed with cancer soon after returning from Iraq in 2006 and has breathed and been fed through tubes since 2015.

Rocio and Brian have been married 14 years. Brian served eight years in the Marine Corps, reaching the rank of sergeant.

Rhianna, 13, is learning how to change her father’s tracheostomy tube. “I’m proud that she is feeling a bit more comfortable changing it,” Brian said, his voice almost inaudible. Rhianna is among more than 3 million youth who help an ill or disabled family member, according to Caregiving in the U.S. 2020.

Brian can barely speak since his tracheostomy. “When it’s just me and Rhianna, I have to ask Rhianna to be my voice,” Brian said.

Rocio watches over Rhianna to make sure she takes the correct steps to change her father’s trach tube, which must be done once a month. “I’ve been slowly teaching her for the past year,” Rocio said.

Rocio looks over daughter Rhianna’s online class schedule, which includes animation drawing, speech therapy and acting class. “Caring for her dad came naturally to her,” Rocio said. “She’s overprotective and will stop what she’s doing to check on him.”

Brian looks at a photograph of himself and Rhianna when she was 3. He’d already been diagnosed with cancer and had started chemotherapy.

Rhianna’s mom is Brian’s primary caregiver. The two look after him on and off all day. “Our care for him doesn’t end,” Rocio said.

Rhianna likes to massage her dad’s head.

“I have told her that one day it will be her taking care of me,” Brian said. “When I’m a lot older, to the point where I won’t be able to care for myself.”