by Laura Romero, Family Support Navigator
A NICU stay affects the whole family. Older siblings are going to experience a certain amount of stress during the baby’s NICU stay. This may be the result of worries about the baby, their parents, or even the disruption of their daily routines. While the way that children respond to the birth of a new baby or to their hospitalization depends on many things – like their developmental level, temperament, family dynamics and support systems – these are some of the things that you can expect to see. Knowing what to expect and what is normal can help you prepare to address their needs.
The 2 year old
Toddlers experience stress from fear of strangers and the loss of parents. The loss of a security object may cause stress. Children at this age can become easily over-stimulated which can cause intense emotional reactions. Hospitals and doctors are frightening to the two year old and extended periods of time spent away from familiar surroundings can be upsetting. Keeping family routines and providing quality time with trusted adults is tremendously reassuring.
The 3 year old
Children at this stage crave stability and predictability. Because of this they can appear stubborn and inflexible. They tend to be possessive, jealous and fear disapproval. So they may begin to use fibs to cover mistakes. They may experience toilet accidents and fear the consequences of that. They are often afraid of strangers and of the dark. It is important to establish and maintain time that is spent with them each day doing things with them that they enjoy.
The 4 year old
Children at this age develop feelings of insecurity. They enjoy attention and fear being rejected or ignored. Four year olds watch what adults are doing and often imitate what they see. They will develop fears of the same things the adults in their lives fear such as spiders, animals, heights or snakes. It is good to help them understand your fears, identify their own, and give them the skills that they need to cope with this uncertainty. Storybooks and art therapy can help.
The 5 year old
Going to school for the first time may be a source of stress for five year olds. They fear separation from their parents and seek constant approval and comfort. At this stage children may develop irrational fears and take things out of context. They need clear, concise, concrete explanations about what is going on. Otherwise, they will come up with their own explanations to try to make sense of things. Five year olds have a great need to protect belongings and may experience extreme sadness if a toy is lost or broken. Allow them to have objects that comfort them – and give lots of hugs.
The 6 year old
Sources of stress for the six year old include meeting the expectations of parents, the demands of a full-time school schedule and competition with peers. There is often sibling rivalry at this stage and an inability to tolerate teasing from family and friends. Six year olds struggle with sitting still, controlling their impulses and making decisions. Give them things to do that they can succeed at to build their confidence and coping skills.
The 7 year old
Seven year olds can be moody, pensive and unhappy. There is a continual need for praise from family and peers. They experience stress when they are disturbed or forced to leave a favored activity. The adults who care for them will need to help them keep their routines and provide a buffer zone from adult worries. Although playing with other kids can help, trying to navigate friendships can cause more problems and emotional upsets at this stage than in the past.
The 8 year old
Eight year olds may become critical about their appearance, abilities and performance. While they need positive feedback from their family there is also an increased resentment of parental authority. There is a struggle for greater independence, and increased interaction with peers takes place. Help them find times of day or circumstances where they can be in charge and feel confident.
The 9 year old
Children at this stage of development may become rebellious. There is a tension between the sexes at this age and often a preference for separation. This stage has a strong attachment to dignity, and children at this age are easily embarrassed which can cause great emotional turmoil and stress. A child at this age may demand that their personal rights be respected and places a high priority on fairness. Be sure to listen to how they interpret what is going on around them, and give them ways to feel like they have some control over situations.
The 10-12 year old
The greatest source of stress at this stage of development is puberty. Social concerns develop and the size differences in children cause many stressful situations. Children at this age want freedom, but too much of it may cause confusion – which can result in bad decisions. The push to gain independence increases, but the need for parental intervention is at a peak for this age group. Money is important to children at this age because of the need to keep up with peers and make impressions on friends. Burnout from over-extended schedules and too many activities is common. Maintaining a structured social schedule is key, but the child should have the option to opt out of some of their usual responsibilities.
The 13-18 year old
The adolescent stage of development is filled with many different sources of stress. They worry about issues and pressures with school, over-extension of time, involvement in too many activities and deadlines that must be met. Appearance and acceptance by peers is important so during this stage of development teens are at a higher risk of developing a poor self-image. Help them find ways to keep up with their most important routines, but let them know that you understand if they can’t fulfill all of their typical responsibilities. Prioritizing will help them cope better.
The Importance of Play
Children of all ages process their emotions through play. They need many opportunities to “play out” their worries and concerns. For younger children this may be done through pretend play while older children may choose to express themselves through avenues such as art and music. No matter what their age, let them know that you want to hear what they have to say and that you will do your best to help them through this crisis.
Rector, Linda (2007). Supporting Siblings & Their Families During Intensive Baby Care. Baltimore, MD: Brookes Publishing.
Anne Claire Hickman, CCLS, CIMI, Child Life Specialist at Dell Children’s Medical Center of Central Texas (Personal Communication, June 9, 2012).